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Summary: Streptococcal pyrogenic exotoxin (Spe) A expression is epidemiologically linked to streptococcal tonsillo‐pharyngitis and outbreaks of scarlet fever, although the mechanisms by which superantigens confer advantage to Streptococcus pyogenes are unclear. S. pyogenes is an exclusively human pathogen. As the leucocyte profile of tonsil is unique, the impact of SpeA production on human tonsil cell function was investigated. Human tonsil cells from routine tonsillectomy were co‐incubated with purified streptococcal superantigens or culture supernatants from isogenic streptococcal isolates, differing only in superantigen production. Tonsil cell proliferation was quantified by tritiated thymidine incorporation, and cell surface characteristics assessed by flow cytometry. Soluble mediators including immunoglobulin were measured using enzyme‐linked immunosorbent assay. Tonsil T cells proliferated in response to SpeA and demonstrated typical release of proinflammatory cytokines. When cultured in the absence of superantigen, tonsil preparations released large quantities of immunoglobulin over 7 days. In contrast, marked B cell apoptosis and abrogation of total immunoglobulin (Ig)A, IgM, and IgG production occurred in the presence of SpeA and other superantigens. In SpeA‐stimulated cultures, T follicular helper (Tfh) cells showed a reduction in C‐X‐C chemokine receptor (CXCR)5 (CD185) expression, but up‐regulation of OX40 (CD134) and inducible T cell co‐stimulator (ICOS) (CD278) expression. The phenotypical change in the Tfh population was associated with impaired chemotactic response to CXCL13. SpeA and other superantigens cause dysregulated tonsil immune function, driving T cells from Tfh to a proliferating phenotype, with resultant loss of B cells and immunoglobulin production, providing superantigen‐producing bacteria with a probable survival advantage. [ABSTRACT FROM AUTHOR]

De novo variants in the gene encoding cyclin‐dependent kinase 13 (CDK13) have been associated with congenital heart defects and intellectual disability (ID). Here, we present the clinical assessment of 15 individuals and report novel de novo missense variants within the kinase domain of CDK13. Furthermore, we describe 2 nonsense variants and a recurrent frame‐shift variant. We demonstrate the synthesis of 2 aberrant CDK13 transcripts in lymphoblastoid cells from an individual with a splice‐site variant. Clinical characteristics of the individuals include mild to severe ID, developmental delay, behavioral problems, (neonatal) hypotonia and a variety of facial dysmorphism. Congenital heart defects were present in 2 individuals of the current cohort, but in at least 42% of all known individuals. An overview of all published cases is provided and does not demonstrate an obvious genotype‐phenotype correlation, although 2 individuals harboring a stop codons at the end of the kinase domain might have a milder phenotype. Overall, there seems not to be a clinically recognizable facial appearance. The variability in the phenotypes impedes an à vue diagnosis of this syndrome and therefore genome‐wide or gene‐panel driven genetic testing is needed. Based on this overview, we provide suggestions for clinical work‐up and management of this recently described ID syndrome. [ABSTRACT FROM AUTHOR]

Invasive group A Streptococcus (iGAS) is frequently associated with emm1 isolates, with an attendant mortality of around 20%. Cases occasionally arise in previously healthy individuals with a history of upper respiratory tract infection, soft tissue contusion, and no obvious portal of entry. Using a new murine model of contusion, we determined the impact of contusion on iGAS bacterial burden and phenotype. Calibrated mild blunt contusion did not provide a focus for initiation or seeding of GAS that was detectable following systemic GAS bacteremia, but instead enhanced GAS migration to the local draining lymph node following GAS inoculation at the same time and site of contusion. Increased migration to lymph node was associated with emergence of mucoid bacteria, although was not specific to mucoid bacteria. In one study, mucoid colonies demonstrated a significant increase in capsular hyaluronan that was not linked to a covRS or rocA mutation, but to a deletion in the promoter of the capsule synthesis locus, hasABC, resulting in a strain with increased fitness for lymph node migration. In summary, in the mild contusion model used, we could not detect seeding of muscle by GAS. Contusion promoted bacterial transit to the local lymph node. The consequences of contusion-associated bacterial lymphatic migration may vary depending on the pathogen and virulence traits selected. [ABSTRACT FROM AUTHOR]

