text: Public Health & Healthcare http://www.mdpi.com/journal/health Latest open access articles published in Public Health & Healthcare at http://www.mdpi.com/journal/health http://www.mdpi.com/2227-9032/2/3/401 This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT) evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their location of care. This provided a unique opportunity to enroll them as a "choice" cohort, following them in the same manner as the trial participants but allowing them to select their setting of care. The objective was to investigate the role of preference and location of care on care outcomes, including satisfaction with care, healing, health-related quality of life (HRQL), pain, and resource use. This is a secondary analysis of a prospective cohort of 126 individuals enrolled in an RCT to receive care at home or in a nurse-clinic (Allocated group), and an additional 104 who received care at home or in a nurse-clinic based on their preference (Choice group). Mobile individuals with a leg ulcer of venous or mixed venous etiology, referred for community leg ulcer care, were eligible. Specially-trained nurses provided care to both groups using an evidence-informed protocol. Baseline data included socio-demographic, circumstance-of-living and a detailed wound assessment. Mean age of the cohort was 68 years. Satisfaction, healing, recurrence, pain, HRQL, and resource utilization did not differ between groups. If available, individuals should have an option of care venue given almost half of those approached indicated a clear preference for clinic or home. With outcomes being similar, health care planners and decision-makers, as well as individuals and their families, can feel confident that the setting of care will not impact the outcomes. However, larger studies in other contexts are needed to explore the interaction between choice and setting. Healthcare 2014-09-19 2 3 Article 10.3390/healthcare2030401 401 416 2227-9032 2014-09-19 doi: 10.3390/healthcare2030401 Margaret Harrison Elizabeth VanDenKerkhof Wilma Hopman Meg Carley http://www.mdpi.com/1660-4601/11/9/9811 Salmonella spp. is associated with fecal pollution and capable of surviving for long periods in aquatic environments. Instead of the traditional, time-consuming biochemical detection, polymerase chain reaction (PCR) allows rapid identification of Salmonella directly concentrated from water samples. However, prevalence of Salmonella may be underestimated because of the vulnerability of PCR to various environmental chemicals like humic acid, compounded by the fact that various DNA polymerases have different susceptibility to humic acid. Because immunomagnetic separation (IMS) theoretically could isolate Salmonella from other microbes and facilitate removal of aquatic PCR inhibitors of different sizes, this study aims to compare the efficiency of conventional PCR combined with immunomagnetic separation (IMS) for Salmonella detection within a moderately polluted watershed. In our study, the positive rate was increased from 17.6% to 47% with nearly ten-fold improvement in the detection limit. These results suggest the sensitivity of Salmonella detection could be enhanced by IMS, particularly in low quality surface waters. Due to its effects on clearance of aquatic pollutants, IMS may be suitable for most DNA polymerases for Salmonella detection. International Journal of Environmental Research and Public Health 2014-09-19 11 9 Article 10.3390/ijerph110909811 9811 9821 1660-4601 2014-09-19 doi: 10.3390/ijerph110909811 Chao-Yu Hsu Bing-Mu Hsu Tien-Yu Chang Tsui-Kang Hsu Shu-Min Shen Yi-Chou Chiu Hung-Jen Wang Wen-Tsai Ji Cheng-Wei Fan Jyh-Larng Chen http://www.mdpi.com/1660-4601/11/9/9790 Emerging research suggests that prolonged sedentary behaviour (SB) is detrimental to health. Changes in SB patterns are likely to occur during particular life stages, for example at retirement age (55–65-year-old). Evidence on socio-ecological SB correlates is scarce and inconsistent in this age group. Moreover, the influence of socio-ecological correlates may vary depending on health and retirement status. This study examined social and environment correlates of overall weekend day sitting among adults at or approaching retirement age, and moderating effects of perceived physical health and retirement status. Baseline data from the Wellbeing, Eating and Exercise for a Long Life study in 2839 Australian adults (55–65-year-old) were analysed. Participants self-reported proximal social factors, neighbourhood social and physical environment, physical health and retirement status. MLwiN multilevel regression analyses were conducted. In the multivariable model, only social support from friends/colleagues to discourage sitting (B = −0.891; p = 0.036) was associated with overall weekend day sitting. No moderation of retirement status, nor physical health were found in the multivariable results. Results from this study suggest the importance of social factors in relation to weekend day sitting among 55–65-year-old adults. Health promotion initiatives in this age group should pay special attention to enhancing social interaction opportunities. Moreover, findings suggest that SB-specific correlates may need to be examined in future research. International Journal of Environmental Research and Public Health 2014-09-19 11 9 Article 10.3390/ijerph110909790 9790 9810 1660-4601 2014-09-19 doi: 10.3390/ijerph110909790 Veerle Van Holle Sarah McNaughton Megan Teychenne Anna Timperio Delfien Van Dyck Ilse De Bourdeaudhuij Jo Salmon http://www.mdpi.com/2072-6643/6/9/3818 Vitamin C is a pivotal antioxidant in the brain and has been reported to have numerous functions, including reactive oxygen species scavenging, neuromodulation, and involvement in angiogenesis. Absence of vitamin C in the brain has been shown to be detrimental to survival in newborn SVCT2(−/−) mice and perinatal deficiency have shown to reduce hippocampal volume and neuron number and cause decreased spatial cognition in guinea pigs, suggesting that maternal vitamin C deficiency could have severe consequences for the offspring. Furthermore, vitamin C deficiency has been proposed to play a role in age-related cognitive decline and in stroke risk and severity. The present review discusses the available literature on effects of vitamin C deficiency on the developing and aging brain with particular focus on in vivo experimentation and clinical studies. Nutrients 2014-09-19 6 9 Review 10.3390/nu6093818 3818 3846 2072-6643 2014-09-19 doi: 10.3390/nu6093818 Stine Hansen Pernille Tveden-Nyborg Jens Lykkesfeldt http://www.mdpi.com/2072-6643/6/9/3802 The Australian Food and Health Dialogue set sodium reduction targets for three food categories (breads, ready-to-eat breakfast cereals and processed meats) to be achieved by December, 2013. Sodium levels for 1849 relevant packaged foods on the shelves of Australian supermarkets between 2010 and 2013 were examined. Changes in mean sodium content were assessed by linear mixed models, and the significance of differences in the proportion of products meeting targets was determined using chi-squared or McNemar's tests. The mean sodium level of bread products fell from 454 to 415 mg/100 g (9% lower, p < 0.001), and the proportion reaching target rose from 42% to 67% (p < 0.005). The mean sodium content of breakfast cereals also fell substantially from 316 to 237 mg/100 g (25% lower, p < 0.001) over the study period. The decline in mean sodium content of bacon/ham/cured meats from 1215 to 1114 mg/100 g (8% lower, p = 0.001) was smaller, but associated with a rise in the proportion meeting the target from 28% to 47%. Declines in mean sodium content did not appreciably differ between companies that did and did not make public commitments to the targets. These data show that the Australian food industry can reduce salt levels of processed foods and provide a strong case for broadening and strengthening of the Food and Health Dialogue (FHD) process. Nutrients 2014-09-19 6 9 Article 10.3390/nu6093802 3802 3817 2072-6643 2014-09-19 doi: 10.3390/nu6093802 Helen Trevena Bruce Neal Elizabeth Dunford Jason Wu http://www.mdpi.com/2072-6643/6/9/3777 It has become increasingly evident that chronic inflammation underpins the development of many chronic diseases including cancer, cardiovascular disease and type 2 diabetes. Oxidative stress is inherently a biochemical dysregulation of the redox status of the intracellular environment, which under homeostatic conditions is a reducing environment, whereas inflammation is the biological response to oxidative stress in that the cell initiates the production of proteins, enzymes, and other compounds to restore homeostasis. At the center of the day-to-day biological response to oxidative stress is the Keap1/Nrf2/ARE pathway, which regulates the transcription of many antioxidant genes that preserve cellular homeostasis and detoxification genes that process and eliminate carcinogens and toxins before they can cause damage. The Keap1/Nrf2/ARE pathway plays a major role in health resilience and can be made more robust and responsive by certain dietary factors. Transient activation of Nrf2 by dietary electrophilic phytochemicals can upregulate antioxidant and chemopreventive enzymes in the absence of actual oxidative stress inducers. Priming the Keap1/Nrf2/ARE pathway by upregulating these enzymes prior to oxidative stress or xenobiotic encounter increases cellular fitness to respond more robustly to oxidative assaults without activating more intense inflammatory NFκB-mediated responses. Nutrients 2014-09-19 6 9 Review 10.3390/nu6093777 3777 3801 2072-6643 2014-09-19 doi: 10.3390/nu6093777 Amanda Stefanson Marica Bakovic http://www.mdpi.com/2072-6643/6/9/3747 Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency. Nutrients 2014-09-19 6 9 Review 10.3390/nu6093747 3747 3776 2072-6643 2014-09-19 doi: 10.3390/nu6093747 Kathryn Beck Cathryn Conlon Rozanne Kruger Jane Coad http://www.mdpi.com/1999-4915/6/9/3487 Both the presence of latently infected cells and cell-to-cell viral transmission are means whereby HIV can partially evade the inhibitory activities of antiretroviral drugs. The clinical use of a novel integrase inhibitor, dolutegravir (DTG), has established hope that this compound may limit HIV persistence, since no treatment-naïve patient treated with DTG has yet developed resistance against this drug, even though a R263K substitution in integrase confers low-level resistance to this drug in tissue culture. Here, we have studied the impact of R263K on HIV replication capacity and the ability of HIV to establish or be reactivated from latency and/or spread through cell-to-cell transmission. We affirm that DTG-resistant viruses have diminished capacity to replicate and establish infection. However, DTG-resistant viruses were efficiently transmitted via cell-to-cell contacts, and were as likely to establish and be reactivated from latent infection as wildtype viruses. Both cell-to-cell transmission of HIV and the establishment of and reemergence from latency are important for the establishment and maintenance of viral reservoirs. Since the DTG and other drug-resistant viruses studied here do not seem to have been impaired in regard to these activities, studies should be undertaken to characterize HIV reservoirs in patients who have been treated with DTG. Viruses 2014-09-19 6 9 Article 10.3390/v6093487 3487 3499 1999-4915 2014-09-19 doi: 10.3390/v6093487 Sophie Bastarache Thibault Mesplède Daniel Donahue Richard Sloan Mark Wainberg http://www.mdpi.com/1999-4915/6/9/3472 Kaposi's sarcoma-associated herpesvirus (KSHV, also named Human herpesvirus 8 HHV-8) is the cause of Kaposi sarcoma (KS), the most common malignancy in HIV-infected individuals worldwide, primary effusion lymphoma (PEL) and multicentric Castleman disease (MCD). KSHV is a double-stranded DNA virus that encodes several homologues of cellular proteins. The structural similarity between viral and host proteins explains why some viral homologues function as their host counterparts, but sometimes at unusual anatomical sites and inappropriate times. In other cases, structural modification in the viral proteins can suppress or override the function of the host homologue, contributing to KSHV-related diseases. For example, viral IL-6 (vIL-6) is sufficiently different from human IL-6 to activate gp130 signaling independent of the α subunit. As a consequence, vIL-6 can activate many cell types that are unresponsive to cellular IL-6, contributing to MCD disease manifestations. Here, we discuss the molecular biology of KSHV homologues of cellular products as conduits of virus/host interaction with a focus on identifying new strategies for therapy of KS and other KSHV-related diseases. Viruses 2014-09-19 6 9 Review 10.3390/v6093472 3472 3486 1999-4915 2014-09-19 doi: 10.3390/v6093472 Shuhei Sakakibara Giovanna Tosato http://www.mdpi.com/1999-4915/6/9/3458 Diagnostic electron microscopy for infectious diseases has the advantage that "everything" in the specimen can be observed, without a priori knowledge of the likely identity of the microorganisms present in the sample. The classical specimen preparation method used employs a droplet of sample, which allows particles to adsorb to a support film, and is subsequently negative stained. This "grid on drop" procedure has a sensitivity range of approximately 106 viruses per mL if no enrichment procedures are used. In the current investigation we present a novel use of filtration that allows us to detect viruses at concentrations as low as 102 viruses per mL. We present here methods based on filtration, in which total virus, and not virus concentration, is the limiting factor for detection. We show that filtration is more sensitive than conventional negative staining and can detect as few as 5 × 103 particles per sample. Viruses 2014-09-19 6 9 Review 10.3390/v6093458 3458 3471 1999-4915 2014-09-19 doi: 10.3390/v6093458 Daniel Beniac Christine Siemens Christine Wright Tim Booth http://www.mdpi.com/1999-4915/6/9/3450 Chia (Salvia hispanica), an herbaceous plant native to Latin America, has become important in the last 20 years due to its beneficial effects on health. Here, we present the first record and identification of two viruses in chia plants. The comparison of the complete nucleotide sequences showed the presence of two viral species with the typical genome organization of bipartite New World begomovirus, identified as Sida mosaic Bolivia virus 2 and Tomato yellow spot virus, according to the ICTV taxonomic criteria for begomovirus classification. DNA-A from Sida mosaic Bolivia virus 2 exhibited 96.1% nucleotide identity with a Bolivian isolate of Sida micrantha, and Tomato yellow spot virus showed 95.3% nucleotide identity with an Argentine bean isolate. This is the first report of begomoviruses infecting chia as well as of the occurrence of Sida mosaic Bolivia virus 2 in Argentina. Viruses 2014-09-19 6 9 Article 10.3390/v6093450 3450 3457 1999-4915 2014-09-19 doi: 10.3390/v6093450 Marcos Celli Maria Perotto Julia Martino Ceferino Flores Vilma Conci Patricia Pardina http://www.mdpi.com/2076-0817/3/3/759 We have recently demonstrated that antibiotic pressure can induce the viable but non-culturable (VBNC) state in Staphylococcus aureus biofilms. Since dormant bacterial cells can undermine anti-infective therapy, a greater understanding of the role of antibiotics of last resort, including daptomycin, is crucial. Methicillin-resistant S. aureus 10850 biofilms were maintained on non-nutrient (NN) agar in the presence or absence of the MIC of daptomycin until loss of culturability. Viable cells were monitored by epifluorescence microscopy and flow cytometry for 150 days. All biofilms reached non-culturability at 40 days and showed a similar amount of viable cells; however, in biofilms exposed to daptomycin, their number remained unchanged throughout the experiment, whereas in those maintained on NN agar alone, no viable cells were detected after 150 days. Gene expression assays showed that after achievement of non-culturability, 16S rDNA and mecA were expressed by all biofilms, whereas glt expression was found only in daptomycin-exposed biofilms. Our findings suggest that low daptomycin concentrations, such as those that are likely to obtain within biofilms, can influence the viability and gene expression of non-culturable S. aureus cells. Resuscitation experiments are needed to establish the VBNC state of daptomycin-exposed biofilms. Pathogens 2014-09-18 3 3 Article 10.3390/pathogens3030759 759 768 2076-0817 2014-09-18 doi: 10.3390/pathogens3030759 Sonia Pasquaroli Barbara Citterio Andrea Cesare Mehdi Amiri Anita Manti Claudia Vuotto Francesca Biavasco http://www.mdpi.com/2072-6643/6/9/3734 The potential role of coffee consumption in the development of various types of cancer has been extensively investigated in epidemiologic studies. How coffee consumption may modulate risk of gastric cancer, however, remains a subject open for investigation. To better quantify this relation, we quantitatively summarized evidence from prospective studies. Eligible studies were identified on PubMed and Embase databases. The summary risk estimates were obtained using the random-effects model. Subgroup, sensitivity and dose-response analyses were conducted. The present meta-analysis included 12 prospective cohort studies. A pooled analysis of these studies suggested that coffee consumption (highest vs. lowest consumption) was not associated with risk of gastric cancer (RR = 1.12, 95% CI = 0.93–1.36). In the subgroup analysis, significant increased risk was detected in the U.S. studies (RR = 1.36, 95% CI = 1.06–1.74) and in the studies with <10 years of follow-up (RR = 1.24, 95% CI = 1.00–1.54), and the greatest increase in risk was observed in those studies without adjustment for smoking (RR = 1.48, 95% CI = 1.13–1.93). There was some evidence of publication bias (P for Egger's test = 0.03). Cumulative evidence from prospective studies suggests that coffee consumption is not associated with risk of gastric cancer. The observed positive results may be confounded by smoking and need further investigation. Nutrients 2014-09-18 6 9 Article 10.3390/nu6093734 3734 3746 2072-6643 2014-09-18 doi: 10.3390/nu6093734 Feiyue Xie Dan Wang Zhifang Huang Yajun Guo http://www.mdpi.com/2077-0383/3/3/1043 Oral urea has been used in the past to treat various diseases like gastric ulcers, liver metastases, sickle cell disease, heart failure, brain oedema, glaucoma, Meniere disease, etc. We have demonstrated for years, the efficacy of urea to treat euvolemic (SIADH) or hypervolemic hyponatremia. We briefly describe the indications of urea use in symptomatic and paucisymptomatic hyponatremic patients. Urea is a non-toxic, cheap product, and protects against osmotic demyelinating syndrome (ODS) in experimental studies. Prospective studies showing the benefit to treat mild chronic hyponatremia due to SIADH and comparing water restriction, urea, high ceiling diuretics, and antivasopressin antagonist antagonist should be done. Journal of Clinical Medicine 2014-09-18 3 3 Article 10.3390/jcm3031043 1043 1049 2077-0383 2014-09-18 doi: 10.3390/jcm3031043 Guy Decaux Fabrice Kengne Bruno Couturier Frédéric Vandergheynst Wim Musch Alain Soupart http://www.mdpi.com/1660-4601/11/9/9776 In the medical field, many outcome variables are dichotomized, and the two possible values of a dichotomized variable are referred to as classes. A dichotomized dataset is class-imbalanced if it consists mostly of one class, and performance of common classification models on this type of dataset tends to be suboptimal. To tackle such a problem, resampling methods, including oversampling and undersampling can be used. This paper aims at illustrating the effect of resampling methods using the National Health and Nutrition Examination Survey (NHANES) wave 2009–2010 dataset. A total of 4677 participants aged ≥20 without self-reported diabetes and with valid blood test results were analyzed. The Classification and Regression Tree (CART) procedure was used to build a classification model on undiagnosed diabetes. A participant demonstrated evidence of diabetes according to WHO diabetes criteria. Exposure variables included demographics and socio-economic status. CART models were fitted using a randomly selected 70% of the data (training dataset), and area under the receiver operating characteristic curve (AUC) was computed using the remaining 30% of the sample for evaluation (testing dataset). CART models were fitted using the training dataset, the oversampled training dataset, the weighted training dataset, and the undersampled training dataset. In addition, resampling case-to-control ratio of 1:1, 1:2, and 1:4 were examined. Resampling methods on the performance of other extensions of CART (random forests and generalized boosted trees) were also examined. CARTs fitted on the oversampled (AUC = 0.70) and undersampled training data (AUC = 0.74) yielded a better classification power than that on the training data (AUC = 0.65). Resampling could also improve the classification power of random forests and generalized boosted trees. To conclude, applying resampling methods in a class-imbalanced dataset improved the classification power of CART, random forests, and generalized boosted trees. International Journal of Environmental Research and Public Health 2014-09-18 11 9 Article 10.3390/ijerph110909776 9776 9789 1660-4601 2014-09-18 doi: 10.3390/ijerph110909776 Paul Lee http://www.mdpi.com/2079-9721/2/3/274 Pulmonary hypertension (PH) is a rare disease, which still carries a poor prognosis. PH is characterized by a pressure overload on the right ventricle (RV), which develops hypertrophy, followed by a progressive failure. Accordingly, recent evidence showed that RV function has an important prognostic role in patients with PH. Echocardiography, cardiac magnetic resonance (CMR), computed tomography, and nuclear imaging allow a non-invasive evaluation of the RV size and function, but only the first two are routinely used in the clinical arena. Some conventional echocardiographic parameters, such as TAPSE (tricuspid anular plane systolic excursion), have demonstrated prognostic value in patients with PH. Moreover, there are some new advanced echo techniques, which can provide a more detailed assessment of RV function. Three-dimensional (3D) echocardiography allows measurement of RV volumes and ejection fraction, and two-dimensional (2D) speckle tracking (STE), allows assessment of RV myocardial mechanics. CMR provides accurate measurement of RV volumes, ejection fraction, and mass and allows the characterization of the RV wall composition by identifying the presence of fibrosis by late gadolinium enhancement. Although CMR seems to hold promise for both initial assessment and follow-up of patients with PH, its main role has been restricted to diagnostic work-up only. Diseases 2014-09-18 2 3 Review 10.3390/diseases2030274 274 295 2079-9721 2014-09-18 doi: 10.3390/diseases2030274 Diletta Peluso Francesco Tona Denisa Muraru Gabriella Romeo Umberto Cucchini Martina Marra Sabino Iliceto Luigi Badano http://www.mdpi.com/1999-4915/6/9/3438 Influenza A viruses infect a remarkably diverse number of hosts. Two completely new influenza A virus subtypes were recently discovered in bats, dramatically expanding the host range of the virus. These bat viruses are extremely divergent from all other known strains and likely have unique replication cycles. Phylogenetic analysis indicates long-term, isolated evolution in bats. This is supported by a high seroprevalence in sampled bat populations. As bats represent ~20% of all classified mammals, these findings suggests the presence of a massive cryptic reservoir of poorly characterized influenza A viruses. Here, we review the exciting progress made on understanding these newly discovered viruses, and discuss their zoonotic potential. Viruses 2014-09-17 6 9 Commentary 10.3390/v6093438 3438 3449 1999-4915 2014-09-17 doi: 10.3390/v6093438 Andrew Mehle http://www.mdpi.com/1660-4601/11/9/9760 Background: Monitoring of human exposure to mercury is important due to its adverse health effects. This study aimed to determine the extent of mercury exposure among mothers and their children in Ireland, and to identify factors associated with elevated levels. It formed part of the Demonstration of a study to Coordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES) pilot biomonitoring study. Methods: Hair mercury concentrations were determined from a convenience sample of 120 mother/child pairs. Mothers also completed a questionnaire. Rigorous quality assurance within DEMOCOPHES guaranteed the accuracy and international comparability of results. Results: Mercury was detected in 79.2% of the samples from mothers, and 62.5% of children's samples. Arithmetic mean levels in mothers (0.262 µg/g hair) and children (0.149 µg /g hair) did not exceed the US EPA guidance value. Levels were significantly higher for those with higher education, and those who consumed more fish. Conclusions: The study demonstrates the benefit of human biomonitoring for assessing and comparing internal exposure levels, both on a population and an individual basis. It enables the potential harmful impact of mercury to be minimised in those highly exposed, and can therefore significantly contribute to population health. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909760 9760 9775 1660-4601 2014-09-17 doi: 10.3390/ijerph110909760 Elizabeth Cullen David Evans Fred Davidson Padraig Burke Damien Burns Andrew Flanagan Chris Griffin Anne Kellegher Rory Mannion Maurice Mulcahy Michael Ryan Pierre Biot Ludwine Casteleyn Argelia Castaño Jürgen Angerer Holger Koch Marta Esteban Birgit Schindler Carmen Navarro Marike Kolossa-Gehring Ulrike Fiddicke Greet Schoeters Elly Hond Ovnair Sepai Karen Exley Louis Bloemen Lisbeth Knudsen Reinhard Joas Anke Joas Dominique Aerts http://www.mdpi.com/1660-4601/11/9/9739 Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909739 9739 9759 1660-4601 2014-09-17 doi: 10.3390/ijerph110909739 Natasja Jensen Katrine Johansen Marianne Kastrup Allan Krasnik Marie Norredam http://www.mdpi.com/1660-4601/11/9/9723 There is an ongoing debate about equity and equality in health care, and whether immigrants benefit equally from services as the non-immigrant population. The study focuses on benefits from and adherence to the diabetes mellitus type 2 (DM 2) disease management program (DMP) among Turkish immigrants in Germany. So far, it has not been researched whether this group benefits from enrollment in the DMP as well as diabetics from the non-immigrant population. Data on the non-immigrant sample (N = 702) stem from a survey among members of a German health insurance, the Turkish immigrant sample (N = 102) was recruited in the area of Hamburg. Identical questions in both surveys enable comparing major components. Regarding process quality, Turkish diabetics do not differ from the non-immigrant sample; moreover, they have significantly more often received documentation and diabetes training. In terms of outcome quality however, results display a greater benefit on behalf of the non-immigrant sample (e.g., blood parameters and body mass index), and they also met more of the DMP criteria. This underlines the need of diabetics with Turkish background for further education and information in order to become the empowered patient as is intended by the DMP as well as to prevent comorbidities. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909723 9723 9738 1660-4601 2014-09-17 doi: 10.3390/ijerph110909723 Anna Makowski Christopher Kofahl http://www.mdpi.com/1660-4601/11/9/9712 Large-scale public health emergencies require a sophisticated, coordinated response involving multiple entities to protect health and minimize suffering. However, the rarity of such emergencies presents a barrier to gathering observational data about the effectiveness of the public health response before such events occur. For this reason, public health practitioners increasingly have relied on simulated emergencies, known as "exercises" as proxies to test their emergency capabilities. However, the formal evaluation of performance in these exercises, historically has been inconsistent, and there is little research to describe how data acquired from simulated emergencies actually support conclusions about the quality of the public health emergency response system. Over the past six years, we have designed and evaluated more than seventy public health emergency exercises, collaborating with public health agencies, hospitals and others to test a wide variety of systems and their capabilities. Using the data and experience that we gathered, we have developed a conceptual framework that describes the essential elements necessary to consider when applying performance measurement science to public health emergency exercises. We suggest that this framework may assist practitioners and researchers who wish to better measure performance in exercises and to improve public health emergency preparedness. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909712 9712 9722 1660-4601 2014-09-17 doi: 10.3390/ijerph110909712 Elena Savoia Foluso Agboola Paul Biddinger http://www.mdpi.com/1660-4601/11/9/9694 The purpose of this study was to quantify how school sanitation conditions are associated with pupils' use of sanitation facilities. We conducted a longitudinal assessment in 60 primary schools in Nyanza Province, Kenya, using structured observations to measure facility conditions and pupils' use at specific facilities. We used multivariable mixed regression models to characterize how pupil to toilet ratio was associated with toilet use at the school-level and also how facility conditions were associated with pupils' use at specific facilities. We found a piecewise linear relationship between decreasing pupil to toilet ratio and increasing pupil toilet use (p < 0.01). Our data also revealed significant associations between toilet use and newer facility age (p < 0.01), facility type (p < 0.01), and the number of toilets in a facility (p < 0.01). We found some evidence suggesting facility dirtiness may deter girls from use (p = 0.06), but not boys (p = 0.98). Our study is the first to rigorously quantify many of these relationships, and provides insight into the complexity of factors affecting pupil toilet use patterns, potentially leading to a better allocation of resources for school sanitation, and to improved health and educational outcomes for children. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909694 9694 9711 1660-4601 2014-09-17 doi: 10.3390/ijerph110909694 Joshua Garn Bethany Caruso Carolyn Drews-Botsch Michael Kramer Babette Brumback Richard Rheingans Matthew Freeman http://www.mdpi.com/1660-4601/11/9/9680 Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers' identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists' perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909680 9680 9693 1660-4601 2014-09-17 doi: 10.3390/ijerph110909680 Sheila Chang Daniel Beacher Soyang Kwon Megan McCarville Helen Binns Adolfo Ariza http://www.mdpi.com/1660-4601/11/9/9660 Consumers are exposed to multiple residues of different pesticides via the diet. Therefore, EU legislation for pesticides requires the evaluation of single active substances as well as the consideration of combination effects. Hence the analysis of combined effects of substances in a broad dose range represents a key challenge to current experimental and regulatory toxicology. Here we report evidence for additive effects for (tri)azole fungicides, a widely used group of antifungal agents, in the human placental cell line Jeg-3. In addition to the triazoles cyproconazole, epoxiconazole, flusilazole and tebuconazole and the azole fungicide prochloraz also pesticides from other chemical classes assumed to act via different modes of action (i.e., the organophosphate chlorpyrifos and the triazinylsulfonylurea herbicide triflusulfuron-methyl) were investigated. Endpoints analysed include synthesis of steroid hormone production (progesterone and estradiol) and gene expression of steroidogenic and non-steroidogenic cytochrome-P-450 (CYP) enzymes. For the triazoles and prochloraz, a dose dependent inhibition of progesterone production was observed and additive effects could be confirmed for several combinations of these substances in vitro. The non-triazoles chlorpyrifos and triflusulfuron-methyl did not affect this endpoint and, in line with this finding, no additivity was observed when these substances were applied in mixtures with prochloraz. While prochloraz slightly increased aromatase expression and estradiol production and triflusulfuron-methyl decreased estradiol production, none of the other substances had effects on the expression levels of steroidogenic CYP-enzymes in Jeg-3 cells. For some triazoles, prochloraz and chlorpyrifos a significant induction of CYP1A1 mRNA expression and potential combination effects for this endpoint were observed. Inhibition of CYP1A1 mRNA induction by the AhR inhibitor CH223191 indicated AhR receptor dependence this effect. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909660 9660 9679 1660-4601 2014-09-17 doi: 10.3390/ijerph110909660 Svenja Rieke Sophie Koehn Karen Hirsch-Ernst Rudolf Pfeil Carsten Kneuer Philip Marx-Stoelting http://www.mdpi.com/1660-4601/11/9/9649 Public concerns about potential health risks of intermediate-frequency (IF) electromagnetic fields are increasing, especially as the use of induction-heating cooktops has spread extensively in Japan and Europe. In order to investigate the properties of IF electromagnetic fields, we examined the effect of exposure to a 23-kHz IF magnetic field of 2 mT for 2, 3, or 4 h on neutrophil chemotaxis and phagocytosis using differentiated human HL-60 cells. Compared with sham exposure, exposure to the IF magnetic field had no effect on neutrophil chemotaxis or phagocytosis. Previous studies demonstrated that exposure to a 23-kHz IF magnetic field of 2 mT (about 74-times the maximum value recommended by the International Commission for Nonionizing Radiation Protection guidelines) may affect the first-line immune responses in humans. To our knowledge, this is the first study to evaluate the effects of IF magnetic fields on cellular immune responses. We found that exposure to an IF magnetic field of 2 mT has minimal if any effect on either the chemotaxis or phagocytic activity of neutrophil-like human HL-60 cells. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909649 9649 9659 1660-4601 2014-09-17 doi: 10.3390/ijerph110909649 Shin Koyama Eijiro Narita Naoki Shinohara Junji Miyakoshi http://www.mdpi.com/1660-4601/11/9/9638 Shisha (waterpipe) smoking is becoming a more prevalent form of tobacco consumption, and is growing worldwide, particularly among the young generation in the Middle East. This cross-sectional study aimed to determine the effects of shisha smoking on lung functions and Fractional Exhaled Nitric Oxide (FeNO) among Saudi young adults. We recruited 146 apparently healthy male subjects (73 control and 73 shisha smokers). The exposed group consisted of male shisha smokers, with mean age 21.54 ± 0.41 (mean ± SEM) range 17–33 years. The control group consisted of similar number (73) of non-smokers with mean age 21.36 ± 0.19 (mean ± SEM) range 18–28 years. Between the groups we considered the factors like age, height, weight, gender, ethnicity and socioeconomic status to estimate the impact of shisha smoking on lung function and fractional exhaled nitric oxide. Lung function test was performed by using an Spirovit-SP-1 Electronic Spirometer. Fractional Exhaled Nitric Oxide (FeNO) was measured by using Niox Mino. A significant decrease in lung function parameters FEV1, FEV1/FVC Ratio, FEF-25%, FEF-50%, FEF-75% and FEF-75–85% was found among shisha smokers relative to their control group. There was also a significant reduction in the Fractional Exhaled Nitric Oxide among Shisha smokers compared to control group. International Journal of Environmental Research and Public Health 2014-09-17 11 9 Article 10.3390/ijerph110909638 9638 9648 1660-4601 2014-09-17 doi: 10.3390/ijerph110909638 Sultan Meo Khaled AlShehri Bader AlHarbi Omar Barayyan Abdulrahman Bawazir Omar Alanazi Ahmed Al-Zuhair http://www.mdpi.com/1660-4601/11/9/9621 Nanosized objects are increasingly present in everyday life and in specialized technological applications. In recent years, as a consequence of concern about their potential adverse effects, intense research effort has led to a better understanding of the physicochemical properties that underlie their biocompatibility or potential toxicity, setting the basis for a rational approach to their use in the different fields of application. Among the functional parameters that can be perturbed by interaction between nanoparticles (NPs) and living structures, calcium homeostasis is one of the key players and has been actively investigated. One of the most relevant biological targets is represented by the nervous system (NS), since it has been shown that these objects can access the NS through several pathways; moreover, engineered nanoparticles are increasingly developed to be used for imaging and drug delivery in the NS. In neurons, calcium homeostasis is tightly regulated through a complex set of mechanisms controlling both calcium increases and recovery to the basal levels, and even minor perturbations can have severe consequences on neuronal viability and function, such as excitability and synaptic transmission. In this review, we will focus on the available knowledge about the effects of NPs on the mechanisms controlling calcium signalling and homeostasis in neurons. We have taken into account the data related to environmental NPs, and, in more detail, studies employing engineered NPs, since their more strictly controlled chemical and physical properties allow a better understanding of the relevant parameters that determine the biological responses they elicit. The literature on this specific subject is all quite recent, and we have based the review on the data present in papers dealing strictly with nanoparticles and calcium signals in neuronal cells; while they presently amount to about 20 papers, and no related review is available, the field is rapidly growing and some relevant information is already available. A few general findings can be summarized: most NPs interfere with neuronal calcium homeostasis by interactions at the plasmamembrane, and not following their internalization; influx from the extracellular medium is the main mechanism involved; the effects are dependent in a complex way from concentration, size and surface properties. International Journal of Environmental Research and Public Health 2014-09-16 11 9 Review 10.3390/ijerph110909621 9621 9637 1660-4601 2014-09-16 doi: 10.3390/ijerph110909621 Davide Lovisolo Alessandra Gilardino Federico Ruffinatti http://www.mdpi.com/1999-4915/6/9/3428 Low-frequency HIV variants possessing resistance mutations against non‑nucleoside reverse transcriptase inhibitors (NNRTI), especially at HIV reverse transcriptase (RT) amino acid (aa) positions K103 and Y181, have been shown to adversely affect treatment response. Therapeutic failure correlates with both the mutant viral variant frequency and the mutational load. We determined the prevalence of NNRTI resistance mutations at several RT aa positions in viruses from 204 antiretroviral (ARV)-naïve HIV-infected individuals using deep sequencing, and examined the relationship between mutant variant frequency and mutational load for those variants. Deep sequencing to ≥0.4% levels found variants with major NNRTI-resistance mutations having a Stanford-HIVdb algorithm value ≥30 for efavirenz and/or nevirapine in 52/204 (25.5%) ARV-naïve HIV-infected persons. Eighteen different major NNRTI mutations were identified at 11 different positions, with the majority of variants being at frequency >1%. The frequency of these variants correlated strongly with the mutational load, but this correlation weakened at low frequencies. Deep sequencing detected additional major NNRTI-resistant viral variants in treatment-naïve HIV-infected individuals. Our study suggests the significance of screening for mutations at all RT aa positions (in addition to K103 and Y181) to estimate the true burden of pre-treatment NNRTI-resistance. An important finding was that variants at low frequency had a wide range of mutational loads (>100-fold) suggesting that frequency alone may underestimate the impact of specific NNRTI-resistant variants. We recommend further evaluation of all low-frequency NNRTI-drug resistant variants with special attention given to the impact of mutational loads of these variants on treatment outcomes. Viruses 2014-09-16 6 9 Article 10.3390/v6093428 3428 3437 1999-4915 2014-09-16 doi: 10.3390/v6093428 Shaili Gupta Max Lataillade Tassos Kyriakides Jennifer Chiarella Elizabeth John Suzin Webb Elizabeth Moreno Birgitte Simen Michael Kozal http://www.mdpi.com/2072-6643/6/9/3727 The joint symposium of The Omega-3 Centre and the Australasian Section American Oil Chemists Society; Recent Advances in Omega-3: Health Benefits, Sources, Products and Bioavailability, was held November 7, 2013 in Newcastle, NSW, Australia. Over 115 attendees received new information on a range of health benefits, aquaculture as a sustainable source of supply, and current and potential new and novel sources of these essential omega-3 long-chain (LC, ≥C20) polyunsaturated fatty acid nutrients (also termed LC omega-3). The theme of "Food versus Fuel" was an inspired way to present a vast array of emerging and ground breaking Omega-3 research that has application across many disciplines. Eleven papers submitted following from the Omega-3 Symposium are published in this Special Issue volume, with topics covered including: an update on the use of the Omega-3 Index (O3I), the effects of dosage and concurrent intake of vitamins/minerals on omega-3 incorporation into red blood cells, the possible use of the O3I as a measure of risk for adiposity, the need for and progress with new land plant sources of docosahexaenoic acid (DHA, 22:6ω3), the current status of farmed Australian and New Zealand fish, and also supplements, in terms of their LC omega-3 and persistent organic pollutants (POP) content, progress with cheap carbon sources in the culture of DHA-producing single cell organisms, a detailed examination of the lipids of the New Zealand Greenshell mussel, and a pilot investigation of the purification of New Zealand hoki liver oil by short path distillation. The selection of papers in this Special Issue collectively highlights a range of forward looking and also new and including positive scientific outcomes occurring in the omega-3 field. Nutrients 2014-09-16 6 9 Commentary 10.3390/nu6093727 3727 3733 2072-6643 2014-09-16 doi: 10.3390/nu6093727 Peter Nichols Alexandra McManus Kevin Krail Andrew Sinclair Matt Miller http://www.mdpi.com/2072-6643/6/9/3711 Oxidative stress induced by reactive oxygen species (ROS) is the major cause of degenerative disorders including aging and disease. In this study, we investigated whether Cordyceps militaris extract (CME) has in vitro protective effects on hydrogen peroxide-induced oxidative stress in human dermal fibroblasts (HDFs). Our results showed that the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity of CME was increased in a dose-dependent manner. We found that hydrogen peroxide treatment in HDFs increased ROS generation and cell death as compared with the control. However, CME improved the survival of HDFs against hydrogen peroxide-induced oxidative stress via inhibition of intracellular ROS production. CME treatment inhibited hydrogen peroxide-induced apoptotic cell death and apoptotic nuclear condensation in HDFs. In addition, CME prevented hydrogen peroxide-induced SA-β-gal-positive cells suggesting CME could inhibit oxidative stress-induced premature senescence. Therefore, these results suggest that CME might have protective effects against oxidative stress-induced premature senescence via scavenging ROS. Nutrients 2014-09-16 6 9 Article 10.3390/nu6093711 3711 3726 2072-6643 2014-09-16 doi: 10.3390/nu6093711 Jun Park Jong Lee Ki Lee Suk-Jin Ha Eock Hong http://www.mdpi.com/2072-6643/6/9/3696 Purpose: The aqueous enzymatic extract from rice bran (AEERB) was rich in protein, γ-oryzanol and tocols. The aim of this study was to investigate the effects of AEERB on the regulation of lipid metabolism and the inhibition of oxidative damage. Methods: The antioxidant activity of AEERB in vitro was measured in terms of radical scavenging capacity, ferric reducing ability power (FRAP) and linoleic acid emulsion system-ferric thiocyanate method (FTC). Male Wistar rats were fed with a normal diet and a high-fat and high-cholesterol diet with or without AEERB. After treatment, biochemical assays of serum, liver and feces lipid levels, the antioxidant enzyme activity, malondialdehyde (MDA) and protein carbonyl were determined. Result: AEERB is completely soluble in water and rich in hydrophilic and lipophilic functional ingredients. AEERB scavenged DPPH• and ABTS•+ and exhibited antioxidant activity slightly lower than that of ascorbic acid in the linoleic acid system. The administration of AEERB reduced serum lipid levels and the atherogenic index compared with those of the hyperlipidemic diet group (HD). The administration of AEERB significantly lowered liver lipid levels, inhibited hepatic 3-hydroxyl-3-methylglutaryl CoA reductase activity, and efficiently promoted the fecal excretion of total lipids and total cholesterol (TC) (p < 0.05). Dietary AEERB enhanced antioxidant status in the serum, liver and brain by increasing the antioxidant enzyme activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) and decreasing the content of MDA and protein carbonyl. Conclusions: The results indicated that AEERB might act as a potent hypolipidemic and antioxidant functional food. Nutrients 2014-09-16 6 9 Article 10.3390/nu6093696 3696 3710 2072-6643 2014-09-16 doi: 10.3390/nu6093696 Yu-Xin Wang Yang Li An-Min Sun Feng-Jiao Wang Guo-Ping Yu http://www.mdpi.com/2072-6643/6/9/3672 The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries. Nutrients 2014-09-16 6 9 Review 10.3390/nu6093672 3672 3695 2072-6643 2014-09-16 doi: 10.3390/nu6093672 Karen Charlton Jacqui Webster Paul Kowal http://www.mdpi.com/2072-6643/6/9/3653 The idea that specific kind of foods may have an addiction potential and that some forms of overeating may represent an addicted behavior has been discussed for decades. In recent years, the interest in food addiction is growing and research on this topic lead to more precise definitions and assessment methods. For example, the Yale Food Addiction Scale has been developed for the measurement of addiction-like eating behavior based on the diagnostic criteria for substance dependence of the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, diagnostic criteria for substance abuse and—dependence were merged, thereby increasing the number of symptoms for substance use disorders (SUDs) in the DSM-5. Moreover, gambling disorder is now included along SUDs as a behavioral addiction. Although a plethora of review articles exist that discuss the applicability of the DSM-IV substance dependence criteria to eating behavior, the transferability of the newly added criteria to eating is unknown. Thus, the current article discusses if and how these new criteria may be translated to overeating. Furthermore, it is examined if the new SUD criteria will impact future research on food addiction, for example, if "diagnosing" food addiction should also be adapted by considering all of the new symptoms. Given the critical response to the revisions in DSM-5, we also discuss if the recent approach of Research Domain Criteria can be helpful in evaluating the concept of food addiction. Nutrients 2014-09-16 6 9 Review 10.3390/nu6093653 3653 3671 2072-6643 2014-09-16 doi: 10.3390/nu6093653 Adrian Meule Ashley Gearhardt http://www.mdpi.com/1660-4601/11/9/9607 While health impact assessment (HIA) has typically been applied to projects, plans or policies, it has significant potential with regard to strategic considerations of major health issues facing society such as climate change. Given the complexity of climate change, assessing health impacts presents new challenges that may require different approaches compared to traditional applications of HIA. This research focuses on the development of health consequence scales suited to assessing and comparing health effects associated with climate change and applied within a HIA framework. This assists in setting priorities for adaptation plans to minimize the public health impacts of climate change. The scales presented in this paper were initially developed for a HIA of climate change in Perth in 2050, but they can be applied across spatial and temporal scales. The design is based on a health effects pyramid with health measures expressed in orders of magnitude and linked to baseline population and health data. The health consequence measures are combined with a measure of likelihood to determine the level of risk associated with each health potential health impact. In addition, a simple visual framework that can be used to collate, compare and communicate the level of health risks associated with climate change has been developed. International Journal of Environmental Research and Public Health 2014-09-16 11 9 Article 10.3390/ijerph110909607 9607 9620 1660-4601 2014-09-16 doi: 10.3390/ijerph110909607 Helen Brown Jeffery Spickett http://www.mdpi.com/1660-4601/11/9/9595 The aim of this study was to analyze the association between waist-to-height ratio (WHtR) and C-reactive protein (CRP) in the elderly (considering their most prevalent morbidities and lifestyles), to investigate the relationship between this anthropometric index and the presence of the most prevalent morbidities (isolated or combined), and to identify which morbidities (analyzed individually) would have greater associations with WHtR. This cross-sectional population-based epidemiological study of a stratified sampling comprised 170 elderly individuals between 60 and 90 years of age (both genders). Home visits were used to administer questionnaires and to perform anthropometric measurements and blood collection. The mean patient age was younger than 70 years, with women comprising the majority (69.41%) and with 90% of the patients presenting with inadequate WHtR. Hypertension was the most prevalent morbidity in this cohort (58.52%), and when analyzed in combination, hypertension plus obesity were the most frequently diagnosed morbidities (17.65%). Obesity, which was among the most prevalent comorbidities, was the only comorbidity combined with WHtR (p = 0.0019). Individuals with no morbidities had lower mean WHtR values compared with individuals with at least one morbidity (p = 0.0075). In the multiple linear regression model, it was identified that when individuals had one or more of the most prevalent comorbidities, the mean WHtR increased by 0.0415 (p = 0.0065). A correlation between WHtR and CRP (p = 0.0379) was also verified. Based on the relationships observed between WHtR (isolated or in combination, data unpublished) and CRP among the elderly, WHtR may represent a screening tool because it is a simple and effective anthropometric index. International Journal of Environmental Research and Public Health 2014-09-16 11 9 Article 10.3390/ijerph110909595 9595 9606 1660-4601 2014-09-16 doi: 10.3390/ijerph110909595 Jousianny Silva Raquel Lima Danielle de Carvalho Pereira Cassia de Oliveira Silva Maria Gonçalves Malaquias Filho Rosália Filizola Ronei de Moraes Luiza Asciutti Maria de Carvalho Costa http://www.mdpi.com/2072-6643/6/9/3641 HIV/AIDS patients are probably more predisposed to vitamin E deficiency, considering that they are more exposed to oxidative stress. Additionally, there are an extensive number of drugs in the highly active antiretroviral therapy (HAART) regimens that may interfere with vitamin E concentrations. The objective of this study was to compare serum concentrations of alpha-tocopherol in 182 HIV/AIDS patients receiving different HAART regimens. The patients were divided into three groups according to regimen: nucleoside analog reverse-transcriptase inhibitors (NRTIs) + non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs); NRTIs + protease inhibitors + ritonavir; NRTIs + other classes. Alpha-tocopherol was assessed by high-performance liquid chromatography. Multiple linear regression analysis was used to evaluate the effects of HAART regimen, time of use, and compliance with the regimen on alpha-tocopherol concentrations. Alpha-tocopherol concentrations were on average 4.12 μmol/L lower for the NRTIs + other classes regimen when compared to the NRTIs + NNRTIs regimen (p = 0.037). A positive association (p < 0.001) was observed between alpha-tocopherol and cholesterol concentrations, a finding due, in part, to the relationship between liposoluble vitamins and lipid profile. This study demonstrated differences in alpha-tocopherol concentrations between patients using different HAART regimens, especially regimens involving the use of new drugs. Long-term prospective cohort studies are needed to monitor vitamin E status in HIV/AIDS patients since the beginning of treatment. Nutrients 2014-09-15 6 9 Article 10.3390/nu6093641 3641 3652 2072-6643 2014-09-15 doi: 10.3390/nu6093641 Daniella Kaio Patricia Rondó Liania Luzia José Souza Aline Firmino Sigrid Santos http://www.mdpi.com/2077-0383/3/3/1033 To date, preconceptual and prenatal patients have been offered gene-by-gene, disorder-by-disorder carrier screening. Newer techniques allow screening of many disorders at one time. The goal of this review is to provide an overview of the current practice and future direction of carrier screening within the preconceptual/prenatal setting. Journal of Clinical Medicine 2014-09-15 3 3 Letter 10.3390/jcm3031033 1033 1042 2077-0383 2014-09-15 doi: 10.3390/jcm3031033 Komal Bajaj Susan Gross http://www.mdpi.com/1660-4601/11/9/9578 An integrated approach was developed to assess exposure and health-risk from polycyclic aromatic hydrocarbons (PAHs) contained in oil mists in a fastener manufacturing industry. One previously developed model and one new model were adopted for predicting oil mist exposure concentrations emitted from metal work fluid (MWF) and PAHs contained in MWF by using the fastener production rate (Pr) and cumulative fastener production rate (CPr) as predictors, respectively. By applying the annual Pr and CPr records to the above two models, long-term workplace PAH exposure concentrations were predicted. In addition, true exposure data was also collected from the field. The predicted and measured concentrations respectively served as the prior and likelihood distributions in the Bayesian decision analysis (BDA), and the resultant posterior distributions were used to determine the long-term exposure and health-risks posed on workers. Results show that long term exposures to PAHs would result in a 3.1%, 96.7%, and 73.4% chance of exceeding the PEL-TWA (0.2 mg/m3), action level (0.1 mg/m3), and acceptable health risk (10−3), respectively. In conclusion, preventive measures should be taken immediately to reduce workers' PAH exposures. International Journal of Environmental Research and Public Health 2014-09-15 11 9 Article 10.3390/ijerph110909578 9578 9594 1660-4601 2014-09-15 doi: 10.3390/ijerph110909578 Hsin-I Hsu Ming-Yeng Lin Yu-Cheng Chen Wang-Yi Chen Chungsik Yoon Mei-Ru Chen Perng-Jy Tsai http://www.mdpi.com/1660-4601/11/9/9553 Vehicles are major sources of air pollutant emissions, and