Search

Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries. CO was measured every minute over 24 h in a sample of homes in Nairobi, Kenya. Data on household characteristics were gathered by questionnaire. Metrics of exposure were summarised and analysis of temporal changes in concentration was performed. Continuous 24-h data were available from 138 homes. The mean (SD), median (IQR) and maximum 24-h CO concentration was 4.9 (6.4), 2.8 (1.0–6.3) and 44 ppm, respectively. 50% of homes had detectable CO concentrations for 847 min (14h07m) or longer during the 24-h period, and 9% of homes would have activated a CO-alarm operating to European specifications. An association between a metric of total CO exposure and self-reported exposure to vapours >15 h per week was identified, however this were not statistically significant after adjustment for the multiple comparisons performed. Mean concentrations were broadly similar in homes from a more affluent area and an informal settlement. A model of typical exposure suggests that cooking is likely to be responsible for approximately 60% of the CO exposure of Nairobi schoolchildren. Household CO concentrations are substantial in Nairobi, Kenya, despite most homes using gas or liquid fuels. Concentrations tend to be highest during the evening, probably associated with periods of cooking. Household air pollution from cooking is the main source of CO exposure of Nairobi schoolchildren. The public health impacts of long-term CO exposure in cities in sub-Saharan Africa may be considerable and should be studied further. [Display omitted] • Carbon monoxide concentrations in homes in a large African city are substantial. • Exposure to CO is likely to adversely affect the health of many urban dwellers in Africa. • CO levels were similar in homes in an informal settlement and a more affluent area. • Children receive most of their CO exposure during the evening when dinner is prepared. [ABSTRACT FROM AUTHOR]

Background: Understanding of the true asymptomatic rate of infection of SARS-CoV-2 is currently limited, as is understanding of the population-based seroprevalence after the first wave of COVID-19 within the UK. The majority of data thus far come from hospitalised patients, with little focus on general population cases, or their symptoms.Methods: We undertook enzyme linked immunosorbent assay characterisation of IgM and IgG responses against SARS-CoV-2 spike glycoprotein and nucleocapsid protein of 431 unselected general-population participants of the TwinsUK cohort from South-East England, aged 19-86 (median age 48; 85% female). 382 participants completed prospective logging of 14 COVID-19 related symptoms via the COVID Symptom Study App, allowing consideration of serology alongside individual symptoms, and a predictive algorithm for estimated COVID-19 previously modelled on PCR positive individuals from a dataset of over 2 million.Findings: We demonstrated a seroprevalence of 12% (51 participants of 431). Of 48 seropositive individuals with full symptom data, nine (19%) were fully asymptomatic, and 16 (27%) were asymptomatic for core COVID-19 symptoms: fever, cough or anosmia. Specificity of anosmia for seropositivity was 95%, compared to 88% for fever cough and anosmia combined. 34 individuals in the cohort were predicted to be Covid-19 positive using the App algorithm, and of those, 18 (52%) were seropositive.Interpretation: Seroprevalence amongst adults from London and South-East England was 12%, and 19% of seropositive individuals with prospective symptom logging were fully asymptomatic throughout the study. Anosmia demonstrated the highest symptom specificity for SARS-CoV-2 antibody response.Funding: NIHR BRC, CDRF, ZOE global LTD, RST-UKRI/MRC. [ABSTRACT FROM AUTHOR]

Azole resistance is a concern for the management of diseases caused by Aspergillus fumigatus in humans. Azole fungicide use in the environment has been identified as a possible cause for development of resistance, which increases the complexity and number of stakeholders involved in this emerging problem. A workshop was held in Amsterdam early 2019 in which stakeholders, including medical and agricultural researchers, representatives from the government, public health, fungicide producers and end-users, reviewed the current evidence supporting environmental selection for resistance and to discuss which research and measures are needed to retain the effectiveness of the azole class for environmental and medical applications. This paper provides an overview of the latest insights and understanding of azole resistance development in the clinical setting and the wider environment. A One Health problem approach was undertaken to list and prioritize which research will be needed to provide missing evidence and to enable preventive interventions. • Environmental azole resistance selection in A. fumigatus threatens medical therapy. • Certain azole fungicide applications have a low risk of resistance selection. • Hotspots involve A. fumigatus growth in plant waste containing azole residues. • Environmental resistance burden may be reduced through a One-Health approach. • AMR research and action plans should include fungal resistance. [ABSTRACT FROM AUTHOR]

Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Resident trauma readiness index increased with training (P <. 001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P <. 05). Expert trauma readiness index was higher than residents (P <. 004) and practicing surgeons (P <. 001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention. [ABSTRACT FROM AUTHOR]