Background. Burnout during registrar training is high, especially in resource-limited settings where stressors are intensified. Burnout leads to decreased quality of life for doctors, poor job and patient satisfaction, and difficulty retaining doctors. Objectives. Primary: to measure burnout among registrars working at Princess Marina Hospital in Gaborone, Botswana. Secondary: to determine factors contributing to burnout and identify potential wellness interventions. Methods. The validated Maslach Burnout Inventory was used to measure the degree of emotional exhaustion, depersonalisation and personal accomplishment. Work-related difficulties and potential wellness interventions were explored through multiple-choice and open-ended questions. Results. Of 40 eligible registrars, 20 (50%) completed the survey. High levels of burnout were reported for emotional exhaustion in 65% (13/20), depersonalisation in 45% (9/20), and personal accomplishment in 35% (7/20) of registrars. A high degree of burnout was reported by 75% (15/20) of registrars in one or more domains. In the previous 7 days, registrars worked an average of 77 hours, took 1.5 overnight calls, slept 5.7 hours per night, and 53% (10/19) had ≥1 of their patients die. Five (25%) registrars considered leaving Botswana to work in another country, which correlated with those with the highest degree of burnout. The most common frustrations included insufficient salary and limited medical resources. Suggested interventions included improved mentorship and wellness lectures. Conclusions. There is a high degree of burnout, especially emotional exhaustion, among registrars. Encouragingly, most registrars have a desire to work in Botswana after training. Future research on improving registrar wellness in low-resource settings is urgently needed. [ABSTRACT FROM AUTHOR]

Aim Laparoscopic ventral rectopexy ( LVR) is a nerve-sparing technique for the treatment of rectal prolapse. Concerns about the use of synthetic meshes in the pelvis and the associated risk of erosion have led to the recent use of biological meshes in some colorectal units. This retrospective study aims to assess the outcomes of patients undergoing LVR using a noncross-linked nondermal biological mesh. Method The medical notes of all patients who underwent LVR between 1 December 2011 and 31 May 2014 were reviewed. The rate of obstructed defaecation before surgery was retrospectively determined from medical records using the Rome III criteria. The rates of obstructed defaecation and faecal incontinence following surgery were determined using a self-reported questionnaire. Results A total of 51 patients had LVR between 1 December 2011 and 31 May 2014. Their mean age was 57.3 ± 2.5 years and the mean follow-up was 23 ± 1 months. There were seven (13.7%) postoperative complications. In total, 45 (88%) patients completed the functional outcome questionnaires. Before surgery, 33 (73.3%) patients complained of symptoms of obstructed defaecation. At the end of follow-up, 22 (48.8%, P = 0.001) patients continued to have some symptoms of obstructed defaecation. Before surgery, 12 (26.7%) patients complained of faecal incontinence. At the end of follow-up, only three (6.7%, P = 0.004) patients reported faecal incontinence. At the end of follow-up, recurrence of symptoms had occurred in six (13.3%) patients. Conclusion LVR using a biological mesh is safe and results in significant reduction in symptoms associated with external rectal prolapse and rectal intussusception. [ABSTRACT FROM AUTHOR]

The first large chain testing machines of the nineteenth century were introduced when the Navy Board changed from hemp anchor cables to wrought iron chain cables. They were some 100 ft (c. 33 m) in length with a capacity of about 100 tons (1 MegaNewton). Nothing seems to have been brought together about the many diverse references to these machines to paint a picture of how such anchor chains came into use and how the first proving machines were developed and used. The main protagonist in this picture is Samuel Brown, whose work on chain link suspension bridges has been well documented, together with just one or two others, namely Thomas Brunton, a merchant, and Robert Flinn, a blacksmith. Brown and Brunton set up their works near Millwall in London, while Flinn worked on the Tyne. Within a few years such machines had spread to most ports and dockyards in the country. A fairly comprehensive picture has emerged although many details will never be known. A small picture of Flinn's machine appears on his note paper but only one scrap view has been found for each of Brown's mechanical machine of 1814 and Brunton's hydraulic machine of 1813. [ABSTRACT FROM AUTHOR]

Objective To quantify the risk of morbidity from vaginal delivery (VD) that pregnant women would be prepared to accept before requesting an elective caesarean section and to compare these views with those of clinicians. Design Cross-sectional survey. Setting Major teaching hospital (nulliparas and midwives) and national samples of medical specialists. Sample Nulliparas ( n = 122), midwives ( n = 84), obstetricians ( n = 166), urogynaecologists ( n = 12) and colorectal surgeons ( n = 79). Methods Face-to-face interviews (nulliparas) and mailed questionnaire (clinicians). Main outcome measures Maximum level of risk participants would be prepared to accept before opting for an elective caesarean section for each of 17 potential complications of VD. Utility scores for each complication were calculated with higher scores (closer to 1) indicating a greater acceptance of risk. Results Pregnant women were willing to accept higher risks than clinicians for all 17 potential complications. They were least accepting of the risks of severe anal incontinence (mean utility score 0.32), emergency caesarean section (0.51), moderate anal incontinence (0.56), severe urinary incontinence (0.56), fourth-degree tears (0.59) and third-degree tears (0.72). The views of midwives were closest to those of pregnant women. Urogynaecologists and colorectal surgeons were the most risk averse, with 42 and 41%, respectively, stating that they would request an elective caesarean for themselves or their partners. Conclusions Pregnant women were willing to accept significantly higher risks of potential complications of VD than clinicians involved in their care. Pregnant women’s views were more closely aligned to midwives than to medical specialists. [ABSTRACT FROM AUTHOR]