individuals living near large roads endure high exposures and health risks associated with traffic-related air pollutants. Air pollution epidemiology, health risk, environmental justice, and transportation planning studies would all benefit from an improved understanding of the key information and metrics needed to assess exposures, as well as the strengths and limitations of alternate exposure metrics. This study develops and evaluates several metrics for characterizing exposure to traffic-related air pollutants for the 218 residential locations of participants in the NEXUS epidemiology study conducted in Detroit (MI, USA). Exposure metrics included proximity to major roads, traffic volume, vehicle mix, traffic density, vehicle exhaust emissions density, and pollutant concentrations predicted by dispersion models. Results presented for each metric include comparisons of exposure distributions, spatial variability, intraclass correlation, concordance and discordance rates, and overall strengths and limitations. While showing some agreement, the simple categorical and proximity classifications (e.g., high diesel/low diesel traffic roads and distance from major roads) do not reflect the range and overlap of exposures seen in the other metrics. Information provided by the traffic density metric, defined as the number of kilometers traveled (VKT) per day within a 300 m buffer around each home, was reasonably consistent with the more sophisticated metrics. Dispersion modeling provided spatially- and temporally-resolved concentrations, along with apportionments that separated concentrations due to traffic emissions and other sources. While several of the exposure metrics showed broad agreement, including traffic density, emissions density and modeled concentrations, these alternatives still produced exposure classifications that differed for a substantial fraction of study participants, e.g., from 20% to 50% of homes, depending on the metric, would be incorrectly classified into "low", "medium" or "high" traffic exposure classes. These and other results suggest the potential for exposure misclassification and the need for refined and validated exposure metrics. While data and computational demands for dispersion modeling of traffic emissions are non-trivial concerns, once established, dispersion modeling systems can provide exposure information for both on- and near-road environments that would benefit future traffic-related assessments. International Journal of Environmental Research and Public Health 2014-09-15 11 9 Article 10.3390/ijerph110909553 9553 9577 1660-4601 2014-09-15 doi: 10.3390/ijerph110909553 Stuart Batterman Janet Burke Vlad Isakov Toby Lewis Bhramar Mukherjee Thomas Robins http://www.mdpi.com/1660-4601/11/9/9532 Living near landfills is a known health hazard prompting recognition of environmental injustice. The study aim was to compare self-reported symptoms of ill health among residents of four neighborhoods, living in haphazardly constructed settlements surrounded by illegal dumpsites in Tijuana, Mexico. One adult from each of 388 households located in Los Laureles Canyon were interviewed about demographics, health status, and symptoms. Distance from each residence to both the nearest dumpsite and the canyon bottom was assessed. The neighborhoods were selected from locations within the canyon, and varied with respect to proximity to dump sites. Residents of San Bernardo reported significantly higher frequencies of ill-health symptoms than the other neighborhoods, including extreme fatigue (OR 3.01 (95% CI 1.6–5.5)), skin problems/irritations (OR 2.73 (95% CI 1.3–5.9)), stomach discomfort (OR 2.47 (1.3–4.8)), eye irritation/tears (OR 2.02 (1.2–3.6)), and confusion/difficulty concentrating (OR 2.39 (1.2–4.8)). Proximity to dumpsites did not explain these results, that varied only slightly when adjusted for distance to nearest dumpsite or distance to the canyon bottom. Because San Bernardo has no paved roads, we hypothesize that dust and the toxicants it carries is a possible explanation for this difference. Studies are needed to further document this association and sources of toxicants. International Journal of Environmental Research and Public Health 2014-09-15 11 9 Article 10.3390/ijerph110909532 9532 9552 1660-4601 2014-09-15 doi: 10.3390/ijerph110909532 Wael Al-Delaimy Catherine Larsen Keith Pezzoli http://www.mdpi.com/1660-4601/11/9/9522 This cross-sectional study examined the differences in barriers to cessation and reasons for quitting smoking among dual smokers of cigarettes and waterpipe tobacco, exclusive cigarette smokers and exclusive waterpipe smokers. Participants were Arab American adults residing in Richmond, Virginia, who were recruited from Middle Eastern grocery stores, restaurants/lounges and faith and charity organizations. The study yielded several key findings: (1) Exclusive cigarette and waterpipe smokers had similar mean barriers to quitting and were more concerned about their health than dual smokers. (F(2, 150) = 5.594, p = 0.0045). This implies that barriers to smoking and health concerns could be a function of the individual who smokes rather than the modality of smoking itself. (2) Exclusive cigarette or waterpipe smokers and dual smokers may have different reasons for quitting, since they have different reasons for smoking. The proportion of smokers who endorsed smoking as a messy habit as the reason among exclusive cigarette smokers was 0.37, whereas the proportion among exclusive waterpipe smokers was 0.04 and among dual smokers 0.39. The difference in proportions is significant, χ2 (df = 2, N = 154) = 13.17, p = 0.0014. In summary, this study supports the need to further investigate dual cigarette and waterpipe smokers, as the study results indicate greater barriers to smoking cessation in this group. Recognition and understanding of these barriers among dual tobacco users would be important for any future tobacco intervention among waterpipe smokers. International Journal of Environmental Research and Public Health 2014-09-15 11 9 Article 10.3390/ijerph110909522 9522 9531 1660-4601 2014-09-15 doi: 10.3390/ijerph110909522 Linda Haddad Omar El-Shahawy Roula Ghadban http://www.mdpi.com/1660-4601/11/9/9503 The present study explores the impact of acculturation on depressive symptoms among Turkish immigrants in Germany, taking into account different dimensions of cultural orientation. A total of 471 patients from two selected samples (254 primary care patients and 217 outpatients of a psychosomatic department) participated. Levels of acculturation were measured as orientation towards culture of origin (CO), and orientation towards the host culture (HC). Acculturation strategies (integration, assimilation, separation, and marginalization) were also assessed as well as their association with depressive symptoms (BDI). Furthermore, gender- and migration-related differences in terms of acculturation and levels of depressive symptomatology were analyzed. Integration was the acculturation strategy associated with the lowest level of depressive symptoms (M = 14.6, SD = 11.9), while marginalization was associated with the highest (M = 23.5, SD = 14.7). Gender was not found to have a significant impact on acculturation but influenced depressive symptoms, with women (M = 21.8, SD = 13.3) reporting higher levels of depressive symptomatology than men (M = 15.1, SD = 14.0; p < 0.001). In first generation immigrants, significantly higher CO (M = 46.6, SD = 8.3; p < 0.001), lower HC (M = 31.0, SD = 9.6; p < 0.001), and higher levels of depressive symptoms (M = 20.2, SD = 14.1; p < 0.001) were found in comparison to second generation immigrants (CO: M = 41.3, SD = 7.4; HC: M = 36.2, SD = 8.8; depressive symptoms: M = 14.0, SD = 12.9). Our results suggest that orientation towards both the heritage and the host culture has a positive effect on the mental health status of immigrants. Future research needs to include representative samples of migrants from different cultures to further explore the association between acculturation and mental health. International Journal of Environmental Research and Public Health 2014-09-12 11 9 Article 10.3390/ijerph110909503 9503 9521 1660-4601 2014-09-12 doi: 10.3390/ijerph110909503 Eva Morawa Yesim Erim http://www.mdpi.com/2072-6643/6/9/3624 Polyunsaturated fatty acids (PUFAs), especially the n-3 series, are known for their protective effects. Considering that cardiovascular diseases are risk factors for dementia, which is common at aging, the aim of this study was to evaluate whether fatty acid status in the elderly was associated with cognitive function and cardiovascular risk. Forty-five elderly persons (age ≥60 years) were included and divided into two groups based on their Mini-Mental Status Examination score adjusted for educational level: the case group (n = 12) and the control group (n = 33). Serum fatty acid composition, homocysteine (Hcy), hs-CRP, lipid profile and different cognitive domains were evaluated. The case group, characterized by reduced cognitive performance, showed higher levels of 14:0, 16:0, 16:1n-7 fatty acids and lower levels of 22:0, 24:1n-9, 22:6n-3 (DHA) and total PUFAs compared to the control group (p < 0.05). The n-6/n-3 ratio was elevated in both study groups, whereas alterations in Hcy, hs-CRP and lipid profile were observed in the case group. Cognitive function was positively associated with the 24:1n-9, DHA and total n-3 PUFAs, while 14:0, 16:0 and 16:1n-7 fatty acids, the n-6/n-3 ratio and Hcy were inversely associated. In addition, n-3 PUFAs, particularly DHA, were inversely associated with cardiovascular risk, assessed by Hcy levels in the elderly. Nutrients 2014-09-12 6 9 Article 10.3390/nu6093624 3624 3640 2072-6643 2014-09-12 doi: 10.3390/nu6093624 Marília Baierle Patrícia Vencato Luiza Oldenburg Suelen Bordignon Murilo Zibetti Clarissa Trentini Marta Duarte Juliana Veit Sabrina Somacal Tatiana Emanuelli Tilman Grune Nicolle Breusing Solange Garcia http://www.mdpi.com/2072-6643/6/9/3601 Vitamin D deficiency is widely prevalent in India, despite abundant sunshine. Fortification of staple foods with vitamin D is a viable strategy to target an entire population. Vitamin D fortification programs implemented in the United States and Canada have improved the vitamin D status in these countries, but a significant proportion of the population is still vitamin D deficient. Before fortification programs are designed and implemented in India, it is necessary to study the efficacy of the American and Canadian vitamin D fortification programs and then improve upon them to suit the Indian scenario. This review explores potential strategies that could be used for the fortification of foods in the Indian context. These strategies have been proposed considering the diverse dietary practices necessitated by social, economic, cultural and religious practices and the diverse climatic conditions in India. Fortification of staple foods, such as chapati flour, maida, rice flour and rice, may be more viable strategies. Targeted fortification strategies to meet the special nutritional needs of children in India are discussed separately in a review entitled, "Fortification of foods with vitamin D in India: Strategies targeted at children". Nutrients 2014-09-12 6 9 Review 10.3390/nu6093601 3601 3623 2072-6643 2014-09-12 doi: 10.3390/nu6093601 Ritu G Ajay Gupta http://www.mdpi.com/1999-4915/6/9/3425 We acknowledge Clement and colleagues for their comments [1] on our paper [2]. We agree that many controversies are being discussed by the hantavirus community, particularly surrounding the interpretation of serological results and the designation of new species and strains. Within this setting, we are grateful for the opportunity to respond to the key factual and methodological points raised by Clements et al. [...] Viruses 2014-09-12 6 9 Reply 10.3390/v6093425 3425 3427 1999-4915 2014-09-12 doi: 10.3390/v6093425 Lisa Jameson Autilia Newton Louise Coole Edmund Newman Miles Carroll Nick Beeching Roger Hewson Robert Christley http://www.mdpi.com/1999-4915/6/9/3415 This British hantavirus IgG prevalence study, aimed at 119 asymptomatic farmers in England, and using indirect immunofluorescence assay (IFA) as screening technique, concluded that rat-transmitted Seoul virus (SEOV) might be the main suspect as hantaviral pathogen in the UK. Exactly the same conclusion, using the same IFA screening technique, resulted from a 1994 serosurvey in the same country, and in 627 clinical cases plus 100 healthy controls. SEOV-positive study subjects were also mainly farmers with heavy rat-exposure, but residing in Northern-Ireland, a region where all other known rodent reservoirs for pathogenic hantaviruses are known to be absent, except the wild rat. A rodent capture action in and around the farms of eight seropositives confirmed SEOV seropositivity in 21.6% of 51 rats. All SEOV seropositives were patients, hospitalized with an acute feverish condition, a majority of which having the clinical picture of hantavirus-induced nephropathy, known as hemorrhagic fever with renal syndrome (HFRS). Leptospirosis, often mimicking perfectly HFRS, was serologically excluded. Thus, SEOV was established as a human hantaviral pathogen in the UK and in Europe 20 years ago. Viruses 2014-09-12 6 9 Comment 10.3390/v6093415 3415 3424 1999-4915 2014-09-12 doi: 10.3390/v6093415 Jan Clement Paula McKenna Valentijn Vergote Marc Van Ranst http://www.mdpi.com/1660-4601/11/9/9491 Cigarette smoking is one of the most significant public health issues and the most common environmental cause of preventable cancer deaths worldwide. EGFR (Epidermal Growth Factor Receptor)-targeted therapy has been used in the treatment of LC (lung cancer), mainly caused by the carcinogens in cigarette smoke, with variable success. Presence of mutations in the KRAS (Kirsten rat sarcoma viral oncogene homolog) driver oncogene may confer worse prognosis and resistance to treatment for reasons not fully understood. NQO1 (NAD(P)H:quinone oxidoreductase), also known as DT-diaphorase, is a major regulator of oxidative stress and activator of mitomycins, compounds that have been targeted in over 600 pre-clinical trials for treatment of LC. We sequenced KRAS and investigated expression of NQO1 and five clinically relevant proteins (DNMT1, DNMT3a, ERK1/2, c-MET, and survivin) in 108 patients with non-small cell lung carcinoma (NSCLC). NQO1, ERK1/2, DNMT1, and DNMT3a but not c-MET and survivin expression was significantly more frequent in patients with KRAS mutations than those without, suggesting the following: (1) oxidative stress may play an important role in the pathogenesis, worse prognosis, and resistance to treatment reported in NSCLC patients with KRAS mutations, (2) selecting patients based on their KRAS mutational status for future clinical trials may increase success rate, and (3) since oxidation of nucleotides also specifically induces transversion mutations, the high rate of KRAS transversions in lung cancer patients may partly be due to the increased oxidative stress in addition to the known carcinogens in cigarette smoke. International Journal of Environmental Research and Public Health 2014-09-12 11 9 Article 10.3390/ijerph110909491 9491 9502 1660-4601 2014-09-12 doi: 10.3390/ijerph110909491 Ahmet Yilmaz Nehad Mohamed Kara Patterson Yan Tang Konstantin Shilo Miguel Villalona-Calero Michael Davis Xiaoping Zhou Wendy Frankel Gregory Otterson Howard Beall Weiqiang Zhao http://www.mdpi.com/1660-4601/11/9/9480 Aims: Aim of this study was to monitor the environment at the Transplant Unit—Hemato-Oncology Clinic, University Hospital Olomouc (Olomouc, Czech Republic) and identify risks for the patients. Methods and Results: Microorganisms were cultivated under standard aerobic conditions. Strains were biochemically identified using the BD Phoenix™ PID Panel (USA). Legionella pneumophila was identified by DNA sequencing. From the air, the most frequently isolated strains were coagulase-negative staphylococci (94.3%), Micrococcus spp. and Bacillus spp. No Gram-negative strains were isolated from the air. From the surfaces, the most frequently isolated Gram-positive strains were coagulase-negative staphylococci (67.4%), Bacillus spp., enterococci (5.5%), Staphylococcus aureus (2.3%) and Micrococcus spp. (1.7%). From the surfaces, the most frequently isolated Gram-negative strains were from genera Pseudomonas (28%), Enterobacter (28%), E. coli (6%), and Klebsiella spp. (5%). From the personnel, the most frequently isolated Gram-positive strains were coagulase-negative staphylococci (59.6%), Bacillus spp. (24.1%) and Staphylococcus aureus (9.8%). From the personnel, the most frequently isolated Gram-negative strains were Enterobacter spp. (61%), Klebsiella oxytoca (18%), and E. coli (11%). Microscopic filamentous fungi were isolated in 13 cases (2.71%). Isolated strains were Aspergillus spp. (4), Trichoderma spp. (2), Penicillium spp. (2), one case of the strains Paecilomyces spp., Eurotium spp., Monilia spp. Conclusions: The study found no significant deviations in the microbial contamination of the cleanroom air. The personnel entrance of the Transplant Unit represent a high risk area, an extreme value (7270 CFU/m3) was recorded. Regime measures are fully effective, no other deficiencies were found. Significance and Impact of the Study: This epidemiological study, which was held for the duration of one year at the Transplant Unit—Hemato-Oncology Clinic, University Hospital Olomouc. The study monitored microbial contamination of the cleanroom air, surfaces, water, colonization of the personnel by bacterial strains of epidemiological consequence. International Journal of Environmental Research and Public Health 2014-09-12 11 9 Article 10.3390/ijerph110909480 9480 9490 1660-4601 2014-09-12 doi: 10.3390/ijerph110909480 Ivanka Matoušková Ondřej Holy http://www.mdpi.com/2077-0383/3/3/1018 Prenatal genetic screening and testing provides prospective parents information about the health of their fetus. It is offered to find or address an increased risk for chromosomal abnormalities or other genetic conditions in the fetus or to identify the cause of fetal structural abnormalities detected by prenatal imaging. Genome-wide tests, such as the already widely-used chromosomal microarray analysis and emerging diagnostic whole exome and whole genome sequencing, have improved the ability to detect clinically significant findings, but have also increased the chance of detecting incidental findings and variants of uncertain significance. There is an extensive ongoing discussion about optimal strategies for