Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model.
In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals. After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable. These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and perinatal health.


Religious participation and HIV-disclosure rationales among people living with HIV/AIDS in rural Swaziland.
Despite the cultural salience of Christianity in many parts of Africa and the expansion of antiretroviral treatment, few studies have examined experiences of religious participation among HIV-positive individuals. Correspondingly, most studies of HIV self-disclosure in sub-Saharan Africa focus primarily on disclosure to sexual partners. Addressing both concerns, the central concern of this article is HIV self-disclosure in church settings, where disclosure rationales functioned as a key heuristic to explore experience of HIV-positivity, religiosity, and church participation. Given 39.2% antenatal HIV prevalence in Swaziland-the highest in the world-and an estimated 6 500 local congregations, this article draws on a medical anthropological project in Swaziland to investigate experiences of church participation among HIV-positive individuals. The data were derived from semi-structured interviews with 28 HIV-positive individuals across three domains: 1) pre- and post-diagnosis religiosity; 2) HIV stigma and support in church settings; and 3) decisions around HIV disclosure. Field research and open-ended interviews with individuals close to people living with HIV, health personnel, and pastors provided important contextual data. A grounded theory analysis showed that HIV disclosure in church settings is a highly reflexive process, mediated by subjective religiosity, the social dynamics of church networks, and broader structural vulnerabilities. Church participation often entailed significant stigma, which negatively affected self-disclosure and help-seeking practices; however, a rhetoric of 'courage' emerged to describe individuals who voluntarily disclosed their HIV-positive status. Pastors and pastors' wives were key protagonists in disclosure strategies. A church-based defense of the meaning of personhood for people living with HIV was among the most important findings. Given that congregations in much of Africa are predominantly female, and because women comprised the majority of the sample, the study productively problematised church settings as sites of analysis where gender, poverty, and religion intersect disease epidemiology in ways that may have untapped programmatic implications.


Sleep disorders in children.
The purpose of this review is to examine how sleep disorders in children are affected by age and comorbid medical influences, and to discuss current understanding of how the clinical manifestations, pathophysiology, and treatment of common childhood sleep disorders differ from those of the adult population. Recently established age-specific norms are required for accurate interpretation of polysomnograms and multiple sleep latency tests in children. Sleep disorders such as insomnia, obstructive sleep apnea, and excessive daytime somnolence are common in both children and adults, but the clinical manifestations and underlying pathophysiology of these disorders vary substantially with age. For example, the bedtime struggles of a temperamental toddler are associated with different symptoms and causative factors compared to psychophysiologic insomnia affecting a middle-aged person. Similarly, a 6-year-old child with obstructive sleep apnea is more likely to exhibit daytime inattention and hyperactivity as a referable daytime symptom than the clear-cut lethargy or sleepiness that most affected adults experience. This review will examine how insomnia, excessive sleepiness, and obstructive sleep apnea differ in children compared to adults.


Growth-dependent Gene Expression Variation Influences the Strength of Codon Usage Biases.
The most highly expressed genes in microbial genomes tend to use a limited set of synonymous codons, often referred to as "preferred codons." The existence of preferred codons is commonly attributed to selection pressures on various aspects of protein translation including accuracy and/or speed. However, gene expression is condition-dependent and even within single-celled organisms transcript and protein abundances can vary depending on a variety of environmental and other factors. Here, we show that growth rate-dependent expression variation is an important constraint that significantly influences the evolution of gene sequences. Using large-scale transcriptomic and proteomic data sets in Escherichia coli and Saccharomyces cerevisiae, we confirm that codon usage biases are strongly associated with gene expression but highlight that this relationship is most pronounced when gene expression measurements are taken during rapid growth conditions. Specifically, genes whose relative expression increases during periods of rapid growth have stronger codon usage biases than comparably expressed genes whose expression decreases during rapid growth conditions. These findings highlight that gene expression measured in any particular condition tells only part of the story regarding the forces shaping the evolution of microbial gene sequences. More generally, our results imply that microbial physiology during rapid growth is critical for explaining long-term translational constraints.


Wnt signaling activates MFSD2A to suppress vascular endothelial transcytosis and maintain blood-retinal barrier.
Breakdown of the blood-retinal barrier (BRB) causes retinal edema and vision loss. We investigated the role of Wnt signaling in maintaining the BRB by limiting transcytosis. Mice lacking either the Wnt co-receptor low-density lipoprotein receptor-related protein 5 (Lrp5-/- ) or the Wnt ligand Norrin (Ndpy/- ) exhibit increased retinal vascular leakage and enhanced endothelial transcytosis. Wnt signaling directly controls the transcription of an endothelium-specific transcytosis inhibitor, major facilitator superfamily domain-containing protein 2a (MFSD2A), in a β-catenin-dependent manner. MFSD2A overexpression reverses Wnt deficiency-induced transcytosis in endothelial cells and in retinas. Moreover, Wnt signaling mediates MFSD2A-dependent vascular endothelium transcytosis through a caveolin-1 (CAV-1)-positive caveolae pathway. In addition, levels of omega-3 fatty acids are also decreased in Wnt signaling-deficient retinas, reflecting the basic function of MFSD2A as a lipid transporter. Our findings uncovered the Wnt/β-catenin/MFSD2A/CAV-1 axis as a key pathway governing endothelium transcytosis and inner BRB integrity.


First Report of the Root-Knot Nematode Meloidogyne hapla Parasitizing Roses in Ethiopia.
Meloidogyne hapla is one of the most damaging plant-parasitic nematodes in temperate regions. This nematode has a wide host range with more than 500 plant taxa including roses. In Ethiopia, rose production has developed over the past 10 years to the second most important export market after coffee. Considering the high damage potential of M. hapla, infestation of roses in Ethiopia with this nematode could result in major economic losses. Therefore, awareness of this nematode species is extremely important. During two surveys conducted in August 2011 and April 2012, M. hapla was detected in soil samples from six out of nine rose producing farms located in the districts of Ziway, Holleta, Sebeta, and Menagesha. At infested farms, rose plants appeared stunted and less productive and often showed symptoms of chlorosis and wilting. Identification was based on morphological and morphometrical characters of females, males, and second-stage juveniles, which were all within the range of variability known for this species (4). Shape of juvenile stylet knobs, shape of male head, and perennial pattern of the females with characteristic punctuations between the anus and tail terminus were also typical for M. hapla. The morphological identification was confirmed by sequence analysis of the D2-D3 expansion segment of the 28S rDNA gene following amplification with the primers D2A (5'-ACAAGTACCGTGAGGGAAAGTT-3') and D3B (5'-TCGGAAGGAACCAGCTACTA-3') (1). PCR products were purified and sequenced at the Macrogene sequencing facility service (Amsterdam, The Netherlands). Sequences were deposited in GenBank (KJ645427 to 33). The sequences were compared with previously published sequences in NCBI database and showed 96 to 100% sequence similarity with M. hapla accession nos. GQ130139, DQ328685, KF430798, and DQ145641. Unfortunately, comparison of sequences did not provide further information about the origin of this Ethiopian population, if it is native to Ethiopia or was imported with infected plant material. To the best of our knowledge, this is the first record of M. hapla occurring in Ethiopia. M. hapla is known as a serious pest of roses in colder climate regions. In Africa, it was previously reported from Tanzania (3) and South Africa (2). Thus, it appears that this species has now become also established in Ethiopia at higher altitudes (1,400 to 2,100 m above sea level) within the urban hinterland of Addis Ababa. References: (1) Baldwin et al. Mol. Phy. Evol. 8:248, 1887. (2) J. H. O'Bannon. Institute Agri. Res. 29, 1975. (3) E. Onkendi and L. N. Moleleki. Eur. J. Pl. Pathol. 136:1, 2013. (4) A. G. Whitehead. Trans. Zool. Soc. Lon.31:263, 1968.


Impact of Post-Covid-19 on driver behaviour: A perspective towards pandemic-sustained transportation.
With the announcement of novel Coronavirus disease 2019 (Covid-19) as a pandemic by World Health Organization (WHO) in March 2020, the whole world went into a lockdown that heavily affected human economic and social life. Since December 2020, with the discovery of effective vaccines, the world is now returning to some normality, particularly for those who are vaccinated. The multimodal transportation has resumed with majority of vaccinated drivers being back on road, driving to their work, and providing transport services. However, there are still several long-term Post-Covid-19 factors, affecting driver health and psychology. The study deployed a systematic search strategy and selected 62 research publications after rigorous evaluation of the literature. The review was based on (1) forming the inclusion and exclusion criteria, (2) selecting the appropriate keywords, and (3) searching of relevant publications and assessing the eligible articles. A broad perspective study is carried out to gauge the impact of Post-Covid-19 scenarios on the driver physical health and mindset in the context of road safety and pandemic-sustained transportation. It was found that the Post-Covid-19 factors such as wearing face-mask during driving, taking oral anti-viral drugs, and fear of contracting disease, significantly impact the driver's performance and situation awareness skills. The analysis suggested that driver's health vitals and psychological driving awareness can be precisely detected through hybrid driver state monitoring methods. The paper conducts a comprehensive review of the published work and provides unique research opportunities to counteract the challenges involved in precise monitoring of driver behaviour under the effects of different Post-Covid-19 factors. The perspective suggested the possible solutions to live with the pandemic in the context of pandemic-sustained transportation.


Biochemical basis for the regulation of biosynthesis of antiparasitics by bacterial hormones.
Diffusible small molecule microbial hormones drastically alter the expression profiles of antibiotics and other drugs in actinobacteria. For example, avenolide (a butenolide) regulates the production of avermectin, derivatives of which are used in the treatment of river blindness and other parasitic diseases. Butenolides and γ-butyrolactones control the production of pharmaceutically important secondary metabolites by binding to TetR family transcriptional repressors. Here, we describe a concise, 22-step synthetic strategy for the production of avenolide. We present crystal structures of the butenolide receptor AvaR1 in isolation and in complex with avenolide, as well as those of AvaR1 bound to an oligonucleotide derived from its operator. Biochemical studies guided by the co-crystal structures enable the identification of 90 new actinobacteria that may be regulated by butenolides, two of which are experimentally verified. These studies provide a foundation for understanding the regulation of microbial secondary metabolite production, which may be exploited for the discovery and production of novel medicines.