Pneumocystis pneumonia (PCP) is a potentially life-threatening fungal infection usually seen in immunocompromised patients. Pneumocystis jirovecii can be easily detected from oral rinse samples in HIV patients with suspected PCP. In this study, a quantitative real-time PCR assay was used to establish the frequency of detection of P. jirovecii in oral rinses from HIV patients without respiratory symptoms or suspicion of PCP. Two saline oral rinses were collected from 100 ambulant HIV patients and from 60 COPD patients (comparator group). Four HIV patients were positive for P. jirovecii. In three patients, the first sample was positive and in one the second one was positive. One of these patients was on PCP prophylaxis and had a CD4+ count of 76 cells/mm3. The mean CD4+ count for all patients was 527 cells/mm3. All qRT-PCR test results for the COPD patients were negative. No patient developed PCP at six months follow-up. The qRT-PCR assay can be used to detect P. jirovecii DNA in oral rinse samples from HIV patients without evident clinical symptoms, however the oral carriage of this fungus was rare in our cohort of patients. In conclusion, although rare, a positive oral rinse P. jirovecii result may reflect colonisation, in particular in patients with HIV. This needs to be kept in mind when using oral rinses and qRT-PCR in the diagnosis of P. jirovecii infection. [ABSTRACT FROM AUTHOR]

Abstract The aims of this study were to screen the phytochemical content, antioxidant, antimicrobial and cytotoxic properties of the extract and its fractions prepared from Catharanthus roseus (L.) G. Don (C. roseus) stem. C. roseus stem was powdered and extracted with methanol using ultrasound-assisted extraction to obtain the crude extract. The crude extract was further fractioned using liquid-liquid extraction technique to obtain extracts of increasing polarity including n -butanol and residual aqueous fractions. The crude extract and its derived fractions were then subjected to phytochemical screening and assayed for antioxidant, antimicrobial and cytotoxic activities. Results showed that the n -butanol fraction contained the highest levels of saponins and phenolics (3037.54 mg ESE/g and 77.87 mg GAE/g, respectively) and possessed the strongest antioxidant capacity amongst the tested extracts. HPLC analysis revealed that this n -butanol fraction had high levels of apigenin and kaempferol, whereas the aqueous fraction contained a high level of gallic acid. The n -butanol fraction was found to effectively inhibit the activity of Escherichia coli and Staphylococccus lugdunensis. The n -butanol fraction also possessed strong cytotoxic activity in vitro against a wide range of cancer cell lines including A2780 (ovarian), H460 (lung), A431 (skin), MIA PaCa-2 (pancreas), Du145 (prostate), HT29 (colon), MCF-7 (breast), BE2-C (neuroblastoma), SJ-G2, U87 and SMA (glioblastoma) at low doses (GI 50 values of 5.2−21.0 µg/mL). These results indicate that the n -butanol fraction prepared from C. roseus stem is a rich source of bioactive compounds which can be isolated for further evaluation as potential antimicrobial drugs or antitumor therapeutic agents. Highlights • The phytochemical profiles of C. roseus stem and its fractions were elucidated. • The n -butanol fraction contained the highest levels of bioactives and the strongest antioxidant power. • This fraction also exhibited strong inhibitory effect on 11 cancer cell lines. • Microbial growth was effectively inhibited by the n -butanol fraction. [ABSTRACT FROM AUTHOR]

Current post-operative recovery assessment exists as a dichotomy, maintaining objectivity whilst providing relevance to patient-centred care. Both objective and subjective measures are utilised in modern recovery assessment and are best viewed as complimentary. At institutional and provider levels, performance indicators are utilised as surrogates for quality of recovery but only if these indicators are assessed in the clinical context from which they are derived. Patient-reported outcomes prioritise the patient's perspective of symptoms and care, which are the most important aspects at the time of assessment but are limited by their susceptibility to response shift and recall bias. Ideally, quality of recovery is assessed using objective measures in concert with measures of clinical complexity and in parallel with patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Traditional perioperative risk prediction recovery identifies patient populations at risk of suboptimal recovery but not individual patients in whom this actually occurs and in whom timely intervention is beneficial. Patient-focused recovery emphasises a return to a semblance of normality and an ability to perform activities previously undertaken. A patient's sense of self-efficacy and engagement in their own care positively influences functional improvement and emotive recovery. The future of recovery assessment is that which is individualised, digitalised, integrated and in real time. Real-time recovery (RTR) assessment is the contemporaneous collection, analysis and reporting of data that enable the identification of suboptimal recovery in individual patients in a timeframe that minimises the delay in the implementation of the targeted treatment. There is a need to validate the clinical utility of existing biometric technology, wireless hybrid devices and digitalised platforms in providing both clinician and patient with RTR data and to determine the effect, if any, that RTR has on patient engagement and outcome. [ABSTRACT FROM AUTHOR]

Modern recovery assessment has progressed from that which addressed purely physiological restitution in the immediate post-operative period to that which is a multi-dimensional construct existing as a continuum and which follows a predictable trajectory. Recovery tools differ in their derivation, validation and scope of assessment. Importantly, few are validated for repeat measures, an aspect crucial when assessing the temporal nature of modern recovery. Recovery can be assessed as a continuous or dichotomous outcome and as occurring within an individual patient or within a group. Dichotomisation of recovery assessment mandates that a threshold be determined, above which recovery is deemed to have occurred. Ideally, recovery is assessed as a dichotomous outcome using the patient as their own pre-operative comparator, thus allowing recovery assessment at an individual patient, as well as group, level and overall as well as within each recovery domain. [ABSTRACT FROM AUTHOR]