diagnostic laboratories to report such findings and for providers to communicate them with patients. While consensus opinions and guidelines are beginning to appear, they often exclude the prenatal setting, due to its unique set of challenging considerations. These include more limited knowledge of the impact of genetic variants when prospectively detected in an ongoing pregnancy, the absence or limitations of detecting clinically recognizable phenotypes at the time of testing and the different decision-making processes that will ensue from testing. In this review, we examine these challenges within the medical ethical framework unique to prenatal care. Journal of Clinical Medicine 2014-09-12 3 3 Review 10.3390/jcm3031018 1018 1032 2077-0383 2014-09-12 doi: 10.3390/jcm3031018 Lauren Westerfield Sandra Darilek Ignatia van den Veyver http://www.mdpi.com/1660-4601/11/9/9460 Exposure to electromagnetic fields (EMF) is a cause of concern for many people. The topic will likely remain for the foreseeable future on the scientific and political agenda, since emissions continue to change in characteristics and levels due to new infrastructure deployments, smart environments and novel wireless devices. Until now, systematic and coordinated efforts to monitor EMF exposure are rare. Furthermore, virtually nothing is known about personal exposure levels. This lack of knowledge is detrimental for any evidence-based risk, exposure and health policy, management and communication. The main objective of the paper is to review the current state of EMF exposure monitoring activities in Europe, to comment on the scientific challenges and deficiencies, and to describe appropriate strategies and tools for EMF exposure assessment and monitoring to be used to support epidemiological health research and to help policy makers, administrators, industry and consumer representatives to base their decisions and communication activities on facts and data. International Journal of Environmental Research and Public Health 2014-09-11 11 9 Article 10.3390/ijerph110909460 9460 9479 1660-4601 2014-09-11 doi: 10.3390/ijerph110909460 Gregor Dürrenberger Jürg Fröhlich Martin Rösli Mats-Olof Mattsson http://www.mdpi.com/2304-8158/3/3/527 This work evaluates the effect of acetic acid dipping on the growth of L. monocytogenes on poultry legs stored at 4 °C for eight days. Fresh inoculated chicken legs were dipped into either a 1% or 2% acetic acid solution (v/v) or distilled water (control). Changes in mesophiles, psychrotrophs, Enterobacteriaceae counts and sensorial characteristics (odor, color, texture and overall appearance) were also evaluated. The shelf life of the samples washed with acetic acid was extended by at least two days over the control samples washed with distilled water. L. monocytogenes counts before decontamination were 5.57 log UFC/g, and after treatment with 2% acetic acid (Day 0), L. monocytogenes counts were 4.47 log UFC/g. Legs washed with 2% acetic acid showed a significant (p < 0.05) inhibitory effect on L. monocytogenes compared to control legs, with a decrease of about 1.31 log units after eight days of storage. Sensory quality was not adversely affected by acetic acid. This study demonstrates that while acetic acid did reduce populations of L. monocytogenes on meat, it did not completely inactivate the pathogen. The application of acetic acid may be used as an additional hurdle contributing to extend the shelf life of raw poultry and reducing populations of L. monocytogenes. Foods 2014-09-11 3 3 Article 10.3390/foods3030527 527 540 2304-8158 2014-09-11 doi: 10.3390/foods3030527 Elena Gonzalez-Fandos Barbara Herrera http://www.mdpi.com/2072-6643/6/9/3587 Iron homeostasis is affected by obesity and obesity-related insulin resistance in a many-facetted fashion. On one hand, iron deficiency and anemia are frequent findings in subjects with progressed stages of obesity. This phenomenon has been well studied in obese adolescents, women and subjects undergoing bariatric surgery. On the other hand, hyperferritinemia with normal or mildly elevated transferrin saturation is observed in approximately one-third of patients with metabolic syndrome (MetS) or nonalcoholic fatty liver disease (NAFLD). This constellation has been named the "dysmetabolic iron overload syndrome (DIOS)". Both elevated body iron stores and iron deficiency are detrimental to health and to the course of obesity-related conditions. Iron deficiency and anemia may impair mitochondrial and cellular energy homeostasis and further increase inactivity and fatigue of obese subjects. Obesity-associated inflammation is tightly linked to iron deficiency and involves impaired duodenal iron absorption associated with low expression of duodenal ferroportin (FPN) along with elevated hepcidin concentrations. This review summarizes the current understanding of the dysregulation of iron homeostasis in obesity. Nutrients 2014-09-11 6 9 Review 10.3390/nu6093587 3587 3600 2072-6643 2014-09-11 doi: 10.3390/nu6093587 Elmar Aigner Alexandra Feldman Christian Datz http://www.mdpi.com/1660-4601/11/9/9446 The association between sleep and work-related injuries among Chinese farmers has not been well studied. This study examined the impact of lack of sleep on agricultural work-related injuries among farmers in China. Data were from a cross-sectional survey of farm-workers in northeastern China. Information was obtained on injuries that occurred in 12 months prior to the survey, on eight sleep-related variables, and on socio-demographic variables. Logistic regression analyses were conducted to test the hypothesis that lack of sleep significantly increased the risk of work-related injuries after controlling for other injury-related risk- factors. Farmers who slept less than six hours per night were 59% more likely to be injured than those who slept more than eight hours per night (OR = 1.59; 95% CI = 1.04, 2.41). The odds of a work-related injury was 2.46 (1.56–3.89) for farmers who reported going to sleep after midnight at least once a week compared with farmers who reported going to sleep after midnight once a month. Farmers who reported having difficulty falling asleep or waking frequently during the night, who often having nightmares, or who experienced daytime sleepiness were at higher injury risk compared with the reference group after controlling for age, gender and alcohol consumption. Reduced sleep hours and poor sleep quality significantly increased the risk of work-related injuries in Chinese farmers. Sleep hours and sleep quality should be considered when assessing occupational safety among farmers. International Journal of Environmental Research and Public Health 2014-09-11 11 9 Article 10.3390/ijerph110909446 9446 9459 1660-4601 2014-09-11 doi: 10.3390/ijerph110909446 Huiping Zhu Yunfeng Han Yaowu Sun Zhiping Xie Xueyan Qian Lorann Stallones Huiyun Xiang Limin Wang http://www.mdpi.com/1660-4601/11/9/9429 Many papers have been published related to the retention and advancement of women in sciences. Engineering geology is one of the professional areas where women have not yet broken the gender barrier. The research issues of this paper are focused on why female students "leak out" at the end of engineering geology studies, and what can be done to encourage them to complete their degrees with an engineering career in mind. The author has studied students' preferences of the final year project required to complete their degree at the University of Salamanca (Salamanca, Spain). It has been found that most female students are choosing a more theoretical final project instead of a practical one relevant to professional employment, contrary to their male peers. Focus group meetings with the students showed that at the end of five years of engineering geology training, many female students, unsatisfied with the content of their courses, feel that their expectations had not been met. They often have preferences for traditional geology rather than applied branches of the subject. Also, they do not feel comfortable with future job prospects in the profession. From the findings of this research it is clear that tutoring and mentoring would be valuable from the beginning of studies to allow all students to become aware of the content and the potential outcomes of engineering geology studies. In the case of female students, it is particularly important for them to know from the very start that they are about to join what is still a man's world but that they are capable of achieving just as much as men can in the profession. Most importantly, the involvement of more female engineers in professional engineering, including teaching duties, should serve as example and role models in students' education and future careers. International Journal of Environmental Research and Public Health 2014-09-11 11 9 Article 10.3390/ijerph110909429 9429 9445 1660-4601 2014-09-11 doi: 10.3390/ijerph110909429 Dolores Pereira http://www.mdpi.com/1660-4601/11/9/9409 We test the hypothesis that climate and environmental conditions are becoming favorable for dengue transmission in San Juan, Puerto Rico. Sea Level Pressure (SLP), Mean Sea Level (MSL), Wind, Sea Surface Temperature (SST), Air Surface Temperature (AST), Rainfall, and confirmed dengue cases were analyzed. We evaluated the dengue incidence and environmental data with Principal Component Analysis, Pearson correlation coefficient, Mann-Kendall trend test and logistic regressions. Results indicated that dry days are increasing and wet days are decreasing. MSL is increasing, posing higher risk of dengue as the perimeter of the San Juan Bay estuary expands and shorelines move inland. Warming is evident with both SST and AST. Maximum and minimum air surface temperature extremes have increased. Between 1992 and 2011, dengue transmission increased by a factor of 3.4 (95% CI: 1.9–6.1) for each 1 °C increase in SST. For the period 2007–2011 alone, dengue incidence reached a factor of 5.2 (95% CI: 1.9–13.9) for each 1 °C increase in SST. Teenagers are consistently the age group that suffers the most infections in San Juan. Results help understand possible impacts of different climate change scenarios in planning for social adaptation and public health interventions. International Journal of Environmental Research and Public Health 2014-09-11 11 9 Article 10.3390/ijerph110909409 9409 9428 1660-4601 2014-09-11 doi: 10.3390/ijerph110909409 Pablo Méndez-Lázaro Frank Muller-Karger Daniel Otis Matthew McCarthy Marisol Peña-Orellana http://www.mdpi.com/2075-4418/4/3/129 A feared complication to liver trauma is delayed vascular complication, such as pseudoaneurysm and arteriovenous fistula (PS/AF) seen as focal enhancement on contrast-enhanced computed tomography (CT) in the arterial phase. A hyperdense area termed transient hepatic attenuation difference (THAD) representing altered hepatic blood flow can be seen in the arterial phase near the liver lesion. The objective of this study was to describe THAD and PS/AF on follow-up CT after blunt liver trauma, and to evaluate if THAD influenced the evaluation of PS/AF. Three radiology residents retrospectively evaluated scans of 78 patients. The gold standard for PS/AF was an evaluation by an experienced senior radiologist, while THAD was a consensus between the residents. PS/AF was present in 14% and THAD in 54%. THAD was located in the periphery of the lesion with hazy borders and mean HU levels of 100, while PS/AF was located within the lesion with focal enhancement and mean HU levels of 170 (p < 0.05). In evaluation of PS/AF, the likelihood of agreement between the observers and the gold standard was 89% when THAD was present, and 98% when THAD was absent (p = 0.04). THAD is common and can hamper the evaluation of PS/AF. Diagnostics 2014-09-10 4 3 Article 10.3390/diagnostics4030129 129 139 2075-4418 2014-09-10 doi: 10.3390/diagnostics4030129 Andreas Brandt Caroline Ewertsen Kristoffer Hansen http://www.mdpi.com/2227-9032/2/3/356 This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds. Healthcare 2014-09-10 2 3 Review 10.3390/healthcare2030356 356 400 2227-9032 2014-09-10 doi: 10.3390/healthcare2030356 Krishna Vyas Henry Vasconez http://www.mdpi.com/1660-4601/11/9/9376 The escalated use of various wireless communication devices, which emit non-ionizing radiofrequency (RF) fields, have raised concerns among the general public regarding the potential adverse effects on human health. During the last six decades, researchers have used different parameters to investigate the effects of in vitro and in vivo exposures of animals and humans or their cells to RF fields. Data reported in peer-reviewed scientific publications were contradictory: some indicated effects while others did not. International organizations have considered all of these data as well as the observations reported in human epidemiological investigations to set-up the guidelines or standards (based on the quality of published studies and the "weight of scientific evidence" approach) for RF exposures in occupationally exposed individuals and the general public. Scientists with relevant expertise in various countries have also considered the published data to provide the required scientific information for policy-makers to develop and disseminate authoritative health information to the general public regarding RF exposures. This paper is a compilation of the conclusions, on the biological effects of RF exposures, from various national and international expert groups, based on their analyses. In general, the expert groups suggested a reduction in exposure levels, precautionary approach, and further research. International Journal of Environmental Research and Public Health 2014-09-10 11 9 Review 10.3390/ijerph110909376 9376 9408 1660-4601 2014-09-10 doi: 10.3390/ijerph110909376 Vijayalaxmi Maria Scarfi http://www.mdpi.com/1660-4601/11/9/9361 Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to either a seated or stand-biased desk equipped classroom, 374 agreed to participate in a week-long data collection during the fall and spring semesters. Each participant's data was collected using Sensewear® armbands and was comprised of measures of energy expenditure (EE) and step count. A hierarchical linear mixed effects model showed that children in seated desk classrooms had significantly lower (EE) and fewer steps during the standardized lecture time than children in stand-biased classrooms after adjusting for grade, race, and gender. The use of a standing desk showed a significant higher mean energy expenditure by 0.16 kcal/min (p < 0.0001) in the fall semester, and a higher EE by 0.08 kcal/min (p = 0.0092) in the spring semester. International Journal of Environmental Research and Public Health 2014-09-10 11 9 Article 10.3390/ijerph110909361 9361 9375 1660-4601 2014-09-10 doi: 10.3390/ijerph110909361 Mark Benden Hongwei Zhao Christina Jeffrey Monica Wendel Jamilia Blake http://www.mdpi.com/1660-4601/11/9/9345 Our aim is to describe the study recruitment and baseline characteristics of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study population. Potential study participants (age 60–77 years, the dementia risk score ≥6) were identified from previous population-based survey cohorts and invited to the screening visit. To be eligible, cognitive performance measured at the screening visit had to be at the mean level or slightly lower than expected for age. Of those invited (n = 5496), 48% (n = 2654) attended the screening visit, and finally 1260 eligible participants were randomized to the intervention and control groups (1:1). The screening visit non-attendees were slightly older, less educated, and had more vascular risk factors and diseases present. The mean (SD) age of the randomized participants was 69.4 (4.7) years, Mini-Mental State Examination 26.7 (2.0) points, systolic blood pressure 140.1 (16.2) mmHg, total serum cholesterol 5.2 (1.0) mmol/L for, and fasting glucose 6.1 (0.9) mmol/L for, with no difference between intervention and control groups. Several modifiable risk factors were present at baseline indicating an opportunity for the intervention. The FINGER study will provide important information on the effect of lifestyle intervention to prevent cognitive impairment among at risk persons. International Journal of Environmental Research and Public Health 2014-09-10 11 9 Article 10.3390/ijerph110909345 9345 9360 1660-4601 2014-09-10 doi: 10.3390/ijerph110909345 Tiia Ngandu Jenni Lehtisalo Esko Levälahti Tiina Laatikainen Jaana Lindström Markku Peltonen Alina Solomon Satu Ahtiluoto Riitta Antikainen Tuomo Hänninen Antti Jula Francesca Mangialasche Teemu Paajanen Satu Pajala Rainer Rauramaa Timo Strandberg Jaakko Tuomilehto Hilkka Soininen Miia Kivipelto http://www.mdpi.com/1660-4601/11/9/9325 The effects of synthetic goethite (α-FeOOH) used as the catalyst in catalytic ozonation for the degradation of disinfection by-product (DBP) precursors are investigated. A biofiltration column applied following the catalytic ozonation process is used to evaluate the efficiency of removing DBP precursors via biotreatment. Ozone can rapidly react with aromatic compounds and oxidize organic compounds, resulting in a decrease in the fluorescence intensity of dissolved organic matter (DOM). In addition, catalytic ozonation can break down large organic molecules, which causes a blue shift in the emission-excitation matrix spectra. Water treated with catalytic ozonation is composed of low-molecular structures, including soluble microbial products (SMPs) and other aromatic proteins (APs). The DOM in SMPs and APs is removed by subsequent biofiltration. Catalytic ozonation has a higher removal efficiency for dissolved organic carbon and higher ultraviolet absorbance at 254 nm compared to those of ozonation without a catalyst. The use of catalytic ozonation and subsequent biofiltration leads to a lower DBP formation potential during chlorination compared to that obtained using ozonation and catalytic ozonation alone. Regarding DBP species during chlorination, the bromine incorporation factor (BIF) of trihalomethanes and haloacetic acids increases with increasing catalyst dosage in catalytic ozonation. Moreover, the highest BIF is obtained for catalytic ozonation and subsequent biofiltration. International Journal of Environmental Research and Public Health 2014-09-10 11 9 Article 10.3390/ijerph110909325 9325 9344 1660-4601 2014-09-10 doi: 10.3390/ijerph110909325 Yu-Hsiang Wang Kuan-Chung Chen http://www.mdpi.com/2072-6643/6/9/3572 Sucrose, extracellular polysaccharide, and glucosyltransferases (GTFs) are key factors in sucrose-dependent adhesion