Medicine

Health care will undoubtedly change over the next 20 or 30 years as eHealth technologies become increasingly used and accepted (Treister, 1997; Yellowlees, 1997, 2001). At a global level, the health care system is moving away from episodic care to concentrating on continuity of care, especially for patients with chronic diseases (Yack, 2000), who will give rise to the greatest disease burden in the future (Murray & Lopez, 1999). Many countries are gradually moving away from a focus on the service provider to a focus on the informed patient, and from an individual approach to treatment to a team approach. Increasingly there is a concern less with the treatment of illness and more with the need for wellness promotion and illness prevention, which, of course, parallels a shift away from traditional care to community care.

Aim: A novel, sensitive and reproducible method for quantification of dolutegravir (DTG) in dried breast milk spots (DBMS) was developed and validated for use in clinical studies. Its application enabled measurement of DTG pharmacokinetics in breastfeeding mothers and their infants. Results/methodology: Sample extraction was by liquid–liquid extraction using tert-butyl methy-ether, with DTG–d5 as an internal standard. DTG was eluted on a reverse phase C18 Waters XBridge (3.5 μm: 2.1 × 50 mm) column using a gradient mobile phase consisting of 0.1% formic acid in deionised water or methanol. The assay was validated over a calibration range of 10–4000 ng/ml. Conclusion: Stability, inter and intra-assay variability were acceptable according to FDA and EMA bioanalytical method guidelines. The assay is robust, accurate, precise and can be reliably applied for analysis of clinical samples in trials from low resource settings.

Hundreds of nurses and other informatics professionals convened in Baltimore, July 16 to 18, for the University of Maryland's 24th Annual Summer Institute in Nursing Informatics (SINI), while dozens more followed the proceedings live via Web streaming. With support from sponsors ESD Consulting and HIMSS, this year's SINI described new roles for clinicians and informaticists in using informatics tools to support patient-centered care across settings. In addition, experts in two think-tanks conducted during SINI explored ongoing challenges in interoperability and data analytics, focusing particularly on issues arising from patient-generated data and health information exchange across settings. National leaders in health informatics filled plenary sessions with a set of distinguished lectures. In the opening keynote address, Philip Fasano, executive vice president and chief information officer, Kaiser Permanente, described online tools that Kaiser members may use to manage their health and communicate with their providers. Martin Kohn, chief medical scientist, Care Delivery Systems, Jointly Health, opened day 2 with a discussion about big data and clinical decision support. Later in the day, participants had the opportunity to hear a follow-up presentation by

Injection-induced necrosis is a rare but dreaded consequence of soft tissue augmentation with filler agents. It usually occurs as a result of injection of filler directly into an artery, but can also result from compression or injury. We provide recommendations on the use of hyaluronidase when vascular compromise is suspected. Consensus recommendations were developed by thorough discussion and debate amongst the authors at a roundtable meeting on Wednesday June 18, 2014 in Las Vegas, NV as well as significant ongoing written and verbal communications amongst the authors in the months prior to journal submission. All authors are experienced tertiary care providers. A prompt diagnosis and immediate treatment with high doses of hyaluronidase (at least 200 U) are critically important. It is not felt necessary to do a skin test in cases of impending necrosis. Some experts recommend dilution with saline to increase dispersion or lidocaine to aid vasodilation. Additional hyaluronidase shou...

Mid-urethral synthetic slings (MUSS) have grown in acceptance and popularity to gain a foremost position in stress urinary incontinence (SUI) surgery. • There are numerous studies that provide a large amount of Level 1 and 2 evidence that support the concept of a sling placed at the level of the mid-urethra. • Long-term follow-up has been published for the original tension-free vaginal tape (TVT) procedure with the most recent publication providing Level 2 evidence with mean follow-up of 11.5 years of 69/91 (77%) of patients from the original series. There was objective cure was in 90% of women and 77% considered themselves subjectively cured, based on the Patient Global Impression of Improvement. • Level 1 evidence with long-term follow-up has been provided comparing colposuspension to TVT at 2 and 5 years. At 5 years for the primary efficacy variable of a negative 1 h stress pad test, there was no difference in success (81% vs 90%). • Two recent meta-analyses provide Level 1 evidence comparing outcomes for retropubic vs transobturator MUSS. One included 18 studies, randomized and cohort: cohort studies had a 12.3% failure rate for transobturator and 13.7% failure for the retropubic approach, randomized studies showed 5.7% failure in the transobturator vs 7.8% in the retropubic group. The other meta-analysis included 11 studies published 2008-2009, which found that the shortterm cure rate was borderline inferior for the transobturator tape group (odds ratio 0.62; 95% confidence interval 0.37-1.00), nearly reaching statistical significance (P = 0.05). • This review details further comparator evidence and evidence for use in specific patient groups (elderly, obese, intrinsic sphincter deficiency, mixed UI).