How the Maori community sees the dental-care system.
This report has addressed the question of how the Maori community sees the system of oral health care by indicating the complex factors influencing the Maori community's attitude toward health issues. These factors preclude the Maori community from many of the perceived benefits of the present oral health-care system. There is a need in this current climate of debate over health policies to re-focus on primary prevention policies that will be relevant to the Maori community of today. No one is seen in the Maori community to be articulating concern for oral health issues. The challenge for the Dental Council of New Zealand is how then to create a focus on oral health issues within the Maori community, and to actively promote oral health care and encourage usage of a system that is affordable, available, accessible, and appropriate. Practical and relevant recommendations arising from Rapuora: Health and Maori Women 1984 and the Hui Hauora Mokopuna, 1990(10) should be considered when planning future health-care systems. Health was one of the four key areas highlighted in the Ka Awatea report, and it will be an important feature of the work of the new Ministry of Maori Development. It is timely that the Dental Council of New Zealand and the Ministry of Maori Development should facilitate oral health-care systems for the future in partnership with the Maori community.


Early childhood social communication deficits in youth at clinical high-risk for psychosis: Associations with functioning and risk.
Effective social functioning requires a broad range of social communication skills that are impaired in psychosis populations. However, little is known about early childhood (4- to 5-year period) social communication during the premorbid (pre-illness) stage of psychosis. The present study utilized retrospective parent reports to examine total early childhood social communication deficits, as well as deficits in two distinct domains, reciprocal social interaction (social smiling/eye gaze) and communication (social chat/gesture), in youth at clinical high-risk (CHR) for psychosis (ages 13-21; 37.2% female). Furthermore, associations between early childhood social communication and CHR youth's current functioning (social, academic/work), symptoms (positive/negative), and risk for conversion to psychosis were examined. Compared to healthy controls, CHR individuals had greater deficits in total and communication-specific early childhood social communication. Early childhood total, communication, and reciprocal social interaction deficits were associated with worse current functioning and greater current negative symptom severity (amotivation/anhedonia) in CHR youth. Early childhood total and reciprocal social interaction deficits were also associated with increased risk for conversion. These findings inform the field's understanding of the etiology and pathophysiology of psychosis by extending the current developmental literature on premorbid deficits in psychosis populations to specific domains of social behavior in a critical developmental period.


Long non-coding RNA AK027294 promotes tumor growth by upregulating PCNA in gastric cancer.
Recent researches have proved that long non-coding RNAs (lncRNAs) has an important role in many diseases. In this research, lncRNA AK027294 was explored to identify how it functions in the development of gastric cancer (GC). Real Time-quantitative-Polymerase Chain Reaction (RT-qPCR) was utilized to detect AK027294 expression in GC patients. Then, MTT assay, colony formation assay, and EdU incorporation assay were performed to identify its function in GC cells. Furthermore, the potential mechanism was also explored using mechanism assays. AK027294 expression level was significantly higher in GC tissue samples and cell lines. Results of MTT assay, colony formation assay, and EdU incorporation assay showed that cell proliferation was inhibited through the silence of AK027294 in GC cells, while cell proliferation was promoted through overexpression of AK027294 in GC cells. Furthermore, the expression of PCNA was downregulated via silence of AK027294 in GC cells, while the expression of PCNA was upregulated via overexpression of AK027294 in GC cells. The correlation analysis showed that PCNA expression was positively correlated with AK027294 expression in GC tissues. Our results suggest that AK027294 could enhance cell proliferation of GC cells by upregulating PCNA and might be applied as a novel target for therapy of GC.


Perceived benefits and health risks of cigarette smoking among young adults: insights from a cross-sectional study.
Perceptions of smoking-related health risks and benefits among young adults (18-24 years) and their smoking behaviour have not been adequately studied in low-income countries like Nepal. This study has examined the perceived risks and the benefits of smoking among young adults who smoke vs. don't smoke. A cross-sectional study was carried out from August to September 2013 among 315 young adults (18-24) from four conveniently selected private colleges of different faculties in Kathmandu Metropolis. The anonymous, self-administrated and semi structured questionnaire contained the information on individual information; smoking behaviour; and perceptions on smoking-related risks and benefits. Kaplan-Meier analysis was used to identify the mean age of smoking initiation. Cox proportion hazard regression was used to assess the relationship between current smoking behaviours and the perceived risks and the benefits of smoking. Overall, the prevalence of current smoking was 16.2 % (Male =28.4 % and female =5.38 %). The mean age of smoking initiation was 16.6 and 17.7 years for male and female respectively. The risk of becoming a current smoking being a management student was higher (HR = 4.72, 95 % CI: 2.19; 10.20) than being a medical student. The risk of current smoking behaviour significantly increased with those who believed that smoking was enjoyable (HR = 4.74, 2.58; 8.72); would help to deal with problems or stress (3.19, 1.76; 5.79); would feel comfortable with friends (4.29, 2.33; 7.92); would be relaxing (6.95, 3.60; 13.43); and something to do when feel bored (3.42, 1.91; 6.13). The young adults who believed that smoking would make yellow teeth (0.53, 0.30; 0.94) and yellow nail (0.53, 0.29; 0.95); and would be bad to their health (0.45, 0.21; 0.98) were significantly at lower risk of becoming a current smoking. Positive perceptions related to smoking are common among young adults. To discourage smoking, future intervention programs should focus communicating not only health risks but also counteract perception of benefits related to smoking.


Reduced Lower-Limb Muscle Strength and Volume in Patients With Type 2 Diabetes in Relation to Neuropathy, Intramuscular Fat, and Vitamin D Levels.
Muscle weakness and atrophy of the lower limbs may develop in patients with diabetes, increasing their risk of falls. The underlying basis of these abnormalities has not been fully explained. The aim of this study was to objectively quantify muscle strength and size in patients with type 2 diabetes mellitus (T2DM) in relation to the severity of neuropathy, intramuscular noncontractile tissue (IMNCT), and vitamin D deficiency. Twenty patients with T2DM and 20 healthy control subjects were matched by age, sex, and BMI. Strength and size of knee extensor, flexor, and ankle plantar and dorsiflexor muscles were assessed in relation to the severity of diabetic sensorimotor polyneuropathy (DSPN), amount of IMNCT, and serum 25-hydroxyvitamin D (25OHD) levels. Compared with control subjects, patients with T2DM had significantly reduced knee extensor strength (P = 0.003) and reduced muscle volume of both knee extensors (P = 0.045) and flexors (P = 0.019). Ankle plantar flexor strength was also significantly reduced (P = 0.001) but without a reduction in ankle plantar flexor (P = 0.23) and dorsiflexor (P = 0.45) muscle volumes. IMNCT was significantly increased in the ankle plantar (P = 0.006) and dorsiflexors (P = 0.005). Patients with DSPN had significantly less knee extensor strength than those without (P = 0.02) but showed no difference in knee extensor volume (P = 0.38) and ankle plantar flexor strength (P = 0.21) or volume (P = 0.96). In patients with <25 nmol/L versus >25 nmol/L 25OHD, no significant differences were found for knee extensor strength and volume (P = 0.32 vs. 0.18) and ankle plantar flexors (P = 0.58 vs. 0.12). Patients with T2DM have a significant reduction in proximal and distal leg muscle strength and a proximal but not distal reduction in muscle volume possibly due to greater intramuscular fat accumulation in distal muscles. Proximal but not distal muscle strength is related to the severity of peripheral neuropathy but not IMNCT or 25OHD level.


kmlShape: An Efficient Method to Cluster Longitudinal Data (Time-Series) According to Their Shapes.
Longitudinal data are data in which each variable is measured repeatedly over time. One possibility for the analysis of such data is to cluster them. The majority of clustering methods group together individual that have close trajectories at given time points. These methods group trajectories that are locally close but not necessarily those that have similar shapes. However, in several circumstances, the progress of a phenomenon may be more important than the moment at which it occurs. One would thus like to achieve a partitioning where each group gathers individuals whose trajectories have similar shapes whatever the time lag between them. In this article, we present a longitudinal data partitioning algorithm based on the shapes of the trajectories rather than on classical distances. Because this algorithm is time consuming, we propose as well two data simplification procedures that make it applicable to high dimensional datasets. In an application to Alzheimer disease, this algorithm revealed a "rapid decline" patient group that was not found by the classical methods. In another application to the feminine menstrual cycle, the algorithm showed, contrarily to the current literature, that the luteinizing hormone presents two peaks in an important proportion of women (22%).


Prescription medications associated with a decreased risk of non-Hodgkin's lymphoma.
Earlier epidemiologic studies have suggested an inverse association between non-Hodgkin's lymphoma and exposure to histamine(2) (H(2)) blockers, nonsteroidal anti-inflammatory drugs, cholesterol-lowering drugs, and antibiotics. Data from the PHARMO database were used to conduct a nested, population-based case-control study that included 1985-1998 drug-dispensing records for 300,000 residents of six Dutch cities. Included were those subjects without a previous history of cancer who were aged >/=20 years and were registered with an incident primary discharge diagnosis of non-Hodgkin's lymphoma between 1991 and 1998. This paper includes data on 211 cases and 800 controls individually matched on sex, age, community pharmacy, calendar time, and duration of follow-up. Conditional logistic regression analysis was used to evaluate the association between non-Hodgkin's lymphoma and categories of cumulative drug use in days. In multivariate analyses, nonsignificant risk reductions were found for all drugs tested, and the negative association tended to increase with increasing duration of use. For women, the odds ratio for H(2) blockers was 0.29 (95% confidence interval: 0.12, 0.69) and for analgesics was 0.40 (95% confidence interval: 0.22, 0.71). Results support an inverse association between occurrence of non-Hodgkin's lymphoma and use of H(2) blockers and analgesics among women, and they warrant confirmation in larger studies.