and play important roles in the process of severe early-childhood caries (S-ECC). However, whether sucrose concentration regulates gtf expression, extracellular polysaccharide synthesis, and sucrose-dependent adhesion is related to the different genotypes of S. mutans isolated from ECC in children and still needs to be investigated. In this study, 52 strains of S. mutans were isolated from children with S-ECC and caries-free (CF) children. Water-insoluble glucan (WIG) synthesis was detected by the anthrone method, adhesion capacity by the turbidimetric method, and expression of gtf by RT-PCR in an in vitro model containing 1%–20% sucrose. The genotypes of S. mutans were analyzed by AP-PCR. The results showed that WIG synthesis, adhesion capacity, and gtf expression increased significantly when the sucrose concentration was from 1% to 10%. WIG synthesis and gtfB as well as gtfC expression of the 1% and 5% groups were significantly lower than those of the 10% and 20% groups (p < 0.05). There were no significant differences between the 10% and 20% groups. The fingerprints of S. mutans detected from individuals in the S-ECC group exhibited a significant difference in diversity compared with those from CF individuals (p < 0.05). Further, the expression of gtfB and gtfC in the S-ECC group was significantly different among the 1- to 5-genotype groups (p < 0.05). It can be concluded that sucrose-dependent adhesion might be related to the diversity of genotypes of S. mutans, and the 10% sucrose level can be seen as a "turning point" and essential factor for the prevention of S-ECC. Nutrients 2014-09-09 6 9 Article 10.3390/nu6093572 3572 3586 2072-6643 2014-09-09 doi: 10.3390/nu6093572 Wei Zhao Wenqing Li Jiacheng Lin Zhuoyu Chen Dongsheng Yu http://www.mdpi.com/2072-6643/6/9/3536 The major components of tea may be significantly influenced according to the type of fermentation, and consequently the effects of different teas will differ. We examined whether green tea fermented with Aquilariae Lignum (fGT) shows a stronger anti-diabetic effect than unfermented green tea (GT) on mice with type 2 diabetes. To evaluate the anti-obesity effect of fGT, we assessed body weight, fecal excretion, serum leptin levels, exocrine pancreatic zymogen granule contents, and periovarian fat weight and adiponectin contents. Blood glucose levels, pancreatic weight, and numbers of pancreatic islet insulin- and glucagon-producing cells were determined to evaluate anti-hypoglycemic effects, while total cholesterol, triglyceride, and low- and high-density lipoprotein levels were determined to evaluate anti-hyperlipidemic effects. The antioxidant effect of fGT was detected by measuring malondialdehyde and glutathione contents and the activities of catalase and superoxide dismutase. fGT showed anti-obesity, anti-hypoglycemic, anti-hyperlipidemia, and antioxidant effects. Additionally, fGT exerted stronger anti-diabetic effects compared with GT. Collectively, these results suggested that fGT fermented with the appropriate amounts of Aquilariae Lignum (49:1) has a stronger effect compared with GT. Thus, fGT is a promising and potent new therapeutic agent for type 2 diabetes. Nutrients 2014-09-09 6 9 Article 10.3390/nu6093536 3536 3571 2072-6643 2014-09-09 doi: 10.3390/nu6093536 Su Kang Ji Lee Eun Lee Dae Jung Chang Song Soo Park Seong Choi Chang Han Sae Ku Young Lee http://www.mdpi.com/1660-4601/11/9/9306 In the beginning of the 21st century, the deterioration of water quality in Taihu Lake, China, has caused widespread concern. The primary source of pollution in Taihu Lake is river inflows. Effective pollution load reduction scenarios need to be implemented in these rivers in order to improve the water quality of Taihu Lake. It is important to select appropriate pollution load reduction scenarios for achieving particular goals. The aim of this study was to facilitate the selection of appropriate scenarios. The QUAL2K model for river water quality was used to simulate the effects of a range of pollution load reduction scenarios in the Wujin River, which is one of the major inflow rivers of Taihu Lake. The model was calibrated for the year 2010 and validated for the year 2011. Various pollution load reduction scenarios were assessed using an analytic hierarchy process, and increasing rates of evaluation indicators were predicted using the Delphi method. The results showed that control of pollution from the source is the optimal method for pollution prevention and control, and the method of "Treatment after Pollution" has bad environmental, social and ecological effects. The method applied in this study can assist for environmental managers to select suitable pollution load reduction scenarios for achieving various objectives. International Journal of Environmental Research and Public Health 2014-09-09 11 9 Article 10.3390/ijerph110909306 9306 9324 1660-4601 2014-09-09 doi: 10.3390/ijerph110909306 Ruibin Zhang Xin Qian Wenting Zhu Hailong Gao Wei Hu Jinhua Wang http://www.mdpi.com/1660-4601/11/9/9286 The emigration of residents following the Fukushima nuclear accident has resulted in aging and depopulation problems in radiation-contaminated areas. The recovery of affected areas, and even those areas with low radioactive pollution levels, is still heavily affected by this problem. This slow recovery consequently affects immigration patterns. This review aims to present possible factors that have contributed to this dilemma. We first present an overview of the evacuation protocol that was administered in the study area following the Fukushima accident. We then analyze characteristics of the subsequent exodus by comparing population data for both before and after the accident. Based on the findings of existing literature, we identify three causes of emigration: (1) The health risks of living in a low radiation zone are still unknown; (2) The post-disaster psychological disturbance and distrust of government information promotes the emigration of evacuees; (3) an absence of economic vitality and of a leading industry renders the area less attractive to individuals residing outside of the city. Further research is needed on this issue, especially with respect to countermeasures for addressing this problem. International Journal of Environmental Research and Public Health 2014-09-09 11 9 Review 10.3390/ijerph110909286 9286 9305 1660-4601 2014-09-09 doi: 10.3390/ijerph110909286 Hui Zhang Wanglin Yan Akihiro Oba Wei Zhang http://www.mdpi.com/1660-4601/11/9/9273 Farmworkers are particularly vulnerable to climate-sensitive health outcomes such as heat-related illness (HRI) given their tasks involve heavy exertion in an outdoor setting. The objectives of the study were to: (1) describe symptoms of HRI experienced by farmworkers and (2) explore factors associated with heat knowledge, level of concern regarding HRI, and comfort level taking breaks at work. Bilingual research staff conducted personal interviews of 100 farmworkers during July and August 2013. Data collected included demographics, work history and current work practices, trainings received, HRI symptoms experienced, health status, and health behaviors. Nearly 30% of participants reported experiencing ≥2 HRI symptoms during the previous work. Few participants had high level of heat knowledge (21.0%) and 15.6% of participants reported being "very concerned" about the health effects of working in hot conditions. Participants who were paid by the piece were more likely to have a high heat knowledge score and be "very concerned" about HRI but less likely to be "very comfortable" taking a break compared to workers paid by the hour than those who had not received HRI training. Results suggest several areas in which employers and agencies conducting outreach and education to the workers about HRI can change their practices including providing cooling measures and HRI training about risk factors for HRI. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909273 9273 9285 1660-4601 2014-09-05 doi: 10.3390/ijerph110909273 Jeffrey Bethel Renee Harger http://www.mdpi.com/2076-0817/3/3/743 The Gram-negative opportunistic pathogen, Klebsiella pneumoniae, is responsible for causing a spectrum of community-acquired and nosocomial infections and typically infects patients with indwelling medical devices, especially urinary catheters, on which this microorganism is able to grow as a biofilm. The increasingly frequent acquisition of antibiotic resistance by K. pneumoniae strains has given rise to a global spread of this multidrug-resistant pathogen, mostly at the hospital level. This scenario is exacerbated when it is noted that intrinsic resistance to antimicrobial agents dramatically increases when K. pneumoniae strains grow as a biofilm. This review will summarize the findings about the antibiotic resistance related to biofilm formation in K. pneumoniae. Pathogens 2014-09-05 3 3 Review 10.3390/pathogens3030743 743 758 2076-0817 2014-09-05 doi: 10.3390/pathogens3030743 Claudia Vuotto Francesca Longo Maria Balice Gianfranco Donelli Pietro Varaldo http://www.mdpi.com/2227-9032/2/3/346 The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body's structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative review examined any paper that discussed any patient in any health care setting who had experienced a psychological impact from the experience of having a wound and the experience of being resilient in that context. Ninety nine papers were located in the initial search with twelve meeting the inclusion criteria and being reviewed. A review of the papers identified that improvement and maintenance of quality of life was perceived to be an important aspect of patient management, but none focused on resilience as a primary endpoint. Further research is required into the clinical benefits of resilient behaviours in patients living with a wound. Healthcare 2014-09-05 2 3 Review 10.3390/healthcare2030346 346 355 2227-9032 2014-09-05 doi: 10.3390/healthcare2030346 Karen Ousey Karen-leigh Edward http://www.mdpi.com/1999-4915/6/9/3400 Continued efforts to define the immunogenic properties of the HIV-1 envelope glycoproteins (Env) are needed to elicit effective antibody (Ab) responses by vaccination. HIV-1 is a highly neutralization-resistant virus due to conformational and glycan shielding of conserved Ab determinants on the virus spike. Elicitation of broadly neutralizing Abs that bind poorly accessible epitope regions on Env is therefore extremely challenging and will likely require selective targeting of specific sub-determinants. To evaluate such approaches there is a pressing need for in vivo studies in both large and small animals, including mice. Currently, most mouse immunization studies are performed in the BALB/c strain; however, the C57BL/6 strain offers improved possibilities for mechanistic studies due to the availability of numerous knock-out strains on this genetic background. Here, we compared Env immunogenicity in BALB/c and C57BL/6 mice and found that the magnitude of the antigen-specific response was somewhat lower in C57BL/6 than in BALB/c mice by ELISA but not significantly different by B cell ELISpot measurements. We then established protocols for the isolation of single Env-specific memory B cells and germinal center (GC) B cells from immunized C57BL/6 mice to facilitate future studies of the elicited response at the monoclonal Ab level. We propose that these protocols can be used to gain an improved understanding of the early recruitment of Env-specific B cells to the GC as well as the archiving of such responses in the memory B cell pool following immunization. Viruses 2014-09-05 6 9 Article 10.3390/v6093400 3400 3414 1999-4915 2014-09-05 doi: 10.3390/v6093400 Martina Soldemo Gabriel Pedersen Gunilla Karlsson Hedestam http://www.mdpi.com/2077-0383/3/3/997 Tens of millions of patients are affected by liver disease worldwide. Many of these patients can benefit from cell therapy involving living metabolically active cells, either by treatment of their liver disease, or by prevention of their disease phenotype. Cell therapies, including hepatocyte transplantation and bioartificial liver (BAL) devices, have been proposed as therapeutic alternatives to the shortage of transplantable livers. Both BAL and hepatocyte transplantation are cellular therapies that avoid use of a whole liver. Hepatocytes are also widely used in drug screening and liver disease modelling. However, the demand for human hepatocytes, heavily outweighs their availability by conventional means. Induced pluripotent stem cells (iPSCs) technology brings together the potential benefits of embryonic stem cells (ESCs) (i.e., self-renewal, pluripotency) and addresses the major ethical and scientific concerns of ESCs: embryo destruction and immune-incompatibility. It has been shown that hepatocyte-like cells (HLCs) can be generated from iPSCs. Furthermore, human iPSCs (hiPSCs) can provide an unlimited source of human hepatocytes and hold great promise for applications in regenerative medicine, drug screening and liver diseases modelling. Despite steady progress, there are still several major obstacles that need to be overcome before iPSCs will reach the bedside. This review will focus on the current state of efforts to derive hiPSCs for potential use in modelling and treatment of liver disease. Journal of Clinical Medicine 2014-09-05 3 3 Review 10.3390/jcm3030997 997 1017 2077-0383 2014-09-05 doi: 10.3390/jcm3030997 Yue Yu Xuehao Wang Scott Nyberg http://www.mdpi.com/2077-0383/3/3/986 First-trimester sonographic assessment of the risk of chromosomal abnormalities is routinely performed throughout the world, primarily by measuring fetal nuchal translucency thickness between 11–13 weeks' gestation, combined with assessment of serum markers. The development of high-frequency transvaginal transducers has led to improved ultrasound resolution and better visualization of fetal anatomy during the first-trimester. Continuous improvement in ultrasound technology allows a thorough detailed assessment of fetal anatomy at the time of the nuchal translucency study. Using transabdominal or transvaginal sonography, or a combination of both approaches, it is now possible to diagnose a wide range of fetal anomalies during the first trimester. Multiple studies reported early diagnosis of major fetal anomalies after demonstrating the association of increased nuchal translucency thickness with structural defect in chromosomally normal and abnormal fetuses. Normal sonographic findings provide reassurance for women at high risk while detection of fetal malformation during the first trimester enables discussion and decisions about possible treatments and interventions, including termination of pregnancy, during an early stage of pregnancy. Journal of Clinical Medicine 2014-09-05 3 3 Review 10.3390/jcm3030986 986 996 2077-0383 2014-09-05 doi: 10.3390/jcm3030986 Ran Neiger http://www.mdpi.com/2077-0383/3/3/972 The ability to capture and analyze fetal cells from maternal circulation or other sources during pregnancy has been a goal of prenatal diagnostics for over thirty years. The vision of replacing invasive prenatal diagnostic procedures with the prospect of having the entire fetal genome in hand non-invasively for chromosomal and molecular studies for both clinical and research use has brought many investigators and innovations into the effort. While the object of this desire, however, has remained elusive, the aspiration for this approach to non-invasive prenatal diagnosis remains and the inquiry has continued. With the advent of screening by cell-free DNA analysis, the standards for fetal cell based prenatal diagnostics have been sharpened. Relevant aspects of the history and the current status of investigations to meet the goal of having an accessible and reliable strategy for capturing and analyzing fetal cells during pregnancy are reviewed. Journal of Clinical Medicine 2014-09-05 3 3 Review 10.3390/jcm3030972 972 985 2077-0383 2014-09-05 doi: 10.3390/jcm3030972 Morris Fiddler http://www.mdpi.com/1660-4601/11/9/9256 In Nigeria, approximately 109 million and 66 million people lack access to sanitation facilities and water, respectively. This study aimed to determine whether children under 5 years old without access to improved water and sanitation facilities are at higher risk of death in Nigeria. Pooled 2003, 2008 and 2013 Nigeria Demographic and Health Survey data were used to examine the impact of water and sanitation on deaths of children aged 0–28 days, 1–11 months, and 12–59 months using Cox regression analysis. Survival information of 63,844 children was obtained, which included 6285 deaths of children under 5 years old; there were 2254 cases of neonatal mortality (0–28 days), 1859 cases of post-neonatal mortality (1–11 months) and 2,172 cases of child mortality (1–4 years old). Over a 10-year period, the odds of neonatal, post-neonatal and child deaths significantly reduced by 31%, 41% and 47% respectively. The risk of mortality from both unimproved water and sanitation was significantly higher by 38% (Adjusted hazard ratios (HR) = 1.38, 95% confidence interval (CI): 1.14–1.66) for post-neonatal mortality and 24% (HR = 1.24, 95% CI: 1.04–1.48) for child mortality. The risk of neonatal mortality increased by 6% (HR = 1.06, 95% CI: 0.85–1.23) but showed no significant effect. The Nigerian government needs to invest more in water and sanitation to reduce preventable child deaths. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909256 9256 9272 1660-4601 2014-09-05 doi: 10.3390/ijerph110909256 Osita Ezeh Kingsley Agho Michael Dibley John Hall Andrew Page http://www.mdpi.com/1660-4601/11/9/9238 The chemical industry poses a potential security risk to factory personnel and neighboring residents. In order to mitigate prospective damage, a synthetic method must be developed for an emergency response. With the development of environmental numeric simulation models, model integration methods, and modern information technology, many Decision Support Systems (DSSs) have been established. However, existing systems still have limitations, in terms of synthetic simulation and network interoperation. In order to resolve these limitations, the matured simulation model for chemical accidents was integrated into the WEB Geographic Information System (WEBGIS) platform. The complete workflow of the emergency response, including raw data (meteorology information, and accident information) management, numeric simulation of different kinds of accidents, environmental impact assessments, and representation of the simulation results were achieved. This allowed comprehensive and real-time simulation of acute accidents in the chemical industry. The main contribution of this paper is that an organizational mechanism of the model set, based on the accident type and pollutant substance; a scheduling mechanism for the parallel processing of multi-accident-type, multi-accident-substance, and multi-simulation-model; and finally a presentation method for scalar and vector data on the web browser on the integration of a WEB Geographic Information System (WEBGIS) platform. The outcomes demonstrated that this method could provide effective support for deciding emergency responses of acute chemical accidents. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909238 9238 9255 1660-4601 2014-09-05 doi: 10.3390/ijerph110909238 Haochen Ni Yikang Rui Jiechen Wang Liang Cheng http://www.mdpi.com/1660-4601/11/9/9217 The recycling of lost phosphorus (P) is important in sustainable development. In line with this objective, biochar adsorption is a promising method of P recovery. Therefore, our study investigates the efficiency and selectivity of magnesium modified corn biochar (Mg/biochar) in relation to P adsorption. It also examines the available P derived from postsorption Mg/biochar. Mg/biochar is rich in magnesium nanoparticles and organic functional groups, and it can adsorb 90% of the equilibrium amount of P within 30 min. The Mg/biochar P adsorption process is mainly controlled by chemical action. The maximum P adsorption amount of Mg/biochar is 239 mg/g. The Langmuir-Freundlich model fits the P adsorption isotherm best. Thermodynamics calculation shows ∆H > 0, ∆G < 0, ∆S > 0, and it demonstrates the P adsorption process is an endothermic, spontaneous, and increasingly disordered. The optimal pH is 9. The amounts of P adsorbed by Mg/B300, Mg/B450, and Mg/B600 from swine wastewater are lower than that adsorbed from synthetic P wastewater by 6.6%, 4.8%, and 4.2%, respectively. Mg/biochar is more resistant to pH and to the influence of coexisting ions than biochar. Finally, postsorption Mg/biochar can release P persistently. The P release equilibrium concentrations are ordered as follows: Mg/B600 > Mg/B450 > Mg/B300. The postsorption Mg/B300, Mg/B450, and Mg/B600 can release 3.3%, 3.9%, and 4.4% of the total adsorbed P, respectively, per interval time. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909217 9217 9237 1660-4601 2014-09-05 doi: 10.3390/ijerph110909217 Ci Fang Tao Zhang Ping Li Rong-feng Jiang Ying-cai Wang http://www.mdpi.com/1660-4601/11/9/9202 Refugees are a particularly vulnerable population who undergo nutrition transition as a result of forced migration. This paper explores how involvement in a community food garden supports African humanitarian migrant connectedness with their new country. A cross-sectional study of a purposive sample of African refugees participating in a campus-based community food garden was conducted. Semi-structured interviews were undertaken with twelve African humanitarian migrants who tended established garden plots within the garden. Interview data were thematically analysed revealing three factors which participants identified as important benefits in relation to community garden participation: land tenure, reconnecting with agri-culture, and community belonging. Community food gardens offer a tangible means for African refugees, and other vulnerable or marginalised populations, to build community and community connections. This is significant given the increasing recognition of the importance of social connectedness for wellbeing International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909202 9202 9216 1660-4601 2014-09-05 doi: 10.3390/ijerph110909202 Neil Harris Fiona Minniss Shawn Somerset http://www.mdpi.com/1660-4601/11/9/9186 Background: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. Methods: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. Results: Participants (N = 22) were 82% female, mean age was 53 (±12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. Discussion: The RR-based group is feasible and safe in treating Chinese American immigrants with depression. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909186 9186 9201 1660-4601 2014-09-05 doi: 10.3390/ijerph110909186 Albert Yeung Lauren Slipp Halsey Niles Jolene Jacquart Choi-Ling Chow Maurizio Fava John Denninger Herbert Benson Gregory Fricchione http://www.mdpi.com/1660-4601/11/9/9171 The aims of this study were to evaluate whether chronic intoxication with mercury chloride (HgCl2), in a low concentration over a long time, can be deposited in the central nervous tissue and to determine if this exposure induces motor and cognitive impairments. Twenty animals were intoxicated for 45 days at a dose of 0.375 mg/kg/day. After this period, the animals underwent a battery of behavioral tests, in a sequence of open field, social recognition, elevated T maze and rotarod tests. They were then sacrificed, their brains collected and the motor cortex and hippocampus dissected for quantification of mercury deposited. This study demonstrates that long-term chronic HgCl2 intoxication in rats promotes functional damage. Exposure to HgCl2 induced anxiety-related responses, short- and long-term memory impairments and motor deficits. Additionally, HgCl2 accumulated in both the hippocampus and cortex of the brain with a higher affinity for the cortex. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909171 9171 9185 1660-4601 2014-09-05 doi: 10.3390/ijerph110909171 Francisco Teixeira Rafael Fernandes Paulo Farias-Junior Natacha Costa Luanna Fernandes Luana Santana Ademir Silva-Junior Marcia Silva Cristiane Maia Rafael Lima http://www.mdpi.com/1660-4601/11/9/9156 A hypothesis testing case-control study evaluated concerns about the toxic effects of organic-mercury (Hg) exposure from thimerosal-containing (49.55% Hg by weight) vaccines on the risk of neurodevelopmental disorders (NDs). Automated medical records were examined to identify cases and controls enrolled from their date-of-birth (1991–2000) in the Vaccine Safety Datalink (VSD) project. ND cases were diagnosed with pervasive developmental disorder (PDD), specific developmental delay, tic disorder or hyperkinetic syndrome of childhood. In addition, putative non-thimerosal-related outcomes of febrile seizure, failure to thrive and cerebral degenerations were examined. The cumulative total dose of Hg exposure from thimerosal-containing hepatitis B vaccine (T-HBV) administered within the first six months of life was calculated. On a per microgram of organic-Hg basis, PDD (odds ratio (OR) = 1.054), specific developmental delay (OR = 1.035), tic disorder (OR = 1.034) and hyperkinetic syndrome of childhood (OR = 1.05) cases were significantly more likely than controls to receive increased organic-Hg exposure. By contrast, none of the non-thimerosal related outcomes were significantly more likely than the controls to have received increased organic-Hg exposure. Routine childhood vaccination may be an important public health tool to reduce infectious disease-associated morbidity/mortality, but the present study significantly associates organic-Hg exposure from T-HBV with an increased risk of an ND diagnosis. International Journal of Environmental Research and Public Health 2014-09-05 11 9 Article 10.3390/ijerph110909156 9156 9170 1660-4601 2014-09-05 doi: 10.3390/ijerph110909156 David Geier Brian Hooker Janet Kern Paul King Lisa Sykes Mark Geier http://www.mdpi.com/2227-9032/2/3/338 Perforating granuloma annulare (GA) is a rare subset of GA with an unknown etiology and chronic course. Herein, we report the case of 72 year-old women with a 3-month history of a post-traumatic, persistent, erythematous and exudative plaque located on her left leg. Differential diagnosis included mycobacterial infection, subcutaneous mycosis, perforating dermatoses, pyoderma and squamous cell carcinoma. The histopathology was highly suggestive of a perforating GA. The patient was treated with betamethasone dipropionate cream applied once daily and a complete resolution of the lesion was observed in three weeks. Despite being a very rare subtype of a common disease, perforating granuloma annulare has clinical and histopathological characteristic features that facilitate the differential diagnosis, avoiding unnecessary procedures and inadequate and potentially more invasive treatments. Healthcare 2014-09-04 2 3 Case Report 10.3390/healthcare2030338 338 345 2227-9032 2014-09-04 doi: 10.3390/healthcare2030338 João Alves Hugo Barreiros Elvira Bártolo http://www.mdpi.com/2072-6643/6/9/3516 Fortified blended foods (FBF) are used for the prevention and treatment of moderate acute malnutrition (MAM) in nutritionally vulnerable individuals, particularly children. A recent review of FBF recommended the addition of animal source food (ASF) in the form of whey protein concentrate (WPC), especially to corn-soy blends. The justification for this recommendation includes the potential of ASF to increase length, weight, muscle mass accretion and recovery from wasting, as well as to improve protein quality and provide essential growth factors. Evidence was collected from the following four different types of studies: (1) epidemiological; (2) ASF versus no intervention or a low-calorie control; (3) ASF versus an isocaloric non-ASF; and (4) ASF versus an isocaloric, isonitrogenous non-ASF. Epidemiological studies consistently associated improved growth outcomes with ASF consumption; however, little evidence from isocaloric and isocaloric, isonitrogenous interventions was found to support the inclusion of meat or milk in FBF. Evidence suggests that whey may benefit muscle mass accretion, but not linear growth. Overall, little evidence supports the costly addition of WPC to FBFs. Further, randomized isocaloric, isonitrogenous ASF interventions with nutritionally vulnerable children are needed. Nutrients 2014-09-04 6 9 Review 10.3390/nu6093516 3516 3535 2072-6643 2014-09-04 doi: 10.3390/nu6093516 Kristen Noriega Brian Lindshield http://www.mdpi.com/2072-6643/6/9/3501 Processed foods are recognized as a major contributor to high dietary sodium intake, associated with increased risk of cardiovascular disease. Different public health actions are being introduced to reduce sodium content in processed foods and sodium intake in general. A gradual reduction of sodium content in processed foods was proposed in Slovenia, but monitoring sodium content in the food supply is essential to evaluate the progress. Our primary objective was to test a new approach for assessing the sales-weighted average sodium content of prepacked foods on the market. We show that a combination of 12-month food sales data provided by food retailers covering the majority of the national market and a comprehensive food composition database compiled using food labelling data represent a robust and cost-effective approach to assessing the sales-weighted average sodium content of prepacked foods. Food categories with the highest sodium content were processed meats (particularly dry cured meat), ready meals (especially frozen pizza) and cheese. The reported results show that in most investigated food categories, market leaders in the Slovenian market have lower sodium contents than the category average. The proposed method represents an excellent tool for monitoring sodium content in the food supply. Nutrients 2014-09-04 6 9 Article 10.3390/nu6093501 3501 3515 2072-6643 2014-09-04 doi: 10.3390/nu6093501 Živa Korošec Igor Pravst http://www.mdpi.com/2072-6643/6/9/3474 Cardiodiabesity has been used to define and describe the well-known relationship between type 2 Diabetes Mellitus (T2DM), obesity, the metabolic syndrome (MetS) and cardiovascular disease (CVD). The objective of this study was to perform a scientific literature review with a systematic search to examine all the cardiovascular risk factors combined and their relationship with adherence to the Mediterranean Diet (MedDiet) pattern as primary prevention against cardiodiabesity in a holistic approach. Research was conducted using the PubMed database including clinical trials, cross-sectional and prospective cohort studies. Thirty-seven studies were reviewed: fourteen related to obesity, ten to CVD, nine to MetS, and four to T2DM. Indeed 33 provided strong evidence on the association between adherence to a MedDiet and a reduced incidence of collective cardiodiabesity risk in epidemiological studies. This scientific evidence makes the MedDiet pattern very useful for preventive strategies directed at the general population and also highlights the need to consider all these diet-related risk factors and health outcomes together in daily primary care. Nutrients 2014-09-04 6 9 Review 10.3390/nu6093474 3474 3500 2072-6643 2014-09-04 doi: 10.3390/nu6093474 Elena García-Fernández Laura Rico-Cabanas Nanna Rosgaard Ramón Estruch Anna Bach-Faig http://www.mdpi.com/2072-6643/6/9/3460 The recognized antagonistic actions between zinc and iron prompted us to study this subject in children. A convenience sample was used. Thirty healthy children between 8 and 9 years of age were studied with the aim of establishing the effect of a 3-mo oral zinc supplementation on iron status. Fifteen individuals were given a placebo (control group), and 15 were given 10 mg Zn/day (experimental group). Blood samples were collected at 0, 60, 120, 180 and 210 min after a 12-h overnight fast, before and after placebo or zinc supplementation. This supplementation was associated with significant improvements in energy, protein, fat, carbohydrate, fiber, calcium, iron, and zinc intake in accordance with the recommendations for age and sex. The basal serum zinc concentration significantly increased after oral zinc supplementation (p < 0.001). However, basal serum iron concentrations and area under the iron curves significantly decreased in the experimental group (p < 0.0001) and remained at the same level throughout the 210-min study. The values obtained for hemoglobin, mean corpuscular volume, ferritin, transferrin, transferrin saturation, ceruloplasmin and total protein were within normal reference ranges. In conclusion, the decrease in serum iron was likely due to the effects of chronic zinc administration, and the decrease in serum iron was not sufficient to cause anemia. Nutrients 2014-09-04 6 9 Article 10.3390/nu6093460 3460 3473 2072-6643 2014-09-04 doi: 10.3390/nu6093460 Naira de Brito Érika Rocha Alfredo de Araújo Silva João Costa Mardone França Maria das Graças Almeida José Brandão-Neto http://www.mdpi.com/1999-4915/6/9/3386 We report an active surveillance study of the occurrence of specific antibodies to European Bat Lyssavirus Type 1 (EBLV-1) in bat species, scarcely studied hitherto, that share the same refuge. From 2004 to 2012, 406 sera were obtained from nine bat species. Blood samples were subjected to a modified fluorescent antibody virus neutralization test to determine the antibody titer. EBLV-1-neutralizing antibodies were detected in six of the nine species analyzed (Pipistrellus pipistrellus, P. kuhlii, Hypsugo savii, Plecotus austriacus, Eptesicus serotinus and Tadarida teniotis). Among all bats sampled, female seroprevalence (20.21%, 95% CI: 14.78%–26.57%) was not significantly higher than the seroprevalence in males (15.02%, 95% CI: 10.51%–20.54%). The results showed that the inter-annual variation in the number of seropositive bats in T. teniotis and P. austriacus showed a peak in 2007 (>70% of EBLV-1 prevalence). However, significant differences were observed in the temporal patterns of the seroprevalence modeling of T. teniotis and P. austriacus. The behavioral ecology of these species involved could explain the different annual fluctuations in EBLV-1 seroprevalence. Viruses 2014-09-04 6 9 Article 10.3390/v6093386 3386 3399 1999-4915 2014-09-04 doi: 10.3390/v6093386 Marc López-Roig Hervé Bourhy Rachel Lavenir Jordi Serra-Cobo http://www.mdpi.com/2227-9032/2/3/324 Venous leg ulcers are a symptom of chronic insufficiency of the veins. This study considered the sustainability of behavior changes arising from a client focus e-Learning education program called the "Leg Ulcer Prevention Program" (LUPP) for people with a venous leg ulcer. Data from two related studies were used to enable a single sample (n = 49) examination of behavior maintenance across an average 8 to 9 months period. Physical activity levels increased over time. Leg elevation, calf muscle exercises, and soap substitute use were seen to fluctuate over the follow up time points. The use of a moisturizer showed gradual decline over time. The provision of a client-focused venous leg ulcer program was associated with behavior changes that had varied sustainability across the evaluation period. Healthcare 2014-09-04 2 3 Article 10.3390/healthcare2030324 324 337 2227-9032 2014-09-04 doi: 10.3390/healthcare2030324 Charne Miller Suzanne Kapp Lisa Donohue http://www.mdpi.com/2072-6643/6/9/3451 The potential for transforming nutritional and health research through the discovery and application of non-invasive markers of dietary intake and metabolic status is profound. The science of metabolomics for the fingerprinting of volatile organic compounds (VOCs) from expired human breath holds great promise in this regard. Coupled with tools utilising sensor technology, breath volatile signatures allow a new horizon of research in which indicators of metabolic risk and indicators of dietary intake could be collected at a population level with unprecedented simplicity and low cost. Metabolomics (measuring metabolites from physiological process) provides a "window into the body", which could transform how we measure health, how we identify and monitor people most at risk of disease and the way we monitor food intake. [...] Nutrients 2014-09-03 6 9 Meeting Report 10.3390/nu6093451 3451 3459 2072-6643 2014-09-03 doi: 10.3390/nu6093451 Nathan O'Callaghan Manny Noakes http://www.mdpi.com/1660-4601/11/9/9154 The authors wish to make the following amendments to their paper published in International Journal of Environmental Research and Public Health [1]: [...] International Journal of Environmental Research and Public Health 2014-09-03 11 9 Correction 10.3390/ijerph110909154 9154 9155 1660-4601 2014-09-03 doi: 10.3390/ijerph110909154 Christine Stauber Byron Kominek Kaida Liang Mumuni Osman Mark Sobsey http://www.mdpi.com/1660-4601/11/9/9142 Background: Exposure of biological subjects to electromagnetic fields with a high frequency is associated with temperature elevation. In our recent studies, we reported that non-invasive radiofrequency (RF) treatment at 