Recognizing the imperiled status of biodiversity and its benefit to human well-being, the world's governments committed in 2010 to take effective and urgent action to halt biodiversity loss through the Convention on Biological Diversity's "Aichi Targets". These targets, and many conservation programs, require monitoring to assess progress toward specific goals. However, comprehensive and easily understood information on biodiversity trends at appropriate spatial scales is often not available to the policy makers, managers, and scientists who require it. We surveyed conservation stakeholders in three geographically diverse regions of critical biodiversity concern (the Tropical Andes, the African Great Lakes, and the Greater Mekong) and found high demand for biodiversity indicator information but uneven availability. To begin to address this need, we present a biodiversity "dashboard"--a visualization of biodiversity indicators designed to enable tracking o...

INTRODUCTION CLOVES syndrome is characterized by lipomatous overgrowth associated with vascular malforma tions, representing a diagnostic and a therapeutic challenge. Rapamycin, an mTOR inhibitor, has proved to be a good therapeutic option in some vascular anomalies. In this article, we report two ca ses of CLOVES syndrome with good response to oral rapamycin treatment. OBJECTIVE To report the outcome of two patients with CLOVES syndrome treated with oral rapamycin. CLINICAL CASES Case 1: A three-year-old female preschooler with CLOVES syndrome and history of repeated hospita lizations due to severe infections resulting from macrocystic lymphatic malformations and due to thrombotic episodes. The patient evolved with poor quality of life, multiple hospitalizations, surgical risk and progression of the lesions, therefore, oral rapamycin was indicated. After six months of treatment, clinical and radiological reduction in the size of the lipomatous and lymphatic masses, cutaneous lympho...

Background Moxibustion is a traditional East Asian medical therapy that uses the heat generated by burning herbal preparations containing Artemisia vulgaris to stimulate acupuncture points. The aim of this review was to evaluate previously published clinical evidence for the use of moxibustion as a treatment for hypertension. Methods We searched 15 databases without language restrictions from their respective dates of inception until March 2010. We included randomized controlled trials (RCTs) comparing moxibustion to either antihypertensive drugs or no treatment. The risk of bias was assessed for each RCT. Results During the course of our search, we identified 519 relevant articles. A total of 4 RCTs met all the inclusion criteria, two of which failed to report favorable effects of moxibustion on blood pressure (BP) compared to the control (antihypertensive drug treatment alone). However, a third RCT showed significant effects of moxibustion as an adjunct treatment to antihypertensi...

To test the hypothesis that selective breeding for high voluntary wheel running negatively affects maternal performance in house mice, we observed maternal behavior and compared litter size and mass, in replicate lines of selected (N =4) and control (N=4) mice from generations 20 and 21 of an artificial selection experiment. At generation 21, selected-line females ran 2.8-times more revolutions per day than females from random-bred control lines, when tested at approximately 6 weeks of age as part of the normal selection protocol. After giving birth, dams from selected and control lines exhibited similar frequencies of maternal behaviors and also spent similar amounts of time in general locomotor activity at litter ages of both 9 and 16 days. Dams from selected lines also performed equally well as controls in repeated pup-retrieval trials. At first parturition, selected-line dams averaged 2.4 g smaller in body mass as compared with dams from the control lines; however, neither litter size nor litter mass at birth (generation 20) or at weaning (generation 21) differed significantly between selected and control lines. We conclude that, at least under the husbandry conditions employed, maternal behavior and reproductive output at first parturition are genetically independent of wheel-running behavior.

HCV is a leading cause of hepatocellular carcinoma and cirrhosis all over the world. Claudins belong to family of tight junction's proteins that are responsible for establishing barriers for controlling the flow of molecules around cells. For therapeutic strategies, regulation of viral entry into the host cells holds a lot of promise. During HCV infection claudin-1 is highly expressed in liver and believed to be associated with HCV virus entry after HCV binding with or without co-receptor CD81. The claudin-1 assembly with tight junctions is regulated by post translational modifications. During claudins assembly and disassembly with tight junctions, phosphorylation is required at C-terminal tail. In cellular proteins, interplay between phosphorylation and O-b-GlcNAc modification is believed to be functional switch, but it is very difficult to monitor these functional and vibrant changes in vivo. Netphos 2.0 and Disphos 1.3 programs were used for potential phosphorylation; NetPhosK 1.0 and KinasePhos for kinase prediction; and YinOYang 1.2 and OGPET to predict possible O-glycosylation sites. We also identified Yin Yang sites that may have potential for O-b-GlcNAc and phosphorylation interplay at same Ser/Thr residues. We for the first time proposed that alternate phosphorylation and O-b-GlcNAc modification on Ser 192, Ser 205, Ser 206; and Thr 191 may provide an on/off switch to regulate assembly of claudin-1 at tight junctions. In addition these phosphorylation sites may be targeted by novel chemotherapeutic agents to prevent phosphorylation lead by HCV viral entry complex.

Background: The MiniMed™ 780G system includes an Advanced Hybrid Closed Loop (AHCL) algorithm which provides for both automated basal and correction bolus insulin delivery. The preliminary performance of the system in real-world settings was evaluated.