Background Allergic diseases caused by fungi are common. The best understood conditions are allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization. Our knowledge of the fungal microbiome (mycobiome) is limited to a few studies involving healthy individuals, asthmatics, and smokers. No study has yet examined the mycobiome in fungal lung disease. Objectives The main aim of this study was to determine the mycobiome in lungs of individuals with well-characterized fungal disease. A secondary objective was to determine possible effects of treatment on the mycobiome. Methods After bronchoscopy, ribosomal internal transcribed spacer region 1 DNA was amplified and sequenced and fungal load determined by real-time PCR. Clinical and treatment variables were correlated with the main species identified. Bronchopulmonary aspergillosis (n = 16), severe asthma with fungal sensitization (n = 16), severe asthma not sensitized to fungi (n = 9), mild asthma patients (n = 7), and 10 healthy control subjects were studied. Results The mycobiome was highly varied with severe asthmatics carrying higher loads of fungus. Healthy individuals had low fungal loads, mostly poorly characterized Malasezziales . The most common fungus in asthmatics was Aspergillus fumigatus complex and this taxon accounted for the increased burden of fungus in the high-level samples. Corticosteroid treatment was significantly associated with increased fungal load ( P < .01). Conclusions The mycobiome is highly variable. Highest loads of fungus are observed in severe asthmatics and the most common fungus is Aspergillus fumigatus complex. Individuals receiving steroid therapy had significantly higher levels of Aspergillus and total fungus in their bronchoalveolar lavage. [ABSTRACT FROM AUTHOR]

Polyphenols of citrus by-products, due to their antioxidant and antimicrobial activities, could be valorized by pharmaceutical and food industries, adding a value to the citrus processing companies. A number of studies have investigated the effect of ultrasound-assisted extraction (UAE) conditions on the recovery of phenolics derived from citrus waste using both organic solvents or mixed aqueous solvent systems. To maximize efficiency, UAE conditions should be tailored to the physical parameters of the solvent(s) employed. The aim of this study was to investigate the effect of four UAE parameters: particle size (1.40–2.80 mm), extraction time (10–60 min), extraction temperature (23–50 °C) and ultrasonic power (150–250 W) on the simultaneous recovery of p -coumaric acid, caffeic acid, chlorogenic acid, and hesperidin from citrus waste using pure water as a solvent. High-performance liquid chromatography (HPLC) was employed for the identification and quantification of the cited compounds. Particle size was determined to be an important parameter affecting compound recovery, with the exception of chlorogenic acid. A particle size of 1.40 mm resulted in the highest recovery of p -coumaric and caffeic acids (0.25 and 0.58 mg/g, respectively), while higher hesperidin yields were achieved from the particle sizes of 2.00 and 1.40 mm (6.44 and 6.27 mg/g, respectively). Extraction temperature significantly affected only the recovery of the flavanone glycoside ( P < 0.05). As the extraction temperature increased from 30 to 50 °C the recovery of hesperidin increased from 6.59 to 7.84 mg/g, respectively. Neither extraction time nor ultrasonic power significantly affected the recovery of any individual phenolic compound. [ABSTRACT FROM AUTHOR]

Plastic litter is an endemic problem within all regions, particularly cities. Much of this litter reaches the world's oceans with well documented environmental impacts. However, the monitoring of urban litter is often piecemeal at best. Citizen science, the action of utilising the public to support research, has been used to excellent effect for both research and engagement, usually for area clean-ups such as beach cleans. However, to date very few studies have assessed plastic pollution at a city scale. This study presents a novel citizen science approach, using a smartphone application to collect geolocated photographs of plastic litter during 5 city-wide surveys. The study has compiled a significant dataset of photographs (n = 3760), classified by plastic type to assess patterns of plastic pollution Portsmouth, UK. The method is shown to have significant potential for further development to facilitate detailed analysis of plastic litter in urban centres across the world. • City-wide surveys can significantly aid understanding of plastic pollution. • Researchers should adopt continuous surveying to minimise barriers to participation. • In-person events should be used at strategic points in the project timeline. • A digital first engagement method has the most potential for scalability. [ABSTRACT FROM AUTHOR]

The Davidson’s plum (DP; Davidsonia pruriens F. Muell) is a fruit native to Australia that is a rich source of phenolic compounds. This study investigated the effects of various extraction solvents (ethanol, methanol, acetone and water) on total phenolic content (TPC), antioxidant capacity (ABTS, DPPH, CUPRAC, FRAP assays) and anti-proliferative activity (MTT, CCK-8 assays) of DP. Our data revealed that extraction solvents significantly affected the physico-chemical, antioxidant and anti-proliferative properties of DP extracts. Within the tested solvents, ethanol was found to be the optimal solvent for extraction of bioactive compounds from DP as its extract had the greatest TPC (94.13 GAE/g), flavonoids (78.33 mg RUE/g), proanthocyanidins (5.33 mg CAE/g), anthocyanidins (2.81 mg CGE/g), as well as possessed the highest antioxidant capacity and anti-proliferative activity against a panel of cancer cell lines. This included cancers of the pancreas, breast, lung, brain, skin, colon and ovary. Therefore, further investigations should be conducted to identify key bioactive compounds to determine the potential for utilization in the nutraceutical and phytopharmaceutical industries. [ABSTRACT FROM AUTHOR]