13.56 MHz with the field ranging from 1 KeV to 20 KeV/m2 inhibits tumor progression in animals with abdominal tumor xenografts and enhances the anticancer effect of chemotherapy. The RF treatment was followed by temperature elevation in tumors to approximately 46 °C during 10 min of exposure. In contrast, the temperature of normal tissues remained within a normal range at approximately 37 °C. Whether all biological effects of RF treatment are limited to its hyperthermic property remains unclear. Here, we compared how RF and hyperthermia (HT) treatments change the proliferation rate, oxygen consumption and autophagy in malignant and nonmalignant cells. Methods: In the current study, cancer and nonmalignant cells of pancreatic origin were exposed to the RF field or to conventional HT at 46 °C, which was chosen based on our previous in vivo studies of the tumor-specific RF-induced hyperthermia. Results: Only RF treatment caused declines in cancer cell viability and proliferation. RF treatment also affected mitochondrial function in cancer cells more than HT treatment did and, unlike HT treatment, was followed by the elevation of autophagosomes in the cytoplasm of cancer cells. Importantly, the effects of RF treatment were negligible in nonmalignant cells. Conclusion: The obtained data indicate that the effects of RF treatment are specific to cancer cells and are not limited to its hyperthermic property. International Journal of Environmental Research and Public Health 2014-09-03 11 9 Article 10.3390/ijerph110909142 9142 9153 1660-4601 2014-09-03 doi: 10.3390/ijerph110909142 Steven Curley Flavio Palalon Kelly Sanders Nadezhda Koshkina http://www.mdpi.com/1660-4601/11/9/9101 Epidemiological studies have identified associations between mortality and changes in concentration of particulate matter. These studies have highlighted the public concerns about health effects of particulate air pollution. Modeling fine particulate matter PM2.5 exposure risk and monitoring day-to-day changes in PM2.5 concentration is a critical step for understanding the pollution problem and embarking on the necessary remedy. This research designs, implements and compares two inverse distance weighting (IDW)-based spatiotemporal interpolation methods, in order to assess the trend of daily PM2.5 concentration for the contiguous United States over the year of 2009, at both the census block group level and county level. Traditionally, when handling spatiotemporal interpolation, researchers tend to treat space and time separately and reduce the spatiotemporal interpolation problems to a sequence of snapshots of spatial interpolations. In this paper, PM2.5 data interpolation is conducted in the continuous space-time domain by integrating space and time simultaneously, using the so-called extension approach. Time values are calculated with the help of a factor under the assumption that spatial and temporal dimensions are equally important when interpolating a continuous changing phenomenon in the space-time domain. Various IDW-based spatiotemporal interpolation methods with different parameter configurations are evaluated by cross-validation. In addition, this study explores computational issues (computer processing speed) faced during implementation of spatiotemporal interpolation for huge data sets. Parallel programming techniques and an advanced data structure, named k-d tree, are adapted in this paper to address the computational challenges. Significant computational improvement has been achieved. Finally, a web-based spatiotemporal IDW-based interpolation application is designed and implemented where users can visualize and animate spatiotemporal interpolation results. International Journal of Environmental Research and Public Health 2014-09-03 11 9 Article 10.3390/ijerph110909101 9101 9141 1660-4601 2014-09-03 doi: 10.3390/ijerph110909101 Lixin Li Travis Losser Charles Yorke Reinhard Piltner http://www.mdpi.com/1660-4601/11/9/9082 Background: Participation in triathlon competitions has increased in recent years. Many studies have described left or right ventricular injury in endurance athletes. The goal of this study was to examine the right and left ventricular cardiac structures and function and dynamic cardio-pulmonary performance in a large cohort of middle- and long-distance triathletes. Methods: 87 triathletes (54 male and 33 female) were examined using spiroergometry and echocardiography. The inclusion criterion was participation in at least one middle- or long distance triathlon. Results: Male triathletes showed a maximum oxygen absorption of 58.1 ± 8.6 mL/min/kg (female triathletes 52.8 ± 5.7 mL/min/kg), maximum ergometer performance of 347.8 ± 49.9 W (female triathletes 264.5 ± 26.1 W). Left ventricular ejection fraction (EF) was normal (male triathletes EF: 61.9% ± 3%, female triathletes EF: 63.0% ± 2.7%) and systolic right ventricular area change fraction (RV AFC%) showed normal values (males RV AFC%: 33.5% ± 2.2%, females 32.2% ± 2.8%). Doppler indices of diastolic function were normal in both groups. With respect to the echocardiographic readings the left ventricular mass for males and females were 217.7 ± 41.6 g and 145.9 ± 31.3 g, respectively. The relative wall thickness for males was 0.50 ± 0.07, whereas it was 0.47 ± 0.09 for females. The probability of left ventricular mass >220 g increased with higher blood pressure during exercise (OR: 1.027, CI 1.002–1.052, p = 0.034) or with higher training volume (OR: 1.23, CI 1.04–1.47, p = 0.019). Conclusions: Right or left ventricular dysfunction could not be found, although the maximal participation in triathlon competitions was 29 years. A left ventricular mass >220 g is more likely to occur with higher arterial pressure during exercise and with a higher training volume. International Journal of Environmental Research and Public Health 2014-09-03 11 9 Article 10.3390/ijerph110909082 9082 9100 1660-4601 2014-09-03 doi: 10.3390/ijerph110909082 Roman Leischik Norman Spelsberg http://www.mdpi.com/2072-6643/6/9/3431 Increased energy consumption, especially increased consumption of sweet energy-dense food, is thought to be one of the main contributors to the escalating rates in overweight individuals and obesity globally. The individual's ability to detect or sense sweetness in the oral cavity is thought to be one of many factors influencing food acceptance, and therefore, taste may play an essential role in modulating food acceptance and/or energy intake. Emerging evidence now suggests that the sweet taste signaling mechanisms identified in the oral cavity also operate in the gastrointestinal system and may influence the development of satiety. Understanding the individual differences in detecting sweetness in both the oral and gastrointestinal system towards both caloric sugar and high intensity sweetener and the functional role of the sweet taste system may be important in understanding the reasons for excess energy intake. This review will summarize evidence of possible associations between the sweet taste mechanisms within the oral cavity, gastrointestinal tract and the brain systems towards both caloric sugar and high intensity sweetener and sweet taste function, which may influence satiation, satiety and, perhaps, predisposition to being overweight and obesity. Nutrients 2014-09-02 6 9 Review 10.3390/nu6093431 3431 3450 2072-6643 2014-09-02 doi: 10.3390/nu6093431 Yu Low Kathleen Lacy Russell Keast http://www.mdpi.com/2072-6643/6/9/3403 Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill's criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. Conclusion: all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor. Nutrients 2014-09-02 6 9 Review 10.3390/nu6093403 3403 3430 2072-6643 2014-09-02 doi: 10.3390/nu6093403 Patricia Weyland William Grant Jill Howie-Esquivel http://www.mdpi.com/2304-8158/3/3/511 Food pathogens frequently cause foodborne diseases. There is a need to rapidly identify the source of the bacteria in order to contain their spread and epidemics. A pre-enrichment culture or a direct culture on agar plate are standard microbiological methods. In this review, we present an update on alternative molecular methods to nucleic acid-based detection for species identification. Biosensor-based methods rely on the recognition of antigen targets or receptors by antibodies, aptamers or high-affinity ligands. The captured antigens may be then directly or indirectly detected through an antibody or high-affinity and high-specificity recognition molecule. Various different detection methods are discussed, from label-free sensors and immunosensors to fluorescence-based ones. Each method shows advantages and disadvantages in terms of equipment, sensitivity, simplicity and cost-effectiveness. Finally, lab-on-a-chip (LOC) devices are introduced briefly, with the potential to be fast, sensitive and useful for on-site bacteria detection in food processing laboratories to check potential contamination by sample monitoring combined with a rapid pre-enrichment step. Foods 2014-09-02 3 3 Review 10.3390/foods3030511 511 526 2304-8158 2014-09-02 doi: 10.3390/foods3030511 Palmiro Poltronieri Valeria Mezzolla Elisabetta Primiceri Giuseppe Maruccio http://www.mdpi.com/1660-4601/11/9/9068 The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540) at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%). The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6). The K6 scores of the following participants were significantly (p < 0.05) and independently high: those with more frequent miscarriage/stillbirth/abortions, those with repeated miscarriages as the cause of infertility, those with infertility of unknown causes, those living with no child, those having a low joint income with their partner, those with the opinion that "women should devote themselves to their household duties" those who had considered stopping treatment, those without the opinion that "married life without children is favorable" and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment. International Journal of Environmental Research and Public Health 2014-09-02 11 9 Article 10.3390/ijerph110909068 9068 9081 1660-4601 2014-09-02 doi: 10.3390/ijerph110909068 Jiro Takaki Yuri Hibino http://www.mdpi.com/1660-4601/11/9/9050 Dogs play many roles and their presence within people's houses has increased. In rural settings dog faeces are not removed from the streets, representing an environmental pollution factor. Our aim was to evaluate the occurrence of environmental contamination with zoonotic intestinal parasites of three groups of dogs in Ponte de Lima, Portugal, with a particular emphasis on Echinococcus granulosus. We collected 592 dog faecal samples from the environment, farm and hunting dogs. Qualitative flotation coprological analysis was performed and the frequency in the positive samples ranged between 57.44% and 81.19% in different groups. We isolated up to four different parasites in one sample and detected seven intestinal parasitic species, genera or families overall. Ancylostomatidae was the most prevalent parasite, followed by Trichuris spp., Toxocara spp., Isospora spp., Dipylidium caninum, Taeniidae and Toxascaris leonina. Taeniidae eggs were analyzed with the PCR technique and revealed not to be from Echinococcus. The parasite prevalence and the diversity of zoonotic parasites found were high, which calls for a greater awareness of the problem among the population, especially hunters. Promoting research at the local level is important to plan control strategies. Health education should be developed with regard to farmers and hunters, and a closer collaboration between researchers, practitioners and public health authorities is needed. International Journal of Environmental Research and Public Health 2014-09-01 11 9 Article 10.3390/ijerph110909050 9050 9067 1660-4601 2014-09-01 doi: 10.3390/ijerph110909050 Teresa Mateus António Castro João Ribeiro Madalena Vieira-Pinto http://www.mdpi.com/1660-4601/11/9/9038 The intestinal microbiota and gut immune system must constantly communicate to maintain a balance between tolerance and activation: on the one hand, our immune system should protect us from pathogenic microbes and on the other hand, most of the millions of microbes in and on our body are innocuous symbionts and some can even be beneficial. Since there is such a close interaction between the immune system and the intestinal microbiota, it is not surprising that some lymphomas such as mucosal-associated lymphoid tissue (MALT) lymphoma have been shown to be caused by the presence of certain bacteria. Animal models played an important role in establishing causation and mechanism of bacteria-induced MALT lymphoma. In this review we discuss different ways that animal models have been applied to establish a link between the gut microbiota and lymphoma and how animal models have helped to elucidate mechanisms of microbiota-induced lymphoma. While there are not a plethora of studies demonstrating a connection between microbiota and lymphoma development, we believe that animal models are a system which can be exploited in the future to enhance our understanding of causation and improve prognosis and treatment of lymphoma. International Journal of Environmental Research and Public Health 2014-09-01 11 9 Review 10.3390/ijerph110909038 9038 9049 1660-4601 2014-09-01 doi: 10.3390/ijerph110909038 Mitsuko Yamamoto Robert Schiestl http://www.mdpi.com/1660-4601/11/9/9024 Several studies have associated exposure to environmental pollutants, especially polycyclic aromatic hydrocarbons (PAHs), with the development of cardiovascular diseases. Considering that 1-hydroxypyrene (1-OHP) is the major biomarker of exposure to pyrenes, the purpose of this study was to evaluate the potential association between 1-OHP and oxidative stress/inflammatory biomarkers in patients who had suffered an acute myocardial infarction (AMI). After adopting the exclusion criteria, 58 post-infarction patients and 41 controls were sub-divided into smokers and non-smokers. Urinary 1-OHP, hematological and biochemical parameters, oxidative stress biomarkers (MDA, SOD, CAT, GPx and exogenous antioxidants) and the inflammatory biomarker (hs-CRP) were analyzed. 1-OHP levels were increased in post-infarct patients compared to controls (p < 0.05) and were correlated to MDA (r = 0.426, p < 0.01), CAT (r = 0.474, p < 0.001) and β-carotene (r = −0.309; p < 0.05) in non-smokers. Furthermore, post-infarction patients had elevated hs-CRP, MDA, CAT and GPx levels compared to controls for both smokers and non-smokers. Besides, β-carotene levels and SOD activity were decreased in post-infarction patients. In summary, our findings indicate that the exposure to pyrenes was associated to lipid damage and alterations of endogenous and exogenous antioxidants, demonstrating that PAHs contribute to oxidative stress and are associated to acute myocardial infarction. International Journal of Environmental Research and Public Health 2014-09-01 11 9 Article 10.3390/ijerph110909024 9024 9037 1660-4601 2014-09-01 doi: 10.3390/ijerph110909024 Fernando Freitas Natália Brucker Juliano Durgante Guilherme Bubols Rachel Bulcão Angela Moro Mariele Charão Marília Baierle Sabrina Nascimento Bruna Gauer Elisa Sauer Marcelo Zimmer Flávia Thiesen Iran Castro Paulo Saldiva Solange Garcia http://www.mdpi.com/1660-4601/11/9/9008 Our study investigates the prevalence, patterns and predictors of tobacco smoking among early adolescent males in Northern Jordan and whether asthma diagnosis affects smoking patterns. A descriptive cross sectional design was used. Males in grades 7 and 8 from four randomly selected high schools in the city of Irbid were enrolled. Data on waterpipe (WP) use and cigarette smoking patterns were obtained (n = 815) using a survey in Arabic language. The overall prevalence of ever having smoked a cigarette was 35.6%, with 86.2% of this group smoking currently. Almost half of the sample reported WP use. The most common age in which adolescents started to experiment with cigarettes was 11–12 years old (49.1%), although 10 years was also common (25.3%). Significant predictors of male cigarette smoking were WP use (OR = 4.15, 95% CI = 2.99–5.76), asthma diagnosis (OR = 2.35, 95% CI = 1.46–3.78), grade 8 (OR = 1.52, 95% CI = 1.10–2.11), and having a sibling who smokes (OR = 2.23, 95% CI = 1.53–3.24). However, this cross-sectional study cannot establish causality, thus longitudinal studies are needed. Public health programs and school-based anti-tobacco smoking interventions that target children in early years at high schools are warranted to prevent the uptake of tobacco use among this vulnerable age group. High school students with asthma should be specifically targeted. International Journal of Environmental Research and Public Health 2014-09-01 11 9 Article 10.3390/ijerph110909008 9008 9023 1660-4601 2014-09-01 doi: 10.3390/ijerph110909008 Nihaya Al-Sheyab Mahmoud Alomari Smita Shah Patrick Gallagher Robyn Gallagher http://www.mdpi.com/1660-4601/11/9/8996 Skin and soft tissue infections caused by Staphylococcus aureus (SA-SSTIs) including methicillin-resistant Staphylococcus aureus (MRSA) have experienced a significant surge all over the world. Changing climatic factors are affecting the global burden of dermatological infections and there is a lack of information on the association between climatic factors and MRSA infections. Therefore, association of temperature and relative humidity (RH) with occurrence of SA-SSTIs (n = 387) and also MRSA (n = 251) was monitored for 18 months in the outpatient clinic at a tertiary care hospital located in Bhubaneswar, Odisha, India. The Kirby-Bauer disk diffusion method was used for antibiotic susceptibility testing. Time-series analysis was used to investigate the potential association of climatic factors (weekly averages of maximum temperature, minimum temperature and RH) with weekly incidence of SA-SSTIs and MRSA infections. The analysis showed that a combination of weekly average maximum temperature above 33 °C coinciding with weekly average RH ranging between 55% and 78%, is most favorable for the occurrence of SA-SSTIs and MRSA and within these parameters, each unit increase in occurrence of MRSA was associated with increase in weekly average maximum temperature of 1.7 °C (p = 0.044) and weekly average RH increase of 10% (p = 0.097). International Journal of Environmental Research and Public Health 2014-08-29 11 9 Article 10.3390/ijerph110908996 8996 9007 1660-4601 2014-08-29 doi: 10.3390/ijerph110908996 Krushna Sahoo Soumyakanta Sahoo Gaetano Marrone Ashish Pathak Cecilia Lundborg Ashok Tamhankar