Composition of grain, forage, and processed fractions from second-generation glyphosate-tolerant soybean, MON 89788, is equivalent to that of conventional soybean (Glycine max L.).
Developments in biotechnology and molecular-assisted breeding have led to the development of a second-generation glyphosate-tolerant soybean product, MON 89788. The MON 89788 event was produced by direct transformation of a cp4 epsps (5-enolpyruvylshikimate-3-phosphate synthase) gene cassette derived from Agrobacterium sp. strain CP4 into an elite soybean germplasm known for its superior agronomic characteristics and high yielding property. The purpose of this work was to assess whether the nutrient and antinutrient levels in seed and forage tissues of MON 89788 are comparable to those in the conventional soybean variety, A3244, which has background genetics similar to MON 89788 but does not contain the cp4 epsps gene cassette. Additional conventional soybean varieties currently in the marketplace were also included in the analysis to establish a range of natural variability for each analyte, where the range of variability is defined by a 99% tolerance interval for that particular analyte. Compositional analyses were conducted on forage, seed and four processed fractions from soybeans grown in ten sites across both the United States and Argentina during the 2004-2005 growing seasons. Forage samples were analyzed for levels of proximates (ash, fat, moisture, and protein) and fiber. Seed samples were analyzed for proximates, fiber, antinutrients, and vitamin E. Defatted, toasted (DT) meal was analyzed for proximates, fiber, amino acids, and antinutrients. Refined, bleached, and deodorized (RBD) oil was analyzed for fatty acids and vitamin E. Protein isolate was analyzed for amino acids and moisture. Crude Lecithin was analyzed for phosphatides. Results of the comparisons indicate that MON 89788 is compositionally and nutritionally equivalent to conventional soybean varieties currently in commerce.


Macrophages in patients with recurrent endometrial polyps could exacerbate Th17 responses.
Endometrial polyps (EPs) are outgrowths in the endometrium with unknown etiology. The fact that EPs can often recur after surgical removal suggests that EPs are not induced by random events but by continuous or recurrent processes in patients. We previously demonstrated that the risk of EP development was positively associated with overactive Th17 responses. However, the requirements of Th17 upregulation are yet unclear. Here, we recruited 26 women with symptomatic EP and 24 without EP, and peripheral mononuclear cells were harvested for the examination of circulating immunity. Compared to controls without EP, the patients with symptomatic EP presented significantly elevated levels of monocyte activation. The circulating monocytes from patients secreted higher levels of tumor necrosis factor (TNF), interleukin (IL)-1β, IL-6 and IL-23 directly ex vivo and with LPS stimulation. In memory CD4+ T cells, monocytes were not required for IL-17 expression, but the presence of activated monocytes significantly increased the secretion of IL-17. In naive CD4+ T cells, activated monocytes were required for significant IL-17 secretion and RORC transcription. Interestingly, the monocytes from EP individuals were significantly more potent in promoting Th17 differentiation from naive CD4+ T cells than the monocytes from controls. Furthermore, we showed that monocyte-mediated Th17 differentiation required the secretion of TNF, IL-1β and IL-6. Together, this study demonstrated activated monocytes supported Th17 inflammation in patients with EP.


Water quality assessment of Kavvayi Lake of northern Kerala, India using CCME water quality index and biological water quality criteria.
Assessment of water quality status of 7 sites of Kavvayi Wetland in northern Kerala (India) was carried out. The physico-chemical, bacteriological and biological parameters were monitored during pre-monsoon, monsoon and post-monsoon seasons. Canadian Council of Ministers of the Environment (CCME) water quality index of the Kavvayi Lake samples ranged from 43.99-44.77; indicating that water quality was threatened or impaired. The poor water quality status might be due to dumping of wastes from municipal and domestic sources and agricultural runoff. Biological water quality criteria (BWQC) determined for wetland revealed that stations such as mixing point of Kariangode River into Kavvayi Lake and Kottikkadavu was moderately polluted in pre-monsoon and post- monsoon seasons. Mixing point of Nileswar River into Kavvayi Lake was moderately polluted in pre-monsoon season. Both calculated indices suggest that quality of lake was found to be influenced by anthropogenic activities such as unscientific tourism and infrastructure development, land encroachment, sand mining, pollution etc. The study was carried out as part of a programme, which aimed to conserve Kavvayi wetland because of its unique ecological and environmental characteristics.


Associations between antioxidant and zinc intake and the 5-year incidence of early age-related maculopathy in the Beaver Dam Eye Study.
Associations between antioxidants and zinc and the 5-year incidence of early, age-related maculopathy (ARM) were investigated in a population-based cohort of middle-aged and older adults participating in the Beaver Dam Eye Study in Beaver Dam, Wisconsin. A food-frequency questionnaire was administered at baseline (1988-1990) to collect dietary information for that time period and a period of time 10 years earlier (1978-1980) from a 50 percent random sample of persons participating in this study. The incidence of the specific lesions of larger drusen (>125 microns) and pigmentary abnormalities and the incidence of any ARM were assessed by masked grading of stereoscopic color fundus photographs in 1,709 persons who participated in 5-year follow-up eye examinations. Significant, but modest, inverse associations (p < 0.05) were observed between intakes of pro-vitamin A carotenoids and dietary vitamin E and the incidence of large drusen and between zinc and the incidence of pigmentary abnormalities. No significant inverse associations were found between antioxidant or zinc intake and the incidence of overall early ARM. If ARM, which is characterized by a broad spectrum of lesions, involves a number of different underlying pathophysiologic processes, then associations between specific antioxidants and the incidence of distinct macular lesions may be biologically important. However, because there were too few incident late ARM cases in this cohort, the authors were unable to assess whether antioxidant intake is associated with the progression of early ARM to late-stage macular degeneration. Clinical trials and longer-term prospective studies are needed to elucidate further the impact of antioxidants and zinc on the development and progression of ARM.


Study of the recovery of phosphorus from struvite precipitation in supernatant line from anaerobic digesters of sludge.
The goal of this work was to study the effective recovery of phosphorus from the supernatant of anaerobic digestion of sewage sludge by precipitation as struvite. The formation of struvite is envisioned as a promising process for nutrient removal and subsequent recovery, thus providing a strong incentive for its implementation, since the sewage is a renewable source of phosphorus. Struvite precipitation was obtained by controlled addition of Mg(OH)2 or MgCl2. We evaluated the removal of ammonia and phosphate under equimolar conditions of magnesium and magnesium stoichiometric excess of 100 to 200% relative to the limiting reagent, under a stirring speed of 300 rpm at pH 8, 9 and 10. The best condition was MgCl2 in 1:1 molar ratio to phosphate, considering the stoichiometric ratio [PO4(3-)]:[NH4(+)] of 0.13 (presented by raw sample). The results show the best cost-benefit ratio, removal of phosphate of 90.6% and ammonium removal of 29%, resulting in 23 mg l(-1) PO4(3-) and 265 mg l(-1) NH4(+) concentration in effluent.


The effect of a community crash reenactment program on teen alcohol awareness and behavior.
Background: Motor vehicle crashes (MVCs) are the leading cause of death in US teens, encompassing greater than one in three deaths. Mock crash reenactments have been used to promote awareness in communities about the effects of drinking and driving. The majority of these programs are for alcohol injury prevention, target high school students, and often involve a scenario of a student driving while under the influence (DUI) and sustaining a fatal car crash. Objective: The purpose of this study is to evaluate the effectiveness of a regional mock crash reenactment upon the students' drinking and driving knowledge and behaviors. Methods: An observational pre-post study was conducted. The survey had seven five-point Likert-scale questions (1 being strongly disagree and 5 strongly agree) measuring outcomes. Students were surveyed before and after the crash reenactment concerning their knowledge and attitudes related to drinking and driving. The survey also included questions that queried participant's age, gender, alcohol consumption history, and seatbelt usage. Results: The final study population included 947 pre-surveys and 840 post-surveys. Students demonstrated no significant increase in knowledge-based drinking and driving questions. However, after the reenactment program, students were 1.39 times less likely to report drinking and driving in the future or that they would get into a car with someone who would drive drunk. Students were 1.7 times more likely to report thinking about the risks associated with drinking and driving after participating in the program. Conclusion: After viewing a mock crash reenactment, students reported they were less likely to drink and drive in the future or get into a car with someone who would drive drunk, and were more likely often think the risks associated with drinking and driving.


Geographic origin of Nepali doctors.
Though the history of in-country training of doctors in Nepal is not long, Nepal had started training doctors in abroad long ago. This is probably the first paper of its kind to correlate the developmental and ecological region to the country of training of Nepali doctors. This retrospective analysis reveals that nearly 38% doctors are trained in India, 22% each from former USSR and Nepal, 10% from Bangladesh, and 2.5% from Pakistan. Other countries contribute very few in the list. Nearly 2/3rd of the doctors represent the central developmental region and most of them are from Kathmandu valley. Ecologically mountain and hills are in great minority compared to Kathmandu valley and Terai. Interestingly training in former USSR shows a bit wider base regarding the origin in terms of developmental region. And Nepal has a clear broad base both in terms of developmental and ecological regions. As most of the doctors among Nepal trained ones are from IOM, the role of IOM way of selecting medical students need a deeper look into it.