A high proportion of individuals with body dysmorphic disorder (BDD) undergo cosmetic treatments in an attempt to ‘fix’ perceived defect/s in their physical appearance. Despite the frequency with which such procedures are sought, few studies have prospectively examined the outcomes of cosmetic procedures in individuals with BDD. This article aims to critically review the literature and discuss the current debate that exists on outcomes of cosmetic treatment for individuals with BDD. An emerging literature suggests the majority of individuals with BDD have poor outcomes after cosmetic interventions; however, based on the current literature, it cannot be fully ruled out that certain individuals with mild BDD and localised appearance concerns may benefit from these interventions. Gaps in the current literature are highlighted, alongside recommendations for future research. Carefully conducted longitudinal studies with well-characterised patient populations are needed. [ABSTRACT FROM AUTHOR]

Episodic psychiatric symptoms are not uncommon and range from panic attacks to repeated violent acts. Some evidence has accumulated over the years that at least in a subset of patients exhibiting these symptoms there may be evidence for the presence of focal cortical/subcortical hyperexcitability. In these cases the condition could be conceptualized as an epilepsy spectrum disorder (ESD) with significant treatment implications. There is currently no clear demarcation of this category of symptoms, their prevalence, an understanding of how these symptoms occur, what is appropriate work up and possible treatments. In this article, we propose that milder degrees of increased neural excitability (i.e., a subthreshold excitation insufficient to cause seizures) may nonetheless be capable of causing observable phenotypic changes. The observable phenotypic changes depend on the degree of hyperexcitability and the location of the hyperexcitable neural tissue. The location of the abnormal neural tissue may dictate the initial manifestation of an attack resulting from activation of the hyperexcitable tissue, but the anatomical connectivity of the abnormal region will dictate the breadth of manifestations. We provide some evidence, derived mainly from either electroencephalography studies of these populations or clinical reports of response to anti-epilepsy treatment, for the assumption and propose methods to test the advanced hypothesis. [ABSTRACT FROM AUTHOR]

Objective: Noninvasive 24-hour ambulatory blood pressure monitoring holds great promise as a useful tool in the management of hypertensive pregnancies and pregnancies considered "at risk" for development of preeclampsia. The purpose of this study was to define ambulatory blood pressure monitoring parameters throughout normal pregnancy, including women considered at risk for development of hypertension who continued to have a completely normal pregnancy.Study Design: Two hundred seventy-six 24-hour ambulatory blood pressure monitoring studies were made cross-sectionally with use of a Spacelabs 90207 device (validated for use in pregnancy), at one or more of 9 to 17, 18 to 22, 26 to 30, and >30 weeks' gestation. Upper limits of normal were defined as the mean plus 2 SDs for awake and sleep ambulatory blood pressure monitoring results at each stage.Results: Average awake upper limits of normal were 130/77, 132/79, 133/81, and 135/86 mm Hg at the four stages of pregnancy, respectively. Systolic blood pressure fell significantly by 12% to 14% (p < 0.0001) and diastolic blood pressure by 18% to 19% (p < 0.0001) during sleep at all stages of pregnancy. Awake ambulatory blood pressure monitoring systolic measurements were 11 to 12 mm Hg higher than "clinic" measurements (p < 0.001) and diastolic measurements were 5 to 11 mm Hg higher (p < 0.0001) throughout pregnancy. Maximum blood pressure variability ranged from 8 to 13 mm Hg.Conclusions: The upper limits of normal ambulatory blood pressure monitoring-derived measurements rise slightly as pregnancy progresses. Awake measurements are higher than "clinic" measurements recorded under relaxed conditions by a clinical researcher. The diurnal blood pressure fall and variabilities are similar during pregnancy to those seen in nonpregnant subjects. These data should provide valuable references for further studies of ambulatory blood pressure monitoring in high risk pregnancies. [ABSTRACT FROM AUTHOR]