Visual process management tools have been developed by lean practitioners as communication aids and are used to help drive operations and processes in real time. Three case studies from aerospace companies describe the physical visual tools that have been implemented to facilitate performance measurement and communication in different engineering processes. Rolls Royce presents an example of how ERP outputs are communicated and controlled in a lean manufacturing process. At Airbus UK (Filton) visual process boards are used to manage a complex knowledge and people based process bringing together multiple supplier inputs in the production of aircraft maintenance manuals. Senior management at Weston Aerospace are using visual process control to run and report on work packages, resources and processes throughout their organisation. These systems act as an extension to metrics, and in themselves may be considered as a dynamic measurement system as they provide instant feedback and can be used to predict a probable outcome if no action is taken. The learning and themes that have made these implementations successful is presented and collated into a set of guidelines for consideration when implementing visual process management tools. [ABSTRACT FROM AUTHOR]

Invasive weeds are potent agents of environmental change. Wetlands are valuable environments that frequently are impinged by a variety of threats including invasive weeds. Melaleuca quinquenervia (Cav.) S.T. Blake (broad-leaved paperbark), though experiencing major diminishment of native populations in Australia, is naturalized and highly invasive in most wetland habitats of south Florida, U.S.A., where it infests more than 202,000 ha. Wetlands in south Florida, including such renowned areas as the Everglades, are being transformed into M. quinquenervia swamps, with major environmental and economic impacts. Current management methods include herbicides, mechanical or hand removal of plants, flooding, and prescribed burning. Insufficient information, high costs, non-target impacts, and the resilience of M. quinquenervia (trunk and root sprouts and massive canopy seed banks) greatly constrain the effectiveness of these control methods. Biological control offers long-term management potential, most likely by reducing the rate of spread and the vitality and growth rate of plants, thus rendering them more vulnerable to other environmental stresses and control methods. The leaf weevil Oxyops vitiosa Pascoe, a natural enemy of M. quinquenervia in Australia, will likely be the first biocontrol agent released against the weed in Florida. More information is needed, especially ecological data, to better understand the invasiveness of M. quinquenervia in Florida and to facilitate its management there. [ABSTRACT FROM AUTHOR]

The article focuses on the social aspects of health education. The author remarks that in the early days that social status was not highly regarded in the U.S. There was no ceiling on the economic status that one might hope to reach honestly through unusual effort and superior ability. In the early, simple, rural, town-meeting economy it was easy to see the value of education and industriousness and of wholesome and hygienic living, to see the reward of effort, to know where government expenditures went and where the money came from. The family's responsibility for its own health was great and education for healthful living of obvious value. Government seems to have unlimited wealth, and, since many of the taxes are hidden, the citizen does not know what a billion dollar outlay costs him. We talk about free clinics, as though nobody had to provide the money for them. Federal grants to states, particularly, are hailed as benefits for which nobody has to pay. Thousands of people do not realize that they are paying directly for government benefits.

Investigates the use of foreign language in teaching a foreign literature. Conclusions about foreign literature courses conducted in foreign languages; Qualifications of an instructor for foreign literature courses; Reasons for considering the use of foreign language as a barrier to the accomplishment of cultural aims.

The article presents information on the incentives and interests which encourage pupils to adopt and maintain the best health practices. Health is a means of enriching life. The incentives which are a desire of the child include desire to grow, desire for approval from one's social group and the desire to imitate those one admires. Apart from these incentives, which may be used in actually motivating the child, there is a group of interests. It has been suggested by the teacher groups that children are naturally interested in the things which include babies, care of dolls-housekeeping duties, cartoons and the class and school loyalty.

Purpose: Concern about maternal morbidity associated with vaginal delivery (VD) may be driving the increasing trend for elective caesarean section (CS). This study aimed to quantify the risk of morbidity from VD that pregnant women would be prepared to accept before requesting an elective CS, and to compare these views with those of clinicians. Methodology: Participants completed a questionnaire to ascertain the maximum level of risk they would be prepared to accept before opting for an elective CS. Utility scores for each complication were calculated, with higher scores (closer to 1) indicating a preference towards VD. Results: 122 pregnant women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 79 colorectal surgeons participated. For the evaluated 18 potential complications of VD pregnant women were willing to accept higher risks than clinicians. Pregnant women were least accepting of risks of severe anal incontinence (mean utility score 0.32), emergency CS (0.51), moderate anal incontinence (0.56), severe urinary incontinence (0.56), fourth degree tears (0.59), and third degree tears (0.72) The views of midwives were closest to those of pregnant women. Urogynaecologists and colorectal surgeons were the most risk averse, with 42% and 41% respectively stating they would request an elective CS for themselves or their partners. Conclusions: Pregnant women were able to quantify the level of risk they are prepared to accept from a VD before opting for an elective CS being aware of the potential complications of elective CS, and these risks were significantly higher than those accepted by the clinicians involved in their care. Their views are more closely aligned to midwives than to specialist clinicians. [ABSTRACT FROM AUTHOR]