The pholcid spiders of Sri Lanka (Araneae: Pholcidae).
As part of the Western Ghats-Sri Lanka biodiversity hotspot, Sri Lanka harbors a rich and diverse fauna, especially in the perhumid southwestern part of the island. However, many invertebrate groups such as spiders continue to be poorly studied. The present paper reviews our knowledge about Pholcidae, a family of spiders that is well represented in Sri Lanka, both by numerous (10) introduced species and by a rich native fauna in five genera (described native Sri Lankan species in parentheses): Belisana Thorell, 1898 (6), Leptopholcus Simon, 1893 (1), Pholcus Walckenaer, 1805 (4), Tissahamia Huber, 2018 (4), and Wanniyala Huber Benjamin, 2005 (9). Fourteen species are newly described: Belisana minneriya sp. n., B. badulla sp. n., B. gowindahela sp. n.; Pholcus metta sp. n., P. puranappui sp. n., P. uva sp. n.; Tissahamia karuna sp. n.; Wanniyala mudita sp. n., W. orientalis sp. n., W. upekkha sp. n., W. ohiya sp. n., W. viharekele sp. n., W. mapalena sp. n., and W. labugama sp. n.. All new species are described from males and females. New Sri Lankan records are given for 16 previously described species. Distribution data suggest that most or all of the 24 native species might be endemic to Sri Lanka, but the Indian pholcid fauna remains almost entirely unknown.


Risk of cancer in retransplants compared to primary kidney transplants in the United States.
Recipients of kidney transplantation have elevated risk of developing cancer. There are limited data on cancer risk in recipients of kidney retransplantation. We used data from the Transplant Cancer Match Study, which links the U.S. transplant registry with 15 cancer registries. Cancer incidence in recipients of kidney retransplantation and primary kidney transplants was compared utilizing Poisson regression, adjusting for demographic and medical characteristics. We assessed 109 224 primary recipients and 6621 retransplants. Compared to primary recipients, retransplants were younger (median age 40 vs. 46 yr), had higher PRA, and more often received induction with polyclonal antibodies (43% vs. 25%). A total of 5757 cancers were observed in primary recipients and 245 in retransplants. Overall cancer risk was similar in retransplants compared with primary recipients (incidence rate ratio [IRR] 1.06, 95% CI 0.93-1.20, adjusted for age, gender, race/ethnicity, PRA, and use of polyclonal induction). However, renal cell carcinoma (RCC) occurred in excess among retransplants (adjusted IRR 2.03, 95% CI 1.45-2.77), based on 514 cases in primary recipients and 43 cases in retransplants. Overall cancer risk did not differ in retransplants compared to primary recipients. Increased risk of RCC may be explained by the presence of acquired cystic kidney disease, which is more likely to develop with additional time with kidney disease and time spent on dialysis waiting for retransplantation.


[Rheumatoid pannus of the wrist].
Presentation of the destructive mechanisms provoked by rheumatoid pannus at the level of ligaments, joints and bones of the wrist. Evaluation of the wrist problems requiring surgical solution, in particular at the radio-carpal and distal radio-ulnar joints. Review of the most useful surgical techniques for soft tissue and bone surgery.


Developing an algorithm across integrated healthcare systems to identify a history of cancer using electronic medical records.
Tumor registries in integrated healthcare systems (IHCS) have high precision for identifying incident cancer but often miss recently diagnosed cancers or those diagnosed outside of the IHCS. We developed an algorithm using the electronic medical record (EMR) to identify people with a history of cancer not captured in the tumor registry to identify adults, aged 40-65 years, with no history of cancer. The algorithm was developed at Kaiser Permanente Colorado, and then applied to 7 other IHCS. We included tumor registry data, diagnosis and procedure codes, chemotherapy files, oncology encounters, and revenue data to develop the algorithm. Each IHCS adapted the algorithm to their EMR data and calculated sensitivity and specificity to evaluate the algorithm's performance after iterative chart review. We included data from over 1.26 million eligible people across 8 IHCS; 55 601 (4.4%) were in a tumor registry, and 44848 (3.5%) had a reported cancer not captured in a registry. The common attributes of the final algorithm at each site were diagnosis and procedure codes. The sensitivity of the algorithm at each IHCS was 90.65%-100%, and the specificity was 87.91%-100%. Relying only on tumor registry data would miss nearly half of the identified cancers. Our algorithm was robust and required only minor modifications to adapt to other EMR systems. This algorithm can identify cancer cases regardless of when the diagnosis occurred and may be useful for a variety of research applications or quality improvement projects around cancer care.


Telephone consultations with patients: a brief study and review of the literature.
The use of the telephone is described in a small, single-handed practice in Israel over a period of six months. Eighty per cent of the 350 calls were received during office hours and none after midnight. There were twice as many female as male callers. Half of the calls were made on behalf of the patient by a third party and 10 per cent were answered by the doctor's wife in his absence. Eighty per cent of the calls were concerned with medical symptoms and in half of the cases the problem was a new one. The commonest diagnoses were upper respiratory tract infection, gastro-intestinal disorders and fever. In more than half the cases, discussion and advice as to home management was sufficient to solve the problem presented. The average annual telephone consultation rate was 2.2 and the call:office visit ratio 1:2.2.The telephone was used to the doctor's satisfaction for two main purposes-the early reporting of new symptoms, and the feedback of follow-up information. It is thought that this behaviour both reduced the surgery consultation rate and extended the range of medical surveillance.


Instrumental and bioanalytical assessment of pharmaceuticals and hormone-like compounds in a major drinking water source-wastewater receiving Zayandeh Rood river, Iran.
Zayandeh Rood river is the most important river in central Iran supplying water for a variety of uses including drinking water for approximately three million inhabitants. The study aimed to investigate the quality of water concerning the presence of pharmaceutical active compounds (PhACs) and hormonelike compounds, which have been only poorly studied in this region. Sampling was performed at seven sites along the river (from headwater sites to downstream drinking water source, corresponding drinking water, and treated wastewater) affected by wastewater effluents, specific drought conditions, and high river-water demand. The targeted and nontargeted chemical analyses and in vitro bioassays were used to evaluate the presence of PhACs and hormonelike compounds in river water. In the samples, 57 PhACs and estrogens were detected with LC-MS/MS with the most common and abundant compounds valsartan, carbamazepine, and caffeine present in the highest concentrations in the treated wastewater in the concentrations of 8.4, 19, and 140 μg/L, respectively. A battery of in vitro bioassays detected high estrogenicity, androgenicity, and AhR-mediated activity (viz., in treated wastewater) in the concentrations 24.2 ng/L, 62.2 ng/L, and 0.98 ng/L of 17β-estradiol, dihydrotestosterone and 2,3,7,8-TCDD equivalents, respectively. In surface water samples, estrogenicity was detected in the range of <0.42 (LOD) to 1.92 ng/L of 17β-estradiol equivalents, and the drinking water source contained 0.74 ng/L of 17β-estradiol equivalents. About 19% of the estrogenicity could be explained by target chemical analyses, and the remaining estrogenicity can be at least partially attributed to the potentiation effect of detected surfactant residues. Drinking water contained several PhACs and estrogens, but the overall assessment suggested minor human health risk according to the relevant effect-based trigger values. To our knowledge, this study provides some of the first comprehensive information on the levels of PhACs and hormones in Iranian waters.


Antiviral activity of some beta-diketones. 1. Aryl alkyl diketones. In vitro activity against both RNA and DNA viruses.
The discovery that 4-[3-ethyl-6-[(3,4-methylenedioxy)phenyl]-3-hexenyl]-3,5-heptanedione (40) exhibited an in vitro inhibitory effect against equine rhinovirus led to a structure--activity study to establish the criteria for optimum activity. Modification of the bridge included removal of the ethyl group and reduction of the double bond. The heptanedione was replaced with hexanedione and pentanedione with a minimal effect. The effect of replacing the heptanedione with beta-keto esters and monoketones was also investigated. Maintaining the hexamethylene bridge and heptanedione, the methylenedioxy group was replaced with various substitutents. In general, most substituents did not adversely affect activity particularly against equine rhinovirus although there was some variation in activity against herpesvirus. Strongly hydrophilic groups significantly reduced activity. Finally, the effect of varying the length of the alkyl bridge was examined in the 4-hydroxyphenyl series, where peak activity was attained with n = 8.


Prenatal Vitamin D Levels in Maternal Sera and Offspring Specific Learning Disorders.
Recent evidence has suggested potential harmful effects of vitamin D deficiency during pregnancy on offspring brain development, for example, elevated risks for neuropsychiatric disorders. Findings on general cognition and academic achievement are mixed, and no studies have examined the effect of prenatal 25-hydroxyvitamin D (25(OH)D) levels on diagnosed specific learning disorders, which was the aim of this study. We examined a nested case-control sample from the source cohort of all singleton-born children in Finland between 1996 and 1997 (n = 115,730). A total of 1607 cases with specific learning disorders (mean age at diagnosis: 9.9 years) and 1607 matched controls were identified from Finnish nationwide registers. Maternal 25(OH)D levels were analyzed from serum samples collected during the first trimester of pregnancy and stored in a national biobank. Conditional logistic regression was used to test the association between maternal 25(OH)D and offspring specific learning disorders. There were no significant associations between maternal 25(OH)D levels and specific learning disorders when vitamin D was examined as a log-transformed continuous variable (adjusted OR 0.98, 95% CI 0.82-1.18, p = 0.84) or as a categorical variable (25(OH)D < 30 nmol/L: adjusted OR 1.03, 95% CI 0.83-1.28, p = 0.77 compared to levels of >50 nmol/L), nor when it was divided into quintiles (adjusted OR for the lowest quintile 1.00, 95% CI 0.78-1.28, p = 0.99 compared to the highest quintile). This study found no association between low maternal 25(OH)D in early pregnancy and offspring specific learning disorders.


Functional siRNA Delivery by Extracellular Vesicle-Liposome Hybrid Nanoparticles.
The therapeutic use of RNA interference is limited by the inability of siRNA molecules to reach their site of action, the cytosol of target cells. Lipid nanoparticles, including liposomes, are commonly employed as siRNA carrier systems to overcome this hurdle, although their widespread use remains limited due to a lack of delivery efficiency. More recently, nature's own carriers of RNA, extracellular vesicles (EVs), are increasingly being considered as alternative siRNA delivery vehicles due to their intrinsic properties. However, they are difficult to load with exogenous cargo. Here, EV-liposome hybrid nanoparticles (hybrids) are prepared and evaluated as an alternative delivery system combining properties of both liposomes and EVs. It is shown that hybrids are spherical particles encapsulating siRNA, contain EV-surface makers, and functionally deliver siRNA to different cell types. The functional behavior of hybrids, in terms of cellular uptake, toxicity, and gene-silencing efficacy, is altered as compared to liposomes and varies among recipient cell types. Moreover, hybrids produced with cardiac progenitor cell (CPC) derived-EVs retain functional properties attributed to CPC-EVs such as activation of endothelial signaling and migration. To conclude, hybrids combine benefits of both synthetic and biological drug delivery systems and might serve as future therapeutic carriers of siRNA.