Elective endoscopy resumed in our outpatient ambulatory center after instituting the preprocedure policy of a confirmed negative coronavirus disease 2019 (COVID-19) reverse transcriptase polymerase chain reaction (RT-PCR) status performed 72 hours before a scheduled procedure as mandated by the state of Illinois. In addition, all patients were required to contemporaneously complete the American Society for Gastrointestinal Endoscopy (ASGE) COVID-19 risk screening questionnaire published April 28, 2020 as outlined in the ASGE guidance document for reopening GI endoscopy during the COVID-19 pandemic. The aim of our study is to report the outcomes of 1000 patients who successfully completed the clinical aspects of the ASGE COVID-19 risk screening questionnaire and whose RT-PCR tests were valid for interpretation. Data were retrospectively collected from patient medical records for demographics, symptom responses to the preprocedure ASGE COVID-19 risk screening questionnaire, and RT-PCR test results of patients scheduled to undergo an elective outpatient endoscopy at Rockford Gastroenterology Associates from May 22 through June 28, 2020. Descriptive statistics and standard calculation methods to determine both positive and negative predictive values were used for data analysis. Eight of 1000 patients included in the study tested positive for COVID-19. Three of 8 patients reported 1 or more symptoms on the ASGE COVID-19 risk screening questionnaire. One hundred nineteen additional patients reported symptoms on the ASGE COVID-19 risk screening questionnaire but tested negative for COVID-19. The positive and negative predictive values of the ASGE COVID-19 risk screening questionnaire were 2.46% and 99.43%, respectively. The low incidence of COVID-19 infection in a community-based ambulatory surgery center is supported by a positive RT-PCR test rate of.80%. Absence of symptoms on the ASGE COVID-19 risk screening questionnaire was highly predictive of a negative RT - PCR test (99.43% negative predictive value), whereas the positive predictive value was low (2.46%) in symptomatic patients. A positive RT-PCR test was invaluable in preventing 5 asymptomatic patients from undergoing endoscopy. Similarly, 119 symptomatic patients underwent endoscopic evaluation who would have otherwise been excluded without RT-PCR testing. Symptom-based screening alone should not be the primary preprocedural assessment tool in selecting patients for undergoing endoscopy during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Lilly pilly (LP) fruit (Syzygium paniculatum Gaertn.) is widely grown in eastern Australia and has been used as food by indigenous Australians. However, there is limited information on its bioactivity. This study investigated the physicochemical and antioxidant properties of the crude fruit extract, identified its bioactive compounds and also assessed its potential anti-proliferative effect on pancreatic cancer cells. Our data showed that the LP extract was water-soluble and possessed a total phenolic content of 96 mg of gallic acid equivalents (GAE)/g, flavonoid levels of 52 mg catechin equivalents (CAE)/g, proanthocyanidin levels of 29 mg CAE/g. Several phenolic compounds such as gallic acid, chlorogenic acid, catechin and epicatechin were identified in the LP extract with levels of 0.39, 2.35, 0.47 and 2.9 mg/g, respectively. Results from six different antioxidant assays revealed that the LP extract pocessed potent antioxidant and free radical scavenging capacity. Although antioxidant capacity of the extract was lower than that of vitamin E, vitamin C and BHT, it could be significantly improved if the extract was to be further purified. We also showed that the LP extract (200 μg/mL) significantly reduced the viability of MiaPaCa-2 and ASPC-1 pancreatic cancer cells to levels comparable to that of the chemotherapeutic agent gemcitabine. For this reason lilly pilly should be further investigated for its health promoting and potential anti-cancer benefits, particularly for pancreatic cancer. [ABSTRACT FROM AUTHOR]

Cervical cancer is a major public health concern in Morocco where it represents the second most common and lethal cancer in women. Human papillomavirus (HPV) vaccines have been licensed in Morocco since 2008 but there is no available data on their acceptability. This study aimed to assess awareness of HPV and the vaccine, and to identify factors associated with acceptability of the vaccine among parents in Morocco. A questionnaire-based survey using face-to-face interviews was conducted in a sample of 852 parents (670 mothers and 182 fathers) with at least one unmarried daughter ≤26 years. The study took place within public and private health centres and clinics in four regions in Morocco between July and August 2012. The main outcome measure was willingness to consider vaccinating a daughter against HPV. Responses revealed very low awareness of HPV infection (5%) and the HPV vaccine (14%). None of the participants had vaccinated their daughters against HPV and only 35% (32% of mothers and 45% of fathers) were willing to consider doing so in the future. Higher education and income, previous awareness of the HPV vaccine and endorsement of the belief that a recommendation from the ministry of health or a doctor to have the vaccine would be encouraging, were associated with mothers' HPV vaccine acceptance. Non-acceptance among mothers was associated with having more than two daughters, believing the vaccine was expensive and lack of information. The only factor associated with the fathers' acceptance of the vaccine was the cost. Increasing HPV and HPV vaccine awareness through educational campaigns, along with active recommendation by physicians and a publically funded vaccination programme could increase parental acceptance of the vaccine in Morocco. [ABSTRACT FROM AUTHOR]

Abstract: The leaves of Carica papaya are generally considered waste but their extracts have been linked with various health benefits. This study aimed to optimize extraction conditions and determine the effect of aqueous extraction on the yield of polyphenols from papaya leaves. The efficiency of water extraction was compared to the organic solvents acetone, ethanol and methanol. A method to prepare crude powder from the leaves was developed, with its composition and antioxidant properties also examined. We show that temperature, extraction time and water-to-leaf ratio had significant effects on the extracted polyphenol yield as well as the scavenging and total antioxidant activities. Optimal extraction conditions were 70°C for 20min, with a water-to-leaf ratio of 100:7.5mL/g. Higher levels of polyphenols were extracted using water in comparison to the organic solvents, while ethanol extraction provided the highest level of saponins. A simple and scalable method was developed to obtain approximately 190g of powder from 1kg of dried papaya leaves. The crude powder contained 6.3% polyphenols, and when compared to butylated hydroxytoluene (BHT), Vitamins C and E and epigallocatechin gallate (EGCG) had lower scavenging and total antioxidant activity. However, as this method used water for extraction, it is considered safe and offers great potential for further purification and application in future studies. [Copyright &y& Elsevier]