Given current extinction trends, the number of species requiring conservation breeding programs (CBPs) is likely to increase dramatically. To inform CBP policies for threatened terrestrial vertebrates, we evaluated the number and representation of threatened vertebrate species on the IUCN Red List held in the ISIS zoo network and estimated the complexity of their management as metapopulations. Our results show that 695 of the 3,955 (23%) terrestrial vertebrate species in ISIS zoos are threatened. Only two of the 59 taxonomic orders show a higher proportion of threatened species in ISIS zoos than would be expected if species were selected at random. In addition, for most taxa, the management of a zoo metapopulation of more than 250 individuals will require the coordination of a cluster of 11 to 24 ISIS zoos within a radius of 2,000 km. Thus, in the zoo network, the representation of species that may require CBPs is currently low and the spatial distribution of these zoo populations makes management difficult. Although the zoo community may have the will and the logistical potential to contribute to conservation actions, including CBPs, to do so will require greater collaboration between zoos and other institutions, alongside the development of international agreements that facilitate cross-border movement of zoo animals. To maximize the effectiveness of integrated conservation actions that include CBPs, it is fundamental that the non-zoo conservation community acknowledges and integrates the expertise and facilities of zoos where it can be helpful.

The commonest cause of death in children in developed countries is trauma, accounting for over 350 deaths/year in the UK. In children, about 75% of trauma occurs on the roads and the majority of these involve blunt trauma with most children sustaining multiple injuries. It is more common in boys (about two-to threefold) and in the summer. The age distribution is bimodal with peaks affecting toddlers and teenagers. Mortality and morbidity have been reduced by preventative strategies, for example traffic calming systems, road safety programmes, seat belts, better car design and bicycle helmets. Once injured, swift management by skilled staff in a trauma network gives the best results and key to this are care in transport, and recognition and management of the injuries and finally rehabilitation. Important strategies for major trauma include what has become known as 'damage limitation surgery'. In children, the absence of a plausible mechanism of injury should raise the suspicion of child abuse, and a plausible mechanism but an unusual situation might suggest neglect (e.g. a skate board injury in an 8-year-old at 23:00 hours).

Objective: To examine whether the gender development of 120 Italian children (40 born to gay fathers [GFs] through surrogacy, 40 born to lesbian mothers [LMs] through sperm donation, and 40 born to heterosexual parents [HPs] through sexual intercourse) aged 3 to 9 years differed as a function of family type and/or child gender. Methods: Children took part in observed free-play sessions while primary caregivers and nonparent caregivers were administered standardized interviews. Hierarchical linear modeling, analysis of covariance, simple effects analysis, and bootstrapping were conducted. Results: Boys and girls of GFs and HPs were reported to show less gender flexibility in their activities and characteristics than boys and girls of LMs. They also received higher scores of gender conforming dress-up play and spent more time playing with genderconforming toys. In all family types, boys and girls were reported to show low levels of gender-nonconforming dress-up play and observed to spend less time playing with gender-nonconforming toys. Overall, comparisons within genders indicated that boys and girls of GFs and HPs were considered more masculine and feminine, respectively, in their behavior and play, relative to boys and girls in LM families. Age was not a significant covariate in any analysis. Conclusion: Our findings do not support the idea that children of gay or lesbian parents show greater gender nonconformity relative to children of HPs. The findings are informative to those concerned with the effects of the absence of a male or female live-in parent on child gender development.

Disease resistance (R) gene cloning in wheat (Triticum aestivum) has been accelerated by the recent surge of genomic resources, facilitated by advances in sequencing technologies and bioinformatics. However, with the challenges of population growth and climate change ahead of us, it is vital not only to clone and functionally characterise a few handfuls R genes, but to do so at an agroecologically relevant scale. Pathogen populations are continually changing, and breeders must have tools and resources available to respond to those changes as quickly as possible if we are to safeguard our daily bread. To meet this challenge, we propose the creation of a wheat R gene atlas by an international community of researchers and breeders. The atlas would take the form of an online directory from which sources of resistance could be identified and deployed to achieve more durable resistance to the major wheat pathogens, such as wheat rusts, blotch diseases, powdery mildew and wheat blast. We present a costed proposal detailing how the interacting molecular components governing disease resistance could be captured from both the host and pathogen through biparental mapping, mutational genomics and whole-genome association genetics. We explore options for the effective configuration and genotyping of diversity panels of hexaploid and tetraploid wheat, as well as their wild relatives and major pathogens, and discuss how the atlas could inform a dynamic, durable approach to R gene deployment. Set against the current magnitude of wheat yield losses worldwide (recently estimated at 209 million tonnes each year; Savary et al., 2019a), this endeavour presents one route for bringing R genes from the lab to the field at a considerable speed and quantity.

We investigated the occurrence and underlying processes of odor-color associations in French and American 6- to 10-year-old children (n = 386) and adults (n = 137). Nine odorants were chosen according to their familiarity to either cultural group. Participants matched each odor with a color, gave hedonic and familiarity judgments, and identified each odor. By 6 years of age, children displayed culture-specific odor-color associations, but age differences were noted in the type of associations. Children and adults in both cultural groups shared common associations and formed associations that were unique to their environment, underscoring the importance of exposure learning in odor-color associations.