Risk factors for left ventricular hypertrophy in chronic hemodialysis patients.
Left ventricular hypertrophy is reported to be common in chronic hemodialysis patients, and also to increase the risk for mortality in chronic hemodialysis patients. An echocardiographical and clinical study was carried out to investigate the risk factors for left ventricular hypertrophy in 151 non-diabetic chronic hemodialysis patients without valvular diseases or myocardial infarction in two hemodialysis units in Fukuoka, Japan. The left ventricular mass index (LVMI) correlated positively to age, systolic blood pressure and interdialysis weight gain while it correlated negatively to the duration of hemodialysis therapy and hematocrit. Resorting to a multivariate analysis, the LVMI was found to positively correlate to age and the systolic blood pressure while it correlated negatively with the duration of hemodialysis therapy and the hematocrit level. These findings suggest that hypertension and anemia may thus be independent risk factors for left ventricular hypertrophy.


[Serum uric acid levels and risk of developing preeclampsia].
It is well known that preeclampsia is associated to high uric acid levels, but the clinical assessment of this relationship is still under consideration. Our research was to evaluate if periodic doses of uric acid during pregnancy might help to identify a high risk group prior to the onset of preeclampsia. We conducted a retrospective investigation in 79 primary gestates with normal blood pressure and 79 women with preeclampsia who were assisted at Hospital Nacional Posadas during 2010. Serum uric acid levels, creatininemia, uremia, and proteinuria data from the clinical records of the pregnant women were considered. Uric acid levels were similar in both groups during the first half of gestation. However, as of the 20th week, uric acid increased 1.5-times in preeclamptic women with no changes in creatinine and urea, confirming that these patients had no renal complications. Furthermore, we noted that higher levels of uric acid correlated with low birth weight. We also observed that pregnant women with a family history of hypertension were more likely to develop this condition. Moreover, we did not find a direct relationship with the fetal sex or the appearance of clinical symptoms. The analytical evidence suggests that changes in uric acid concentrations may be due to metabolic alterations at the initial stages of preeclampsia. Therefore, we propose that monitoring levels of uric acid during pregnancy might contribute to the early control of this condition.


Surrogate outcomes: experiences at the Common Drug Review.
Surrogate outcomes are a significant challenge in drug evaluation for health technology assessment (HTA) agencies. The research objectives were to: identify factors associated with surrogate use and acceptability in Canada's Common Drug Review (CDR) recommendations, and compare the CDR with other HTA or regulatory agencies regarding surrogate concerns. Final recommendations were identified from CDR inception (September 2003) to December 31, 2010. Recommendations were classified by type of outcome (surrogate, final, other) and acceptability of surrogates (determined by the presence/absence of statements of concern regarding surrogates). Descriptive and statistical analyses examined factors related to surrogate use and acceptability. For thirteen surrogate-based submissions, recommendations from international HTA and regulatory agencies were reviewed for statements about surrogate acceptability. Of 156 final recommendations, 68 (44%) involved surrogates. The overall 'do not list' (DNL) rate was 48%; the DNL rate for surrogates was 41% (p = 0.175). The DNL rate was 64% for non-accepted surrogates (n = 28) versus 25% for accepted surrogates (odds ratio 5.4, p = 0.002). Clinical uncertainty, use of economic evidence over price alone, and a premium price were significantly associated with non-accepted surrogates. Surrogates were used most commonly for HIV, diabetes, rare diseases, cardiovascular disease and cancer. For the subset of drugs studied, other HTA agencies did not express concerns for most recommendations, while regulatory agencies frequently stated surrogate acceptance. The majority of surrogates were accepted at the CDR. Non-accepted surrogates were significantly associated with clinical uncertainty and a DNL recommendation. There was inconsistency of surrogate acceptability across several international agencies. Stakeholders should consider collaboratively establishing guidelines on the use, validation, and acceptability of surrogates.


Anomalous Left Coronary Artery From the Pulmonary Artery in Infants and Toddlers Misdiagnosed as Myocarditis.
Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect. Children with this anomaly are usually asymptomatic at birth and develop symptoms later on in life, which may mimic myocarditis. We sought to delineate clinical, laboratory, and epidemiological aspects of this anomaly. A retrospective analysis of children with ALCAPA evaluated in a tertiary medical center in southern Israel was performed. A computerized search for all patients with the diagnosis of ALCAPA between 2000 and 2011 was performed. The medical records were reviewed; demographic, clinical, and laboratory data were extracted. A total of 9 patients were included. In 4 patients, acute deterioration required evaluation in the pediatric emergency medicine department; in all 4, the initial clinical suspicion was myocarditis. Failure to thrive was recorded in 7 (77.7%) of the 9 patients and asthma or wheezing were recorded in 5 (55.5%) of the 9 patients. Normal heart size was recorded in 4 (44.4%) of the 9 patients. Electrocardiographic abnormalities were present in all of the patients (100%). A total of 141,675 births were recorded during the study period, giving an incidence of at least 1 case (0.00635%) per 15,741 births. Children evaluated in the emergency medicine department with suspected myocarditis should be evaluated specifically for ALCAPA. The clinical findings that should raise the suspicion of this anomaly are failure to thrive and either a diagnosis of asthma or recurrent wheezing.


Morphometric and functional study of apoptotic cell chromatin.
Apoptosis is usually characterized by profound morphological nuclear changes. Chromatin undergoes a progressive condensation that eventually involves all the nucleus. At earlier stages chromatin appears as divided in compact and diffuse areas, while the nuclear pores disappear from the nuclear envelope that surrounds the compact areas, and cluster around diffuse chromatin. Here we have performed a morphometric study on the different chromatin areas of freeze-fractured apoptotic cell nuclei in order to investigate its morphometric and functional organization. We have found large portions of inactive chromatin aggregations corresponding to the dense cap-shaped patches, while domains of nucleosomic fibres have been identified in the diffuse chromatin areas. The correlation of the nucleosomic fibre/diffuse chromatin domain with the nuclear pore clusters is demonstrated, and its implications with a possible residual nuclear activity are discussed.


Population-based cohort studies of type 2 diabetes and stomach cancer risk in Chinese men and women.
Although positive associations have been found for diabetes and a number of cancer sites, investigations of stomach cancer are limited and the results lack consistency. In this prospective study we investigated the relationship between type 2 diabetes mellitus (T2DM) and stomach cancer risk in mainland China. We assessed the associations among T2DM, T2DM duration, and stomach cancer risk in two prospective population-based cohorts, the Shanghai Women's Health Study and the Shanghai Men's Health Study. Included in the study were 61 480 men and 74 941 women. Stomach cancer cases were identified through annual record linkage to the Shanghai Cancer Registry, and verified through home visits and review of medical charts. After a median follow-up of 7.5 years for the Shanghai Men's Health Study and 13.2 years for the Shanghai Women's Health Study, a total of 755 incident cases of stomach cancer (376 men and 379 women) were identified through to September 2013. Overall, we did not find any evidence that T2DM was associated with an increased risk of stomach cancer either in men (multi-adjusted hazard ratio = 0.83, 95% confidence interval, 0.59-1.16) or in women (multi-adjusted hazard ratio = 0.92, 95% confidence interval, 0.68-1.25). Our findings from two large prospective population-based cohorts suggest that T2DM was not associated with stomach cancer risk.


Investigating public support for biosecurity measures to mitigate pathogen transmission through the herpetological trade.
The expanding global trade in herpetofauna has contributed to new infectious disease dynamics and pathways that allow for the rapid spread of pathogens geographically. Improved biosecurity is needed to mitigate adverse biodiversity, economic and human health impacts associated with pathogen transmission through the herpetological trade. However, general lack of knowledge of the pathogen transmission risks associated with the global trade in herpetofauna and public opposition to biosecurity measures are critical obstacles to successfully preventing pathogen transmission. In 2019 we administered a survey to 2,007 members of the public in the United States of America to ascertain their support for interventions to prevent the spread of Batrachochytrium dendrobatidis (Bd), Batrachochytrium salamandrivorans (Bsal), ranaviruses, and Salmonella through the herpetological trade. We presented survey respondents with different potential hazards associated with pathogen transmission through this trade, namely ecological, economic, and human health impacts. We used structural equation models to determine how these different hazards and respondents' characteristics influenced respondents' support for quarantine and veterinary observation of herpetofauna imported into the United States, mandatory tests for diseases of concern, and best practices to reduce stress and improve the care of live herpetofauna during transport to the United States. Respondents' values and their perceived susceptibility and sensitivity to different hazards associated with pathogen transmission were key determinants of their support for biosecurity. Respondents with strong biospheric and altruistic values demonstrated sensitivity to ecological and human health impacts associated with pathogen transmission, whereas respondents with strong egoistic values demonstrated sensitivity to economic impacts. Respondents had limited knowledge of Bd, Bsal or ranaviruses, the size of the herpetological trade, or how this trade may contribute to pathogen transmission. Improved outreach and education on pathogen transmission through the herpetological trade is required, but it is important that messages are tailored to people with different values to elicit their support for biosecurity.