Abstract: Pancreatico-pleural fistula is an uncommon cause of recurrent pleural effusion. Delayed diagnosis may occur if fluid amylase level is not obtained early in the clinical course. As most cases of pancreatico-pleural effusion are due to chronic pancreatitis, endoscopic therapy may be effective if pancreatic fluid secretion can be diverted to a more physiologic pathway. However, when severe pancreatitis leads to disconnection of the pancreatic duct, it precludes conventional endoscopic treatment via transpapillary stenting of the pancreatic duct. We describe a patient with a chronic, refractory pancreatico-pleural fistula arising from chronic pancreatitis with a disconnected pancreatic duct syndrome, which resolved following endoscopic ultrasound-guided therapy. [Copyright &y& Elsevier]

Objectives: This observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy. Study design: Four groups of non-pregnant women (n=18), pregnant controls (n=25), women with gestational hypertension (n=21) and preeclampsia (n=10) were included. Main outcome measures: Maternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy. Results: Higher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r=-.51, p<0.01 and r=-.49, p<0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r=-.35, p=0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r=-0.33, p=0.03). Conclusions: It seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy. Study design: Four groups of non-pregnant women (n =18), pregnant controls (n =25), women with gestational hypertension (n =21) and preeclampsia (n =10) were included. Main outcome measures: Maternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy. Results: Higher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r =−.51, p <0.01 and r =−.49, p <0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r =−.35, p =0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r =−0.33, p =0.03). Conclusions: It seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase. [Copyright &y& Elsevier]

Summary: Objective: To investigate the effects of a matrix metalloproteinase (MMP) inhibitor on joint pathology and pain behavior in the rat meniscal transection (MNX) model of osteoarthritis (OA) and evaluate which aspects of structural disease modification contribute to symptom improvement. Methods: OA pathology was induced in male Lewis rats, by transecting the medial collateral ligament with (MNX) or without (SHAM) a full thickness cut through the meniscus. MNX animals were orally administered an equipotent MMP 2, 8, 9, 12, 13 inhibitor (0.25, 1 and 5mg/kg/day) or vehicle from day 1. Chondropathy, osteophytosis, osteochondral vascularity were assessed from toluidine blue stained coronal sections of the total knee joint and weight-bearing asymmetry by incapacitance. Group differences were evaluated using 1-way analysis of variance (ANOVA) and associations as Spearman''s correlation coefficients. Results: Treatment with the MMP inhibitor reduced weight-bearing asymmetry from day 14 onwards, and attenuated chondropathy (both P <0.05). Osteochondral vascularity was elevated in MNX compared with SHAM-operated animals (P <0.001) and reduced, dose-dependently, by MMP inhibitor treatment (r =−0.89, P <0.05). Reduced osteochondral vascularity and chondropathy were associated with the amelioration of weight-bearing asymmetry (both P <0.05). Conclusion: Here we show that treatment with a MMP inhibitor reduces joint damage, osteochondral angiogenesis and behavioral evidence of pain. The association between osteochondral angiogenesis and pain behavior may be explained by perivascular nerve growth or stimulation of subchondral nerves following loss of osteochondral integrity. Our data suggest that targeting angiogenesis may have utility in the treatment of pain associated with structural damage in OA. [Copyright &y& Elsevier]

Summary: Objective: We have previously described angiogenesis at the osteochondral junction and in synovium of knees from patients with osteoarthritis (OA), but little is known about how closely animal models of OA resemble human disease with respect to vascular growth. This study aimed to characterise two animal models of knee OA with particular respect to osteochondral and synovial angiogenesis. Method: We examined the spontaneous Dunkin–Hartley (DH) guinea pig and medial meniscal transection (MNX) rat models of OA. Vessels at the osteochondral junction and in the synovium were identified by lectin immunohistochemistry and quantified by computer-assisted image analysis. Disease severity was assessed using a scoring system. Results: Blood vessels crossed the osteochondral junction in juvenile rats and guinea pigs, with higher densities in the lateral than medial tibial plateau, the number decreasing with maturation in the absence of other OA changes. In the rat model, increased vascular density was observed both at the osteochondral junction and in the synovium, whilst osteochondral vascularity in control rats decreased with maturation, OA rats showed a persistence of blood vessels at the osteochondral junction. In rat synovium, blood vessel fractional area was increased in the hypertrophied synovium 14 days after surgery, then decreased to control levels by day 28. Significant differences in vascularity were not observed between affected (medial) and spared (lateral) compartments of guinea pig knees. Conclusion: The rat meniscal transection model of OA reproducibly displays both osteochondral and synovial angiogenesis comparable to our previous observations in human knee OA. DH guinea pigs, by contrast, display low vascularity throughout their protracted course of OA development. Changes in vascularisation occur early during the development of OA in the rat, and may contribute to the pathogenesis of OA. [Copyright &y& Elsevier]

Abstract: DNA profiling of biological trace evidence has been used for many years. The application of this technique specifically to the DNA profiling of earprints has not to date been thoroughly investigated. This report presents the results of 60 earprints collected from three healthy adult volunteers under controlled laboratory conditions. DNA profile analysis revealed that high levels of non-donor alleles are observed when earprints are collected for DNA profiling. The source of these non-donor alleles is investigated and the impact that their presence within the profile may have on the use of this technique is discussed. [Copyright &y& Elsevier]