Three interconnected positions are advocated: (1) although serving as a useful model, the immune self does not exist as such; (2) instead of a self/nonself demarcation, the immune system 'sees' itself, i.e., it does not ignore the 'self' or attack the 'other;' but exhibits a spectrum of responses, which when viewed from outside the system appear as discrimination of 'self' and 'nonself' based on certain criteria of reactivity. When immune reactions are conceived in terms of normal physiology and open exchange with the environment, where borders dividing host and foreign are elusive and changing, host defense is only part of the immune system's functions, which actually comprise two basic tasks: protection, i.e., to preserve host integrity, and maintenance of organismic identity. And thus (3) if the spectrum of immunity is enlarged, differentiating low reactive 'autoimmune' reactions from activated immune responses against the '...

The aim of this review was to present various topics related to lactose intolerance with special attention given to the role of fermented foods and probiotics in alleviating gastrointestinal symptoms. Lactose intolerance is a common digestive problem in which the human body is unable to digest lactose, known as milk sugar. Lactose intolerance can either be hereditary or a consequence of intestinal diseases. Recent work has demonstrated that fermented dairy products and probiotics can modify the metabolic activities of colonic microbiota and may alleviate the symptoms of lactose intolerance. We suggest that, lactose free dairy products could be recommended as alternatives for the alleviation of lactose intolerance and for the promotion of human health and wellness.

This paper looks at the journey of eleven counsellors in marital counselling centres in French-speaking Belgium, from the creation of the centres in 1953, to the 1970s, when contraception became legal, and abortion became a public issue. At the time of Humanae Vitae, groups of volunteers, working within Catholic organisations where counselling took place, began to structure their activity around Carl Rogers’s ethics of client-centred therapy, placing their religious ideology in a secondary position to focus on the problems experienced by the couples and women they were receiving in the centres. These were often challenges they were experiencing themselves in their own lives. The reiteration of the Catholic orthodox view on contraception through Humanae Vitae marked a gap between the counsellors and the Church. This contribution questions the identity-related tension of Catholics working in conjugal counselling centres and the type of commitments they made to both the conjugal centre...

Background: Ascorbic acid (vitamin C, ascorbate) has been shown to protect cells against various types of oxidant injury at physiologically relevant concentrations. Vitamin C has been suggested as having both a preventative and therapeutic role in a number of pathologies when administered at much higher-than-recommended dietary allowance levels. This article reviews the scientific rational for intravenous vitamin C as a potential treatment for cancer.

Traditionally, the American child welfare system intervenes in cases of evident and severe maltreatment. Families in need of help, but who have not reached a crisis, are excluded from typical services. Some suggest that if these families were served, few would be rereferred to the child welfare system. California’s Differential Response (DR) has three tracks, of which ‘‘Track 1’’ targets families screened out of child protective services (CPS) and refers them to agencies that provide voluntary, home-based services and referrals. This study examined child-welfare trajectories for families receiving Track 1 DR services in one California county. Using survival analysis, treatment group children (N = 134) were compared to children eligible for services but denied due to program capacity (comparison group N = 511). Findings suggest no statistically significant differences between groups on the likelihood of a re-report following program participation, timing of maltreatment reports, or r...

Increasingly, nurse scientists are incorporating "omics" measures (e.g., genomics, transcriptomics, proteomics, and metabolomics) in studies of biologic determinants of health and behavior. The role of omics in nursing science can be conceptualized in several ways: (a) as a portfolio of biological measures (biomarkers) to monitor individual risk, (b) as a set of combined data elements that can generate new knowledge based on large and complex patient data sets, (c) as baseline information that promotes health education and potentially personalized interventions, and (d) as a platform to understand how environmental parameters (e.g., diet) interact with the individual's physiology. In this article, we provide exemplars of nursing scientists who use omics to better understand specific health conditions. We highlight various ongoing nursing research investigations incorporating omics technologies to study chronic pain vulnerability, risk for a pain-related condition, card...

Biogas and biohydrogen are compatible gaseous biofuels that can be blended with natural gas for reticulated fuel supply to reduce greenhouse gas emissions. Sustainably grown woody biomass is emerging as a potential feedstock in the production of biofuels. Woody biomass is widely available, uses non-arable land for plantation, does not require synthetic fertilisers to grow and acts as a carbon sink. The cellulose and hemicellulose fractions of wood are renewable sources of sugars that can be used for fermentative production of gaseous biofuels. However, widespread use of wood as a gaseous biofuel feedstock is constrained due to the recalcitrant nature of wood to enzymatic hydrolysis. Pretreatment makes cellulose and hemicellulose accessible to microbial enzymes to produce fermentable sugars. Here we review wood composition, its structure and different pretreatment techniques in the context of their effects on deconstruction of wood to improve hydrolysis and fermentative gaseous fuel ...