Cookie- versus cracker-baking--what's the difference? Flour functionality requirements explored by SRC and alveography.
The many differences between cookie- and cracker-baking are discussed and described in terms of the functionality, and functional requirements, of the major biscuit ingredients--flour and sugar. Both types of products are similar in their major ingredients, but different in their formulas and processes. One of the most important and consequential differences between traditional cracker and cookie formulas is sugar (i.e., sucrose) concentration: usually lower than 30% in a typical cracker formula and higher than 30% in a typical cookie formula. Gluten development is facilitated in lower-sugar cracker doughs during mixing and sheeting; this is a critical factor linked to baked-cracker quality. Therefore, soft wheat flours with greater gluten quality and strength are typically preferred for cracker production. In contrast, the concentrated aqueous sugar solutions existing in high-sugar cookie doughs generally act as an antiplasticizer, compared with water alone, so gluten development during dough mixing and starch gelatinization/pasting during baking are delayed or prevented in most cookie systems. Traditional cookies and crackers are low-moisture baked goods, which are desirably made from flours with low water absorption [low water-holding capacity (WHC)], and low levels of damaged starch and water-soluble pentosans (i.e., water-accessible arabinoxylans). Rheological (e.g., alveography) and baking tests are often used to evaluate flour quality for baked-goods applications, but the solvent retention capacity (SRC) method (AACC 56-11) is a better diagnostic tool for predicting the functional contribution of each individual flour functional component, as well as the overall functionality of flours for cookie- and/or cracker-baking.


Life satisfaction and happiness in patients shielding from the COVID-19 global pandemic: A randomised controlled study of the 'mood as information' theory.
To extrapolate the 'mood as information' theory to the unique and ecologically relevant setting of the COVID-19 pandemic; the specific aim was to inform health care providers of the impact of bringing the pandemic to salience during life satisfaction evaluations, assessing whether this 'prime' results in increased or decreased reports of satisfaction which are derived unconsciously. Prospective Randomised Interventional Study. Renal Transplant Department in a tertiary centre in the United Kingdom. 200 Renal transplant patients aged between 20 and 88 years. Telephone interviews were undertaken between 1st May, 2020 and 29th May, 2020, at the height of 'shielding' from COVID-19. Participants were randomised into 2 groups, with 1 group receiving a simple 'priming question' regarding the COVID pandemic and the other group having no prior contact. Individuals were then asked to rate their own overall lifetime happiness; desire to change; overall life satisfaction and momentary happiness on a scale of 1 to 10 for each measure. Independent sample t-tests were used to compare results between the two groups, with a type 1 error rate below 5% considered statistically significant. Participants' overall happiness with their life as a whole revealed that individuals who were primed with a question about COVID-19 reported increased overall happiness with their life compared to individuals who had not been primed (+0.88, 95% confidence interval 0.42 to 1.35, p = 0.0002). In addition, participants in the primed group reported less desire to change their life when compared to the non-primed group (-1.35, 95% confidence interval -2.06 to -0.65, p = 0.0002). Participants who were primed with the COVID-19 question also reported a higher overall satisfaction with their life than individuals who had not been primed (+1.01, 95% confidence interval 0.50 to 1.52, p = 0.0001). Finally, the participants who received the priming question demonstrated increased reported momentary happiness (+0.64, 95% confidence interval 0.03 to 1.24, p = 0.04). The results demonstrated that bringing salience to the COVID-19 pandemic with a simple question leads to positive changes in both momentary happiness and other components of global life satisfaction, thereby extrapolating evidence for the application of the mood-as-information theory to more extreme life circumstances. Given the importance of patient-reported evaluations, these findings have implications for how, when and where accurate and reproducible measurements of life satisfaction should be obtained.


Erythrocytes associated with idiopathic membranous glomerulopathy.
Erythrocytosis has been observed in association with a number of renal diseases. We report for the first time the occurrence of true erythrocytosis in a patient with nephrotic syndrome due to idiopathic membranous glomerulopathy. Serum erythropoietin activity was found to be normal. The mechanism responsible for the erythrocytosis of renal parenchymal disease remains to be elucidated.


Changes over lactation in breast milk serum proteins involved in the maturation of immune and digestive system of the infant.
To objective of this study was to better understand the biological functions of breast milk proteins in relation to the growth and development of infants over the first six months of life. Breast milk samples from four individual women collected at seven time points in the first six months after delivery were analyzed by filter aided sample preparation and dimethyl labeling combined with liquid chromatography tandem mass spectrometry. A total of 247 and 200 milk serum proteins were identified and quantified, respectively. The milk serum proteome showed a high similarity (80% overlap) on the qualitative level between women and over lactation. The quantitative changes in milk serum proteins were mainly caused by three groups of proteins, enzymes, and transport and immunity proteins. Of these 21 significantly changed proteins, 30% were transport proteins, such as serum albumin and fatty acid binding protein, which are both involved in transporting nutrients to the infant. The decrease of the enzyme bile salt-activated lipase as well as the immunity proteins immunoglobulins and lactoferrin coincide with the gradual maturation of the digestive and immune system of infants. The human milk serum proteome didn't differ qualitatively but it did quantitatively, both between mothers and as lactation advanced. The changes of the breast milk serum proteome over lactation corresponded with the development of the digestive and immune system of infants. Breast milk proteins provide nutrition, but also contribute to healthy development of infants. Despite the previously reported large number of identified breast milk proteins and their changes over lactation, less is known on the changes of these proteins in individual mothers. This study is the first to determine the qualitative and quantitative changes of milk proteome over lactation between individual mothers. The results indicate that the differences in the milk proteome between individual mothers are more related to the quantitative level than qualitative level. The correlation between the changes of milk proteins and the gradual maturation of the gastrointestinal tract and immune system in infants, contributes to a better understanding of the biological functions of human milk proteins for the growth and development of infants.


Total and mitochondrial nitrosative stress, decreased brain-derived neurotrophic factor (BDNF) levels and glutamate uptake, and evidence of endoplasmic reticulum stress in the hippocampus of vitamin A-treated rats.
Vitamin A supplementation has caused concern among public health researchers due to its ability in decreasing life quality from acute toxicological effects to increasing mortality rates among vitamin supplement users. For example, it was described cognitive decline (i.e. irritability, anxiety, and depression) in patients subjected to long-term vitamin A therapy, as occurs in cancer treatment. However, the mechanism by which vitamin A affects mammalian cognition is not completely understood. Then, we performed the present work to investigate the effects of vitamin A supplementation at clinical doses (1,000-9,000 IU/kg day(-1)) for 28 days on rat hippocampal nitrosative stress levels (both total and mitochondrial), bioenergetics states, brain-derived neurotrophic factor (BDNF), alpha- and beta-synucleins, BiP and dopamine receptor 2 (D2 receptor) contents, and glutamate uptake. We observed mitochondrial impairment regarding respiratory chain function: increased complex I-III, but decreased complex IV enzyme activity. Also, decreased BDNF levels were observed in vitamin A-treated rats. The present data demonstrates, at least in part, that mitochondrial dysfunction and decreased BDNF and D2 receptors levels, as well as decreased glutamate uptake may take an important role in the mechanism behind the previously reported cognitive disturbances associated to vitamin A supplementation.


Bone Regeneration Effect of Hyperbaric Oxygen Therapy Duration on Calvarial Defects in Irradiated Rats.
In this study, we evaluated changes in bone remodeling in an irradiated rat calvarial defect model according to duration of hyperbaric oxygen therapy. The 28 rats were divided into four groups. Radiation of 12 Gy was applied to the skull, and 5-mm critical size defects were formed on both sides of the skull. Bone grafts were applied to one side of formed defects. From the day after surgery, HBO was applied for 0, 1, and 3 weeks. At 6 weeks after bone graft, experimental sites were removed and analyzed for radiography, histology, and histomorphometry. Micro-CT analysis showed a significant increase in new bone volume in the HBO-3 group, with or without bone graft. When bone grafting was performed, BV, BS, and BS/TV all significantly increased. Histomorphometric analysis showed significant increases in %NBA and %BVN in the HBO-1 and HBO-3 groups, regardless of bone graft. Hyperbaric oxygen therapy was effective for bone regeneration with only 1 week of treatment.


Early Versus Delayed Cholecystectomy for Acute Cholecystitis, Are the 72 hours Still the Rule?: A Randomized Trial.
The aim of this study was to compare clinical outcomes of early versus delayed laparoscopic cholecystectomy (LC) in acute cholecystitis with more than 72 hours of symptoms. LC is the treatment of acute cholecystitis, with consensus recommendation that patients should be operated within 72 hours of evolution. Data however remain weak with no prospective study focusing on patients beyond 72 hours of symptoms. Patients with acute cholecystitis and more than 72 hours of symptoms were randomly assigned to early LC (ELC) or delayed LC (DLC). ELC was performed following hospital admission. DLC was planned at least 6 weeks after initial antibiotic treatment. Primary outcome was overall morbidity following initial diagnosis. Secondary outcomes were total length of stay, duration of antibiotic therapy, hospital costs, and surgical outcome. Eighty-six patients were randomized (42 in ELC and 44 in DLC group). Overall morbidity was lower in ELC [6 (14%) vs 17 (39%) patients, P = 0.015]. Median total length of stay (4 vs 7 days, P < 0.001) and duration of antibiotic therapy (2 vs 10 days, P < 0.001) were shorter in the ELC group. Total hospital costs were lower in ELC (9349&OV0556; vs 12,361 &OV0556;, P = 0.018). Operative time and postoperative complications were similar (91 vs 88 min; P = 0.910) and (15% vs 17%; P = 1.000), respectively. ELC for acute cholecystitis even beyond 72 hours of symptoms is safe and associated with less overall morbidity, shorter total hospital stay, and duration of antibiotic therapy, as well as reduced cost compared with delayed cholecystectomy (NCT01548339).