Abstract: Background: The shortage of pharmacists across the nation has been much publicized and has been identified as one of the reasons for new schools of pharmacy to open or for existing colleges and schools of pharmacy to increase their class sizes. This article represents the assessment of a new school of pharmacy''s evaluation of staffing and practice in its geographic area. Objective: This survey represents the first data point within the School of Pharmacy assessment plan and will be repeated at several intervals after the program opens to longitudinally evaluate its impact on pharmacy staffing and services within West Virginia. Methods: Using a modified Dillman survey methodology a random sample of 548 pharmacists in West Virginia, approximately one-third the active roster, were surveyed regarding staffing and services in West Virginia. Results: A response rate of 32.78% was achieved and findings indicated that there is a staffing shortage of pharmacists within West Virginia, that staffing impacts the services pharmacists provide, and that more pharmacists would be willing to offer disease management services if staffing levels were at appropriate levels. Conclusions: A shortage of pharmacists does exist in West Virginia and it has implications on patient care. Longitudinal evaluation of the impact of a new pharmacy program will be conducted and the staffing and services within West Virginia should be continued to be studied. [Copyright &y& Elsevier]

Fuel moisture content (FMC) is used in forest fire danger models to characterise the moisture status of the foliage. FMC expresses the amount of water in a leaf relative to the amount of dry matter and differs from measures of leaf water content which express the amount of water in a leaf relative to its area. FMC is related to both leaf water content and leaf dry matter content, and the relationships between FMC and remotely sensed reflectance will therefore be affected by variation in both leaf biophysical properties. This paper uses spectral reflectance data from the Leaf Optical Properties EXperiment (LOPEX) and modelled data from the Prospect leaf reflectance model to examine the relationships between FMC, leaf equivalent water thickness (EWT) and a range of spectral vegetation indices (VI) designed to estimate leaf and canopy water content. Significant correlations were found between FMC and all of the selected vegetation indices for both modelled and measured data, but statistically stronger relationships were found with leaf EWT; overall, the water index (WI) was found to be most strongly correlated with FMC. The accuracy of FMC estimation was very low when the global range of FMC was examined, but for a restricted range of 0–100%, FMC was estimated with a root-mean-square error (RMSE) of 15% in the model simulations and 51% with the measured data. The paper shows that the estimation of live FMC from remotely sensed vegetation indices is likely to be problematic when there is variability in both leaf water content and leaf dry matter content in the target leaves. Estimating FMC from remotely sensed data at the canopy level is likely to be further complicated by spatial and temporal variations in leaf area index (LAI). Further research is required to assess the potential of canopy reflectance model inversion to estimate live fuel moisture content where a priori information on vegetation properties may be used to constrain the inversion process. [Copyright &y& Elsevier]

Wildland fires burn large areas of the earth''s land surface annually, causing significant environmental damage and danger to human health. In order to mitigate the effects, and to better manage the incidence of such fires, fire behaviour models are used to predict, among other things, the likelihood of ignition, the rate of spread, and the intensity and duration of burning. A key input parameter to these models is the amount of water in the vegetation, described as the fuel moisture content (FMC). A number of studies have shown that vegetation indices (VI) calculated from red and NIR reflectances may be used to map spatial and temporal variation in FMC in a range of fire-prone environments, with varying degrees of success. Strong empirical relationships may be established between VI and FMC over grasslands, yet over shrublands and forests, the relationships are weaker. If FMC is to be estimated with greater accuracy and consistency than is currently achieved, it is necessary to fully understand the relative contribution that spatial and temporal variation in the various biophysical and geometrical variables make to reflectance variability at the leaf and canopy level.This paper uses a modelling approach to investigate the sensitivity of reflectance data at leaf and canopy level to variation in the biophysical variables that are used to compute FMC. At the leaf level, the results show that the sensitivity of reflectance to variation in leaf water and dry matter content, used to compute FMC, is greatest in the SWIR and NIR, respectively. Variation in FMC has no effect in the visible wavelengths. At the canopy level, the results show that the sensitivity of reflectance to variation in leaf water and dry matter content is heavily dependent upon the type of model used and the range of variation over which the variables are tested. In the longer wavelengths of the SWIR, the competing influence of variable leaf area index, fractional vegetation cover, and solar zenith angle is shown to be greater than that at the shorter wavelengths of the SWIR and NIR. Empirical relationships between the normalised difference water index (NDWI) and FMC are shown to be weaker than that with canopy water content. However, when the range of the variables under study is more limited, useful empirical relationships between FMC and remotely sensed VI may be established. [Copyright &y& Elsevier]

Examines whether parameters of 24-hour blood pressure monitoring could predict development of preeclampsia or gestational hypertension in at-risk women. Blood pressure readings in women with usual and high risk of developing the disorders; Differences in awake and sleeping blood pressure.

Discusses the vascular reactivity in phases of normal menstrual cycles and anovulatory cycles of women taking oral contraceptives and compares vascular reactivity of women in the follicular phase of the normal menstrual cycle with that of men of a similar age group. Measurement of forearm blood flow with plethysmography; Response of women taking oral contraceptives to angiotensin II; Greater vascular reactivity of men to norepinephrine than do women.