Increasing violence and inter-group conflict in the American Southwest is prevalent into the 13th and 14th centuries AD. In the northern Mogollon region during this time period, the site of Grasshopper Pueblo experienced a shift in social organization as population movements occurred in response to regional stressors. The skeletal remains of 187 adult individuals from the site are analyzed for nonlethal and lethal trauma, musculoskeletal stress markers, and pathology as indicators of changing social dynamics. Nonlethal, healed trauma is present in all adult age groups and both sexes. Approximately one-third (n=63) of the population has healed cranial depression fractures. Females and males are fairly equal in the proportion of cranial injuries incurred; however more females are injured overall when post-cranial injuries are added. Musculoskeletal stress markers do not differ substantially among age groups or between sexes. Heavy musculature development is also similar for groups with and without cranial depression fractures. The results of this study suggest that interpersonal violence was ubiquitous within the pueblo and may have escalated as the community grew in size. Immigrants from other parts of the Southwest may have sought refuge at Grasshopper only to find that the community was experiencing its own social stress.

The worldwide epidemic of obesity has become an important public health issue, with serious psychological and social consequences. Obesity is a multifactorial disorder in which various elements (genetic, host, and environment), play a definite role, even if none of them satisfactorily explains its etiology. A number of neurological comorbidities, such as anxiety and depression, charges the global obesity burden, and evidence suggests the hypothesis that the brain could be the seat of the initial malfunction leading to obesity. The gut microbiome plays an important role in energy homeostasis regulating energy harvesting, fat deposition, as well as feeding behavior and appetite. Dietary patterns, like the Western diet, are known to be a major cause of the obesity epidemic, probably promoting a dysbiotic drift in the gut microbiota. Moreover, the existence of a “gut–brain axis” suggests a role for microbiome on hosts’ behavior according to different modalities, including interaction th...

Main Outcome Measures: Failure of NOM (f-NOM). Results: A total of 164 patients (42%) were operated on immediately. Of the remaining 224 who were offered a trial of NOM, the treatment failed in 85 patients (38%). At the end, 64% of patients required surgery. Multivariate analysis identified 2 independent predictors of f-NOM: grade V BSI and the presence of a brain injury. The likelihood of f-NOM was 32% if no predictor was present, 56% if 1 was present, and 100% if both were present. The mortality of patients for whom NOM failed was almost 7-fold higher than those with successful NOM (4.7% vs 0.7%; P =.07). Conclusions: Nearly two-thirds of patients with grade IV or V BSI require surgery. A grade V BSI and brain injury predict failure of NOM. This data must be taken into account when generalizations are made about the overall high success rates of NOM, which do not represent severe BSI.

Caffeic acid phenethyl ester (CAPE) is the major pharmacologically-active component of some propolis types, rich in polyphenols, such as poplar propolis types. CAPE has the potential to be applied as a pharmaceutical as it possesses most of the pharmacological activities of propolis, such as anti-proliferative, antioxidant, immunomodulatory, antidiabetic, anti-inflammatory and antimicrobial. Its advantage is that it lacks some of the downsides of total propolis extracts, such as inability for unified standardization, which is cornerstone for implementing its therapeutic potential as a drug. The current paper provides an overview on the pharmacodynamic principles of CAPE. We present literature search outcomes form ClinicalTrials.gov database and from scientific publications, available on Scopus and Crossref databases. We take a round view of CAPE’s potential therapeutic implications in light of approved drugs with related modes of action.

Objective : To assess intern pharmacists’ perceived preparedness for practice, document the extent of their involvement.  in selected pharmacy related activities during the internship period, as well as determine their future career path. Methodology: A descriptive cross-sectional study was conducted among intern pharmacists using an eight item questionnaire. Simple descriptive statistics were used to calculate frequency counts and percentages with regard to respondent demographics and Likert scale responses. Results: Eighty-five percent of the 20 respondents perceived that they are prepared to perform dispensing and retail, and patient care activities with only half of them in multidisciplinary team care but not pharmaceutical business management (13, 65%). Close to two-thirds of respondents were often involved in patient care (13, 65%). Only six (30%) were often part of a multidisciplinary health care team. Nearly all (18, 90%) want to work in an environment with more patient cont...

T-cell receptor excision circles (TRECs) and κ-deleting recombination excision circles (KRECs) are recently used for detection of T or B cell lymphopenia in neonates based on region-specific cutoff levels. Here, we report cutoffs for TREC and KREC copies useful for newborn screening and/or diagnosis of primary immunodeficiency diseases (PID) in Iran. DNA was extracted from a single 3.2 mm punch of dried blood spots collected from 2160 anonymized newborns referred to two major referral health centers between 2014 and 2016. For refinement of the cutoffs, 51 patients with a definite diagnosis of severe combined immunodeficiency, X-linked agammaglobulinaemia and combined immunodeficiency, including ataxia telangiectasia, human phosphoglucomutase 3 and Janus kinase-3 deficiency, as well as 47 healthy controls were included. Samples from patients with an X-linked hyper-IgM-syndrome, Wiskott-Aldrich syndrome and DNA ligase 4 deficiency were considered as disease controls. Triplex-quantitat...

To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy. A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively. Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation. Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations. Abbreviations: aGRF = anterior ground reaction force, bE = belly excursion, bL = belly length, BW = body weight, CI = confidence interval, CP = cerebral palsy, ES = effect size, fE = fascicle excursion, fL = fascicle length, GRF = ground reaction force, MDF = maximum dorsiflexion, MG = medial gastrocnemius, MTJ = myotendinous junction, NP = negative power, P = power, PP = positive power, RJA = resting joint angle, ROM = range of movement, SCP = spastic cerebral palsy, SD = standard deviation, SE = standard error, TD = typically developing, tE = tendon excursion, tL = tendon length, vGRF = vertical ground reaction force.