Relationship between hydrogen consumption, dehalogenation, and the reduction of sulfur oxyanions by Desulfomonile tiedjei.
Resting-cell suspensions of Desulfomonile tiedjei consumed H2 with 3-chloro-, 3-bromo-, and 3-iodobenzoate as electron acceptors with rates of 0.50, 0.44, and 0.04 mumol h-1 mg-1, respectively. However, benzoate and 3-fluorobenzoate were not metabolized by this bacterium. In addition, H2 uptake was at least fourfold faster when sulfate, sulfite, or thiosulfate was available as the electron acceptor instead of a haloaromatic substrate. When sulfite and 3-chlorobenzoate were both available for this purpose, the rate of H2 uptake by D. tiedjei was intermediate between that obtained with either electron acceptor alone. Hydrogen concentrations were reduced to comparably low levels when either 3-chlorobenzoate, sulfate, or sulfite was available as an electron acceptor, but significantly less H2 depletion was evident with benzoate or nitrate. Rates of 3-chlorobenzoate dechlorination increased from an endogenous rate of 14.5 to 17.1, 74.0, 81.1, and 82.3 nmol h-1 mg-1 with acetate, pyruvate, H2, and formate, respectively, as the electron donors. Sulfite and thiosulfate inhibited dehalogenation, but sulfate and NaCl had no effect. Dehalogenation and H2 metabolism were also inhibited by acetylene, molybdate, selenate, and metronidazole. Sulfite reduction and dehalogenation were inhibited by the same respiratory inhibitors. These results suggest that the reduction of sulfite and dehalogenation may share part of the same electron transport chain. The kinetics of H2 consumption and the direct inhibition of dehalogenation by sulfite and thiosulfate in D. tiedjei cells clearly indicate that the reduction of sulfur oxyanions is favored over aryl dehalogenation for the removal of reducing equivalents under anaerobic conditions.(ABSTRACT TRUNCATED AT 250 WORDS)


High environmental stress and productivity increase functional diversity along a deep-sea hydrothermal vent gradient.
Productivity and environmental stress are major drivers of multiple biodiversity facets and faunal community structure. Little is known on their interacting effects on early community assembly processes in the deep sea (>200 m), the largest environment on Earth. However, at hydrothermal vents productivity correlates, at least partially, with environmental stress. Here, we studied the colonization of rock substrata deployed along a deep-sea hydrothermal vent gradient at four sites with and without direct influence of vent fluids at 1,700-m depth in the Lucky Strike vent field (Mid-Atlantic Ridge [MAR]). We examined in detail the composition of faunal communities (>20 μm) established after 2 yr and evaluated species and functional patterns. We expected the stressful hydrothermal activity to (1) limit functional diversity and (2) filter for traits clustering functionally similar species. However, our observations did not support our hypotheses. On the contrary, our results show that hydrothermal activity enhanced functional diversity. Moreover, despite high species diversity, environmental conditions at surrounding sites appear to filter for specific traits, thereby reducing functional richness. In fact, diversity in ecological functions may relax the effect of competition, allowing several species to coexist in high densities in the reduced space of the highly productive vent habitats under direct fluid emissions. We suggest that the high productivity at fluid-influenced sites supports higher functional diversity and traits that are more energetically expensive. The presence of exclusive species and functional entities led to a high turnover between surrounding sites. As a result, some of these sites contributed more than expected to the total species and functional β diversities. The observed faunal overlap and energy links (exported productivity) suggest that rather than operating as separate entities, habitats with and without influence of hydrothermal fluids may be considered as interconnected entities. Low functional richness and environmental filtering suggest that surrounding areas, with their very heterogeneous species and functional assemblages, may be especially vulnerable to environmental changes related to natural and anthropogenic impacts, including deep-sea mining.


Journal article reporting standards for quantitative research in psychology: The APA Publications and Communications Board task force report.
Following a review of extant reporting standards for scientific publication, and reviewing 10 years of experience since publication of the first set of reporting standards by the American Psychological Association (APA; APA Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008), the APA Working Group on Quantitative Research Reporting Standards recommended some modifications to the original standards. Examples of modifications include division of hypotheses, analyses, and conclusions into 3 groupings (primary, secondary, and exploratory) and some changes to the section on meta-analysis. Several new modules are included that report standards for observational studies, clinical trials, longitudinal studies, replication studies, and N-of-1 studies. In addition, standards for analytic methods with unique characteristics and output (structural equation modeling and Bayesian analysis) are included. These proposals were accepted by the Publications and Communications Board of APA and supersede the standards included in the 6th edition of the Publication Manual of the American Psychological Association (APA, 2010). (PsycINFO Database Record


Local time in diffusive media and applications to imaging.
Local time is the measure of how much time a random walk has visited a given position. In multiple scattering media, where waves are diffuse, local time measures the sensitivity of the waves to the local medium's properties. Local variations of absorption, velocity, and scattering between two measurements yield variations in the wave field. These variations are proportional to the local time of the volume where the change happened and the amplitude of variation. The wave field variations are measured using correlations and can be used as input in a inversion algorithm to produce variation maps. The present article gives the expression of the local time in dimensions one, two, and three and an expression of its fluctuations, in order to perform such inversions and estimate their accuracy.


Multiple sclerosis presenting with acute remitting psychiatric symptoms.
Two patients are described in whom acute symptoms of apparently primary psychiatric disease could be diagnosed in retrospect as due to multiple sclerosis. In both patients the initial symptoms recovered completely. In a third patient, also presenting with mental symptoms, this diagnosis would not have been suspected on clinical grounds but is suggested by the results of modern diagnostic techniques.


Reasons for compliance or noncompliance with advice to test for hepatitis C via an internet-mediated blood screening service: a qualitative study.
Hepatitis C virus (HCV) is mainly transmitted by exposure to infected blood, and can lead to liver cirrhosis and liver cancer. Since the onset of HCV and the development of liver cirrhosis usually are asymptomatic, many HCV-infected individuals are still undiagnosed. To identify individuals infected with HCV in the general population, a low threshold, internet-mediated blood testing service was set up. We performed a qualitative study examining reasons for compliance and noncompliance with advice to test for HCV via the online blood testing service. Semistructured telephone interviews were conducted with 33 website visitors who had been advised to test for HCV (18 testers, 15 non-testers). Transcribed interviews were analyzed qualitatively and interpreted using psychosocial theories of health behavior. Reasons for testing pertaining to the online service were: the testing procedure is autonomous, personalized test advice is provided online, reminder emails are sent, and there is an online planning tool. Reasons for testing not specific to the online service were: knowing one's status can prevent liver disease and further transmission of HCV, HCV is curable, testing can provide reassurance, physical complaints are present, and there is liver disease in one's social environment. Service-related reasons for not testing pertained to inconvenient testing facilities, a lack of commitment due to the low threshold character of the service, computer/printing problems, and incorrectly interpreting an online planning tool. The reasons for not testing that are not specific to the online service were: the belief that personal risk is low, the absence of symptoms, low perceived urgency for testing and treatment, fear of the consequences of a positive test result, avoiding threatening information, and a discouraging social environment. Features specific to the online service played a significant role in motivation to test for HCV above and beyond the more conventional perceived health benefits of HCV testing. However, some online specific features were considered problematic and need to be adapted. Methods and strategies for dealing with these impeding factors and for improving compliance with testing via the online service are outlined.


Seriousness, preventability, and burden impact of reported adverse drug reactions in Lombardy emergency departments: a retrospective 2-year characterization.
The purpose of this study was to determine the prevalence of adverse drug reactions (ADRs) reported in emergency departments (EDs) and carry out a thorough characterization of these to assess preventability, seriousness that required hospitalization, subsequent 30-day mortality, and economic burden. This was a retrospective cohort study of data from an active pharmacovigilance project at 32 EDs in the Lombardy region collected between January 1, 2010 and December 31, 2011. Demographic, clinical, and pharmacological data on patients admitted to EDs were collected by trained and qualified monitors, and deterministic record linkage was performed to estimate hospitalizations. Pharmacoeconomic analyses were based on Diagnosis-Related Group reimbursement. 8,862 ADRs collected with an overall prevalence rate of 3.5 per 1,000 visits. Of all ADRs, 42% were probably/definitely preventable and 46.4% were serious, 15% required hospitalization, and 1.5% resulted in death. The System Organ Classes most frequently associated with ADRs were: skin and subcutaneous tissue, gastrointestinal, respiratory thoracic and mediastinal, and nervous system disorders. The most common Anatomical Therapeutic Chemical classes involved in admissions were J (anti-infectives and immunomodulating agents), B (blood and blood-forming organs), and N (nervous system). Older age, yellow and red triage, higher number of concomitantly taken drugs, and previous attendance in ED for the same ADR were significantly associated with an increased risk of hospitalization. The total cost associated with ADR management was €5,184,270, with a mean cost per patient of €585. Fifty-eight percent of the economic burden was defined as probably/definitely preventable. ADRs are a serious health/economic issue in EDs. This assessment provides a thorough estimation of their seriousness, preventability, and burden impact in a large population from a representative European region.


Expression patterns of murine lysosome-associated membrane protein 2 (Lamp-2) transcripts during morphogenesis.
We report the isolation and characterization of the murine homologues to human and chicken lysosome-associated membrane protein (Lamp)-2 transcripts and their prevalent expression patterns during development. Lamp-2 transcripts code for proteins predominant in and specific for the lysosomal membrane. The function of these proteins is still under investigation. Other than in the lysosomal membrane, Lamp-2 proteins have been detected at the plasma membrane of cells in a differentiation dependent and activation dependent manner. They were also observed at the plasma membrane of cells, which secrete lysosomal hydrolases. Involvement of Lamp-2 in cell adhesion during such events has been proposed. A study of the developmental expression patterns of m-Lamp-2 transcripts was undertaken to help elucidate possible functions of their respective proteins. The m-Lamp-2b transcript was prevalent in neural crest derived ganglia. The m-Lamp-2a and -2c transcripts were similarly expressed in structures containing neural crest derived tissue with the strongest signals detected in thymus. However, m-Lamp-2a and -2c transcript expression differed in mesoderm or endoderm derived mesenchymal and epithelial tissues. M-Lamp-2c expression was pronounced in mesenchyme early in development, in limb connective tissue, and in lung parenchyma, whereas m-Lamp-2a was prevalent in the liver, the pancreas, and in differentiating kidney epithelium, and became increasingly prominent in the epithelial lining of the digestive and the respiratory tract during development. These results correlated with the detection of m-Lamp-2 protein in these tissues. In conclusion, all m-Lamp-2 transcripts were detected in tissues undergoing apoptosis during development requiring phagolysosome involvement. In addition, m-Lamp-2a and m-Lamp-2c transcripts were observed in epithelium and mesenchyme during the time of epithelial-mesenchymal interaction, mesenchymal-epithelial transformation, and branching. Their expression pattern became more tissue and cell type specific as differentiation progressed. These patterns indicate a possible involvement of m-Lamp-2 proteins in cell/cell or cell/extracellular matrix interaction, and appear to reflect tissue and cell type specific roles of lysosomes during morphogenesis.