Analyzes the fecal porphyrins in river otters collected from an oiled area in Prince William Sound in the U.S. Examination of significance of combined probabilities; Difference in physiological response of river otters between oiled and nonoiled areas.

Summary: Cathepsin K is a cysteine proteinase which is believed to contribute to osteoarthritis (OA) pathogenesis. This brief report evaluates the effect of the novel selective cathepsin K inhibitor AZ12606133 on cartilage metabolism in the Dunkin–Hartley guinea pig model of spontaneous OA. In parallel, electrophysiological studies were performed to determine whether acute and chronic treatment with the cathepsin K inhibitor could alter joint nociception. Acute treatment of OA knees with AZ12606133 had no effect on joint afferent nerve activity; however, prolonged (1 month) administration of the cathepsin K inhibitor delivered via a chronically implanted osmotic pump significantly reduced mechanosensitivity in response to both non-noxious and noxious joint movements. Urinal concentrations of the cartilage breakdown products cross-linked C-telopeptides of type II collagen (CTXII) were also reduced by chronic cathepsin K inhibition. These data suggest that prolonged AZ12606133 administration can reduce cartilage turnover and joint nociception in the Dunkin–Hartley guinea pig model of spontaneous OA. [ABSTRACT FROM AUTHOR]

As an island continent, Australia experiences diversified climatic conditions, giving a unique botanical diversity with many plants native to Australia. Australian flora including native fruits have been used for many years as food and medicine. Many native fruits have unique qualities and potential uses as functional ingredients. Among the native fruits, eleven prominent native species have been commercially produced in Australia including bush tomato, Davidson's plum, desert lime, finger lime, Kakadu plum, lemon aspen, muntries, quandong, Tasmanian pepper berry, and Illawarra plum. As the global demand for high quality and functional natural products is steadily growing, native fruits have great opportunities to be used as a rich source of nutrients, flavouring and colouring agents, natural preservatives and functional ingredients. This review outlines production, highlights the nutritive and bioactive components, reviews traditional and current uses, and discusses potential applications of the eleven commercialised Australian native fruits for future utilisation and research. [ABSTRACT FROM AUTHOR]

Mechanistic target of rapamycin (mTOR) is a central regulator of cell growth, proliferation, survival and metabolism. mTOR inhibition is increasingly used in antitumoral therapies and mTOR inhibition with rapamycin was shown to be cardioprotective during aging and cardiac stress. Studies in genetic mice models have shown that mTOR is essential for heart development and cardiac function in adult. However, mTOR functions during postnatal cardiac development are not fully elucidated. We have therefore generated a cardiac-specific mTOR knockout mouse using α-MHC-Cre mice leading to mTOR inactivation in early postnatal mouse myocardium. The mutant mice develop a severe lethal dilated cardiomyopathy due to defects in cardiomyocyte growth, survival and subsequent fibrosis. In contrast to adult myocardium, both mTORC1 and mTORC2 activities are impaired in juvenile heart, as shown by hypophosphorylation of the translation inhibitor 4E-BP1 and loss of the cardioprotective AKTS473 phosphorylation. We find that translation initiation defects and altered ribosome biogenesis both contribute to impaired cardiomyocyte growth. In addition, we show that increased apoptosis is associated with activation of JNK kinase and p53 accumulation. Moreover mTORcmKO hearts display a strong decreased expression of the primary oxygen carrier, myoglobin, and HIF1α accumulation suggesting hypoxia. However, mTORcmKO hearts do not display HIF1 hypoxic response consistently with mTOR being essential for HIF1-dependant trancriptionnal activity. These observations indicate that hypoxia-induced apoptosis likely contribute to DCM in mTORcmKO mice. Altogether, our results demonstrate that mTOR is a key regulator of cardiomyocyte growth, viability and oxygen supply in early postnatal myocardium. Our findings highlight potential cardiotoxicity of new mTOR inhibitors and the importance to set up optimal treatments in cardiology to both target mTOR hypertrophic functions and maintain adequate oxygen supply. [ABSTRACT FROM AUTHOR]

Summary Objectives The purpose of the current study was to determine whether or not presenting patients with a video model improves efficacy of the assessment as defined by efficiency and decreased variability in trials during the acoustic component of voice evaluations. Methods Twenty pediatric participants with a mean age of 7.6 years (SD = 1.50; range = 6–11 years), 32 college-age participants with a mean age of 21.32 years (SD = 1.61; range = 18–30 years), and 17 adult participants with a mean age of 54.29 years (SD = 2.78; range = 50–70 years) were included in the study and divided into experimental and control groups. The experimental group viewed a training video prior to receiving verbal instructions and performing acoustic assessment tasks, whereas the control group received verbal instruction only prior to completing the acoustic assessment. Primary measures included the number of clinician cues required and instructional time. Standard deviations of acoustic measurements (eg, minimum and maximum frequency) were also examined to determine effects on stability. Results Individuals in the experimental group required significantly less cues, P  = 0.012, compared to the control group. Although some trends were observed in instructional time and stability of measurements, no significant differences were observed. Conclusions The findings of this study may be useful for speech-language pathologists in regard to improving assessment of patients' voice disorders with the use of video modeling. [ABSTRACT FROM AUTHOR]