Background The irrational use of medicines, and increasingly antimicrobials, remains a key health problem in many developing countries including Zambia. Inappropriate, ineffective and inefficient use of medicines is common in health facilities at all levels. There are many factors influencing irrational prescribing and dispensing of antimicrobials including patients, prescribers, dispensers, the supply system (including industry influences), government regulations and medicines information and misinformation. Study aim The aim of the study was to assess the rational use and availability of antimicrobials at primary level health facilities under the Lusaka district community health office, Zambia. Study design The study was a cross-sectional descriptive study, with prospective and retrospective components. A standardized research methodology, including tools and indicators, adapted from the World Health Organization, was employed. Study population and sampling The study population included all the 30 government primary level health facilities (health centres) in Lusaka District, from which 20 primary health facilities were sampled using a combination of purposive and random sampling. Using the WHO standard indicators of rational drug use, this study assessed 800 patient encounters, 520 medicines inventory records, and other baseline data, from 20 health facilities at three different levels under the Lusaka district community health office, Zambia. Data collection The data collection tools were numbered and labeled. Tool 1: Prescribing Indicator Form was used to collect prescribing data; Tool 2: Patient Care (Pharmacy) Form was used to record dispensing data; Tool 3: Antimicrobial Availability Form for recording data for the availability of the key indicator antimicrobials and their substitutes; Tool 4: Facility Indicator Consolidation Reporting Form was iv used for consolidating the data collected for each health facility under study; and Tool 5: Facility Medicines Use Indicator Consolidation Form was used for the consolidation of the drug use data for the entire study. Third year Pharmacy Technology students were trained for the data collection process. The patients were first observed from outside the prescriber's room and the dispensing area for consultation and dispensing times respectively, and then they were interviewed to collect the prescribing and dispensing data. The tools were pre-tested. Data analysis After data checking and consolidation, quantitative data were categorized into continuous numerical variables. Calculations were done manually and using computerized analysis (Epi Info package) and presented as simple frequency and means. Ethics Ethical clearance for the study was obtained from University of the Western Cape Senate Research Committee. Permission was obtained from the Lusaka Provincial and District health offices, being the authorities that are overseeing the health facilities included in the study. Furthermore, permission was obtained from the health centre in-charges. Consent was obtained from healthcare providers and patients. Key results and discussion The study found that at the primary level facilities there were more Clinical Officers (55%) than Medical Doctors (25%) and Registered Nurses (20%) in charge of prescribing. The main dispensers were Pharmacy Technologists (85%); there were no Pharmacists available in any of the facilities. A third [259 (32.4 %)] of all the 800 patients in the study were children below 12 years of age. Across the clinics, a mean of 2.94 medicines were prescribed per prescription, with an extremely low rate of prescribing drugs by generic name (36.7%). The proportion of prescriptions including an antibiotic was 36.2 % and 3.4 % included an injectable drug. Linking the antimicrobials and injections to patient diagnoses indicated that many were probably irrational, prescribing decisions. Amoxicillin and metronidazole were by far the most commonly prescribed antimicrobials at 32.0 % and 17.2 % of total antimicrobials, respectively. The essential drugs list was available in 80.0% of facilities and a high percentage of medicines were prescribed from the essential medicines list (81.2%). The overall v mean percentage of medicines packages correctly labeled was considerably low at 44.8 %. The average consultation time was short at 4.0 (range 1-8.4) minutes, whereas the dispensing times were equally short and averaged at 116.6 (range 15-360) seconds, with the range of 15 to 360 seconds. The average percentage of first line antimicrobials available at health facilities was 79 %; and the average percentage of second line, substitute, antimicrobials available was 15 %. Conclusion In line with studies from other settings, this medicines use study found considerable overuse and irrational use of antimicrobials in the primary health care clinics in Lusaka District. Irrational medicine prescribing was common and poor dispensing practices were also seen, resulting in poor use of and adherence to medicines and, consequently, poor therapeutic outcomes. Recommendations Several recommendations have been formulated. They include: Reinforcing the Drug Therapeutic Committees (DTCs) at the national and the local facility level to help manage medicines use; clarification of prescribers and dispensers roles and responsibilities; development, enforcement or adaption of standard operating procedures (SOPS) for prescribing and dispensing; and improvement of prescribing and dispensing practices through introduction of appropriate education, supervision and audit. vi DECLARATION I hereby declare that this study "ASSESSMENT OF THE RATIONAL USE AND AVAILABILITY OF ANTIMICROBIALS AT PRIMARY LEVEL HEALTH FACILITIES UNDER THE LUSAKA DISTRICT COMMUNITY HEALTH OFFICE, ZAMBIA" is my own work and it has not been submitted for any degree or examination to any other university, and that all sources I have used or quoted have been indicated and acknowledged by referencing.