Surgical treatment of colon cancer in patients aged 80 years and older : analysis of 31,574 patients in the SEER-Medicare database.
Age-related disparities in colon cancer treatment exist, with older patients being less likely to receive recommended therapy. However, to the authors' knowledge, few studies to date have focused on receipt of surgery. The objective of the current study was to describe patterns of surgery in patients aged ≥ 80 years with colon cancer and examine outcomes with and without colectomy. Medicare beneficiaries aged ≥ 80 years with colon cancer who were diagnosed between 1992 and 2005 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Multivariable logistic regression analysis was used to assess factors associated with nonoperative management. Kaplan-Meier survival analysis determined 1-year overall and colon cancer-specific survival. Of 31,574 patients, 80% underwent colectomy. Approximately 46% were diagnosed during an urgent/emergent hospital admission, with decreased 1-year overall survival (70% vs 86% for patients diagnosed during an elective admission) noted among these individuals. Factors found to be most predictive of nonoperative management included older age, black race, more hospital admissions, use of home oxygen, use of a wheelchair, being frail, and having dementia. For both operative and nonoperative patients, the 1-year overall survival rate was lower than the colon cancer-specific survival rate (operative patients: 78% vs 89%; nonoperative patients: 58% vs 78%). The majority of older patients with colon cancer undergo surgery, with improved outcomes noted compared with nonoperative management. However, many patients who are not selected for surgery die of unrelated causes, reflecting good surgical selection. Patients undergoing surgery during an urgent/emergent admission have an increased short-term mortality risk. Because the earlier detection of colon cancer may increase the percentage of older patients undergoing elective surgery, the findings of the current study may have policy implications for colon cancer screening and suggest that age should not be the only factor driving cancer screening recommendations.


Macroeconomics in an open economy.
The customary treatment of national economies as closed and self-contained must be substantially modified to allow for those economies that typically trade goods, services, and securities with other countries in increasing volume. Open economy macroeconomics is essential to understanding the major events of the U.S. economy over the past half dozen years. Both the sharp rise in the dollar and the unprecedentedly large U.S. trade deficit are linked to the U.S. budget deficit, as is the drop in the rate of inflation.


Seasonal variations in the macronutrient mineral and proximate composition of two clams (Chamelea gallina and Donax trunculus).
Two bivalve's species (Chamelea gallina and Donax trunculus) were investigated in terms of proximate and mineral compositions (sodium, potassium, magnesium, calcium, iodine and selenium) throughout the year. The concentrations of minerals were determined using inductively coupled plasma mass spectrometry. Ranges of moisture, protein, fat, ash and carbohydrate contents were 82.70-86.57%, 6.86-8.99%, 0.58-1.20%, 2.44-2.95% and 2.70-4.50% for C. gallina, and were 81.09-85.55%, 8.13-10.61%, 0.69-1.33%, 3.19-4.06% and 2.31-3.18% for D. trunculus, respectively. The highest sodium, potassium, magnesium, calcium, iodine and selenium contents for two species were found in the summer, followed by spring, autumn and winter. The concentrations of metals in two tissues exceeded the acceptable levels for a food source for human consumption.


Is Patient Support Program Participation Associated with Longer Persistence and Improved Adherence Among New Users of Adalimumab? A Retrospective Cohort Study.
Adalimumab (ADA) is a medication used in the treatment of several autoimmune diseases. Despite the beneficial effects of ADA, its adherence and persistence rates are low. Patients treated with ADA from Clalit Health Services (CHS) can enroll in AbbVie's patient support program (PSP), which aims to improve ADA adherence and persistence. Therefore, we examine whether PSP participation is associated with a longer persistence and/or an improved adherence to ADA. A real-world retrospective cohort study of all new ADA users from CHS, comparing those enrolled in the offered PSP to those not enrolled. The data regarding PSP users can be tracked using CHS's data warehouse. The index date was defined as the date of the patients' first purchase of ADA occurring between August 1, 2012 and December 31, 2014. The follow-up data were collected at 12, 24, and 36 months. Persistence was assessed using survival analyses of time until discontinuation, and adherence was assessed using medication possession ratio (MPR). There were 1520 patients in the study, 755 (49.7%) of whom were PSP users. PSP users were 54.3% female vs. 51.9% among non-PSP users (p = 0.355) and they were significantly younger than non-PSP users (mean age 42.3 vs. 45.0 years, p = 0.002) The PSP and non-PSP users' persistence was 673 and 574 days, respectively (p < 0.001). Further, the PSP users were more likely than the non-PSP users to be persistently taking medication at the 12-month follow-up (57.5% vs. 45.6%, p < 0.001). The 12-month mean adherence rate among those with at least 12 months of persistence was significantly improved for the PSP users compared to the non-PSP users (94.1% vs. 92.9%, p = 0.026). The AbbVie PSP provided to CHS patients was associated with a longer persistence among new users of ADA. It was also associated with significantly higher adherence rate within the first 12 months. AbbVie Inc.


Borderline personality disorder co-morbidity: relationship to the internalizing-externalizing structure of common mental disorders.
Borderline personality disorder (BPD) shows high levels of co-morbidity with an array of psychiatric disorders. The meaning and causes of this co-morbidity are not fully understood. Our objective was to investigate and clarify the complex co-morbidity of BPD by integrating it into the structure of common mental disorders. We conducted exploratory and confirmatory factor analyses on diagnostic interview data from a representative US population-based sample of 34 653 civilian, non-institutionalized individuals aged ≥18 years. We modeled the structure of lifetime DSM-IV diagnoses of BPD and antisocial personality disorder (ASPD), major depressive disorder, dysthymic disorder, panic disorder with agoraphobia, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, alcohol dependence, nicotine dependence, marijuana dependence, and any other drug dependence. In both women and men, the internalizing-externalizing structure of common mental disorders captured the co-morbidity among all disorders including BPD. Although BPD was unidimensional in terms of its symptoms, BPD as a disorder showed associations with both the distress subfactor of the internalizing dimension and the externalizing dimension. The complex patterns of co-morbidity observed with BPD represent connections to other disorders at the level of latent internalizing and externalizing dimensions. BPD is meaningfully connected with liabilities shared with common mental disorders, and these liability dimensions provide a beneficial focus for understanding the co-morbidity, etiology and treatment of BPD.


Effect of oversized partial postdilatation on coatings of contemporary durable polymer-based drug-eluting stents: a scanning electron microscopy study.
Oversized postdilation of drug-eluting stents (DES) is often performed to avoid stent malapposition. In stents implanted in long lesion or major bifurcations, extremely oversized partial postdilation may be required, which exposes DES coating to extreme forces. This study aims to assess shape and incidence of coating irregularities on durable polymer-based DES following extremely oversized partial postdilatation. Fifteen DES samples (3 3.5 mm stents of Cypher Select plus [Cordis Europa, Roden, the Netherlands], Taxus Liberté[Boston Scientific Corp., Natick, MA, USA], Endeavor Sprint [Medtronic Vascular, Santa Rosa, CA, USA], Endeavor Resolute [Medtronic Vascular, Santa Rosa, CA, USA], and Xience V [Abbott Vascular, Santa Clara, CA, USA]) were deployed in sterile water (37 °C) at 14 atm, followed by a proximal postdilation with noncompliant 5.0-mm balloons at 18 atm. Stents were then examined with scanning electron microscopy. Thorough examination of a total of 660 scanning electron microscopic images demonstrated that shape and incidence of coating irregularities in the postdilated and/or transitional DES regions differed only mildly from the nonpostdilated regions. Cypher Select plus showed more peeling without bare metal aspect in the postdilated and transitional regions, and cracks were wider (P < 0.001) in the postdilated and transitional regions; in Taxus Liberté one additional irregularity (torn webbing) and more wrinkles were observed (P < 0.05 for both); in Endeavor Resolute wider cracks were found in the extremely postdilated region only (P < 0.001). Endeavor Sprint and Xience V showed no differences in shape or incidence of coating irregularities between oversized and nonoversized stent regions. Bench side assessment of five contemporary durable polymer-based DES with scanning electron microscopy suggests that even very aggressive stent postdilatation results in no more than mild differences in coating irregularities between postdilated and nonpostdilated stent regions.


A determinant of resistance of Neisseria gonorrhoeae to killing by human phagocytes: an outer membrane lipoprotein of about 20 kDa with a high content of glutamic acid.
A protein of about 20 kDa was extracted by sodium cholate (1%, w/v) from outer membranes of a strain of Neisseria gonorrhoeae, BS4 (agar), which is resistant to killing by human phagocytes. When the protein was purified by repeated fractionation on Sephadex G75, contamination with other outer-membrane proteins and lipopolysaccharide was negligible. The protein contained a full complement of amino acids, with high levels of glutamic acid. Carbohydrate, detected by the anthrone method and by sugar and hexosamine analysis, was present, but at very low levels. There was a significant content of fatty acids (about 5.7% of the protein), indicating a lipoprotein. The 20 kDa lipoprotein: (1) neutralized the ability of antiserum against whole organisms of BS4 (agar) to reduce the resistance of this strain to phagocyte killing; (2) evoked in mice an antiserum which reduced this resistance and immunoblotted only with 20 kDa lipoprotein in the cholate extract of outer membranes; and (3) promoted resistance to intracellular killing of an otherwise phagocyte susceptible gonococcal strain (BSSH). This is strong evidence that it is a determinant of gonococcal resistance to phagocyte killing.