To provide expert recommendations for the safe and effective application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD). Participants included a group of 17 expert clinicians and researchers with expertise in the clinical application of rTMS, representing both the National Network of Depression Centers (NNDC) rTMS Task Group and the American Psychiatric Association Council on Research (APA CoR) Task Force on Novel Biomarkers and Treatments. The consensus statement is based on a review of extensive literature from 2 databases (OvidSP MEDLINE and PsycINFO) searched from 1990 through 2016. The search terms included variants of major depressive disorder and transcranial magnetic stimulation. The results were limited to articles written in English that focused on adult populations. Of the approximately 1,500 retrieved studies, a total of 118 publications were included in the consensus statement and were supplemented with expert ...

Daily new cases of COVID-19 as a series of data points ordered in time is one representation of time series data. Our works expect to understand the data characteristics that is related to existing government policies. This paper aims to highlight the impact report and analyses of some COVID-19 policies in East Java province districts. The study is focused on the policy execution before and during the new normal situation of COVID-19 using time series data of new cases as possible and easily observable results. Aside from time series analysis, some visual analysis is performed as well. The experiments focused on some questions related to the policy effectiveness: finding patterns of daily new cases to instigate the need for other local policies and understanding any precedence on occurred cases for nearby districts. Although the second question is not confirmable, the first question verifies more tightened social distancing is still necessary for the new normal.

Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middleincome countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed. Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments. Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

Craving is considered to play an important role in the persistence of drug use and relapse of drug use. Very few studies have looked into the subjective experience of this phenomena. This study attempts to study craving comprehensively as described by the ...

Nieceliakalna nadwrażliwość na gluten (NCNG)-choroba ponownie odkryta Non-celiac gluten sensitivity (NCGS)-an old diagnosis recently rediscovered Kamil K. Hozyasz Klinika Pediatrii instytutu matki i Dziecka w Warszawie A-przygotowanie projektu badania, B-zbieranie danych, C-analiza statystyczna, D-interpretacja danych, E-przygotowanie maszynopisu, F-opracowanie piśmiennictwa, G-pozyskanie funduszy W medycynie akademickiej nieceliakalna nadwrażliwość na gluten (NCNG, ang. non-celiac gluten sensitivity) jest nowo zaakceptowanym rozpoznaniem klinicznym, którego istnienie było długo negowane. Częstość występowania NCNG w populacji ogólnej, jak i w grupach zwiększonego ryzyka, nie została dotychczas precyzyjnie określona, gdyż pacjenci często sami wysuwają podejrzenie tej choroby i wprowadzają restrykcyjną, jak w celiakii, dietę bezglutenową bez nadzoru medycznego. Definicja NCNG obejmuje zróżnicowaną grupę pacjentów. Nie zidentyfikowano swoistego biomarkera choroby. Rozpoznanie NCNG ustala się po wykluczeniu celiakii i alergii na pszenicę. Objawy choroby ustępują na diecie bezglutenowej, a nawracają po ponownym wprowadzeniu glutenu. Istnienie nowej jednostki nozologicznej potwierdził konsensus ekspercki, jakkolwiek szczegółowa patofizjologia choroby, leżąca u podstaw bardzo zróżnicowanej manifestacji klinicznej, obejmującej m.in. ból brzucha, biegunkę lub zaparcia, uporczywe wzdęcia, niedokrwistość, drętwienia kończyn, ból stawów i mięśni, zaburzenia snu, przewlekłe zmęczenie i depresję, pozostaje nieznana. Brakuje wiedzy dotyczącej naturalnego przebiegu schorzenia. Pomimo braku precyzyjnych kryteriów diagnostycznych choroba stanowi dowód per se na możliwość skutecznego leczenia dietą zaburzeń przewodu pokarmowego i dysfunkcji psychicznych. Z powodu przekonania o prozdrowotnych właściwościach pokarmów bezglutenowych dietę bezglutenową stosuje coraz więcej ludzi zdrowych, także w Polsce. Profesjonaliści medyczni muszą być świadomi, że certyfikowane produkty bezglutenowe są drogie i nieuzasadnione medycznie stosowanie diety bezglutenowej w wielu przypadkach może niepotrzebnie pogarszać kondycję finansową rodzin. Słowa kluczowe: nadwrażliwość na gluten, celiakia, alergia na gluten. Non-celiac gluten sensitivity (NCGS) is a newly recognised clinical entity by academic medical professionals, but it is better to consider it an old diagnosis recently rediscovered. The overall prevalence of NCGS in the general population is currently unknown largely because patients often self-diagnose and place themselves on the celiac-type gluten-free diet (GFD) without medical supervision. NCGS is an umbrella term and may incorporate different subgroups of patients. Now there is no specific biomarker that can be used to identify the entity. NCGS diagnosis can be reached only by excluding celiac disease and wheat allergy. Symptoms must disappear with the withdrawal of gluten and reappear quickly when gluten is reintroduced. NCGS existence has been recently supported by two expert meetings, however mechanisms by which gluten triggers symptoms, mimicking irritable bowel syndrome and skin rashes, numbness,"foggy mind", disturbed sleep patterns, have yet to be identified. Knowledge about NCGS natural history and outcome is still lacking. NCNG is the entity awaiting better diagnostics criteria, however a dietary approach for the management of patients with gastrointestinal symptoms and lack of well being no longer seems elusive. There is a growing segment of the population that seeks out gluten-free products because of a wider notion that gluten-free constitutes a healthier option. Major area of concern that must be addressed by medical professionals is the high cost of GFD.

The Grains for Health FoundationÕs Whole Grains Summit, held May 19-22, 2012 in Minneapolis, was the first meeting of its kind to convene >300 scientists, educators, food technologists, grain breeders, food manufacturers, marketers, health professionals, and regulators from around the world. Its goals were to identify potential avenues for collaborative efforts and formulate new approaches to whole-grains research and health communications that support global public health and business. This paper summarizes some of the challenges and opportunities that researchers and nutrition educators face in expanding the knowledge base on whole grains and health and in translating and disseminating that knowledge to consumers. The consensus of the summit was that effective, long-term, public-private partnerships are needed to reach across the globe and galvanize the whole-grains community to collaborate effectively in translating whole-grains science into strategies that increase the availability and affordability of more healthful, grain-based food products. A prerequisite of that is the need to build trust among diverse multidisciplinary professionals involved in the growing, producing, marketing, and regulating of whole-grain products and between the grain and public health communities.

In the last twenty years, many different approaches to deal with Computer-Interpretable clinical Guidelines (CIGs) have been developed, each one proposing its own representation formalism (mostly based on the Task-Network Model) execution engine. We propose META-GLARE a shell for easily defining new CIG systems. Using META-GLARE, CIG system designers can easily define their own systems (basically by defining their representation language), with a minimal programming effort. META-GLARE is thus a flexible and powerful vehicle for research about CIGs, since it supports easy and fast prototyping of new CIG systems.

Background Bullying has public health importance. It has been reported that both the victims and perpetrators of bullying are more likely to have suicidal ideation and other suicidal behaviours. Moreover, bullying can be a precursor for school violence and can contribute to poor academic performance. The purpose of the study was to raise awareness on the subject in China. We, therefore conducted an analysis of secondary data to determine the prevalence and correlates of having been bullied among in-school adolescents. Methods The data was taken from the Beijing Global School-Based Health Survey conducted in 2003. A weighted analysis to reduce bias due to differing patterns of non-response was conducted using statistical software (SPSS version 14.0). We conducted a backward logistic regression analysis to determine independent predictors for being bullied. Results Out of a total of 2,348 in-school adolescents who participated in the survey, 20% (23% males, and 17% females) reported h...

The liver is a sexually dimorphic organ presenting gender differences in its metabolism, functions, enzyme activity, membrane lipid composition and immune response. This paper aimed to assess whether gender may predict virological response to standard antiviral therapy in subjects with chronic hepatitis C (CHC). Methods: The authors retrospectively analyzed 100 patients with genotype 1 CHC (55 men, 45 women), who performed standard antiviral therapy (interferon and ribavirin for 12 months) in the period 2002-2012, evaluated with blood tests and abdominal ultrasound to compare different virological and biochemical response in both gender. Results: Rate of substained virological response (SVR) was higher, but not significant, in women than men (46.7% vs. 34.5%, P = 0.05); difference became significant after stratification by age (< 50 and ≥ 50 years). Specifically in the group aged under 50 years, rate of SVR was significantly higher in women than in men (66.7% vs. 38.2%, P < 0.05). Conclusion: Female gender may predict virological response to standard antiviral therapy in subjects with CHC aged below 50 years. Considering new potent and more expensive antiviral drugs actually available for HCV treatment, it could be useful to identify candidates firstly eligible to therapy.

Background To determine whether waist-to-height ratio correlates with coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by coronary angiography in Bangladeshi population. Methods This cross sectional study was done on patients in Department of Cardiology in DMCH and those referred in the cath-lab of the Department of Cardiology for CAG during November 2009 to October 2010 involving 120 patients. They were divided into group-A (with coronary score ≥7) and group-B (coronary score &lt;7) depending on Gensisni score. Result There were no statistically significant difference regarding the distribution of age, sex and clinical diagnosis and parameters between the two groups. The mean age of patients was 51.7 ± 8.2 years and 48.8 ± 9.1 years in Group A and Group B respectively with a male predominance in both the groups. Patients in group A had higher BMI ≥25 and waist to height ratio (≥0.55) than Group B which showed a statistically significant asso...

The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement.

Diagnostic workup of scrotal lesions should begin with a complete clinical history and physical examination, including analysis of risk factors such as family history of testicular cancer, personal history of tumor in the contralateral testis, and cryptorchidism, followed by imaging. Scrotal ultrasonography (US) with a combination of gray-scale and color Doppler techniques has been the first-line imaging modality for evaluation of testicular and extratesticular lesions because of its low cost, wide availability, and high diagnostic accuracy. However, US has limitations related to operator dependence, the relatively small field of view, and lack of tissue characterization. Magnetic resonance (MR) imaging, because of its superior soft-tissue contrast and multiplanar capabilities, is increasingly being used as a supplemental diagnostic problem-solving tool in cases where scrotal US findings are inconclusive or nondiagnostic. In addition to morphology, lesion location, and tissue charac...