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Oncoplastic breast conserving surgery (BCS) frequently induces asymmetry. Contralateral reduction mammoplasty (CRM) is therefore part of the oncoplastic approach. Our patients frequently declined CRM when offered as a second-stage procedure after the completion of adjuvant treatments. This qualitative interview study was conducted to explore the factors involved in patient decision-making about CRM. From the prospective hospital database of patients who underwent oncoplastic BCS for stage I-III breast cancer since 2010, 25 patients were sampled using stratified purposeful sampling on age, preoperative cup size, and time elapsed since the completion of adjuvant treatments. Nine had undergone CRM. Individual face-to-face semi-structured interviews were conducted at the hospital or at patients' homes. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data saturation occurred after analysis of the fifth interview, although variability within the data kept expanding until the last interview was coded. Eighteen patients reported postoperative breast asymmetry. Breast symmetry was important to our patients and information provision about CRM had been adequate. The following factors motivated patients to choose CRM: perceivable asymmetry, satisfaction with the outcome of oncoplastic BCS, and the wish for breast reduction before cancer diagnosis. Patients weighed these considerations against their concerns about surgery risks and recovery time. Reluctance to have nonessential surgery to the unaffected breast was an important reason to decide against CRM. Breast asymmetry is often tolerated after oncoplastic BCS because of concerns about surgery risks and recovery time and reluctance to have nonessential surgery to the healthy breast. [ABSTRACT FROM AUTHOR]

Abstract Background Immunocompromised travellers (ICTs) are at increased risk of travel-related health problems. Therefore, they are advised to attend specialised pre-travel clinics for advice on vaccination, malaria chemoprophylaxis and on-demand antibiotics. However, studies yield conflicting data regarding travel-related health problems encountered by ICTs; questioning the rationale for certain advices, and particularly the advice of on-demand antibiotics. Objective To evaluate self-reported travel-related health problems, antibiotic use, medical visits and risk behaviours in ICTs and controls. Methods We conducted a questionnaire-based observational study with pilot character. We recruited participants from a (medical) pre-travel clinic. Telephone interviews were conducted 2–4 weeks post-travelling, applying a structured questionnaire. Results We included 30 ICTs and 30 controls. More ICTs than controls reported travel-related health problems, antibiotic use and medical visits, although not statistically significant. Travellers' diarrhoea appeared to be more severe in ICTs. Furthermore one ICT was hospitalized post-travel due to pneumonia. Of ICTs, 2/30 (7%) used on demand antibiotics while not indicated (according to the protocol of the Dutch national coordinating centre for travel advice or prescribed by a physician). Reversely, 6/30 (20%) did not use on demand antibiotics while actually indicated according to this protocol. Discussion Our findings substantiate the recommendation of on demand antibiotics. However, ICTs did often not use on demand antibiotics correctly; they therefore need very careful instructions. [ABSTRACT FROM AUTHOR]

Background Invasive pneumococcal disease (IPD) is associated with high morbidity and mortality, with immunocompromised patients (ICPs) at particular risk. Therefore, guidelines recommend pneumococcal vaccination for these patients. However, guidelines are scarcely underpinned with references to incidence studies of IPD in this population. This, potentially results in unawareness of the importance of vaccination and low vaccination rates. The objective of this systematic review and meta-analysis was to assess the incidence of IPD in ICPs. Methods We systematically searched PubMed and Embase to identify studies in English published before December 6th, 2017 that included terms related to ‘incidence’, ‘rate’, ‘pneumococcal’, ‘pneumoniae’, ‘meningitis’, ‘septicemia’, or ‘bacteremia’. We focused on patients with HIV, transplantation and chronic inflammatory diseases. Results We included 45 studies in the systematic review reporting an incidence or rate of IPD, defined as isolation of Streptococcus pneumoniae from a normally sterile site. Random effects meta-analysis of 38 studies showed a pooled IPD incidence of 331/100,000 person years in patients with HIV in the late-antiretroviral treatment era in non-African countries, and 318/100,000 in African countries; 696 and 812/100,000 in patients who underwent an autologous or allogeneic stem cell transplantation, respectively; 465/100,000 in patients with a solid organ transplantation; and 65/100,000 in patients with chronic inflammatory diseases. In healthy control cohorts, the pooled incidence was 10/100,000. Discussion ICPs are at increased risk of contracting IPD, especially those with HIV, and those who underwent transplantation. Based on our findings, we recommend pneumococcal vaccination in immunocompromised patients. Prospero registration ID: CRD42016048438. [ABSTRACT FROM AUTHOR]

Background The acute phase of chikungunya is well documented; less so are its long-term effects. This systematic literature review provides an overview of the currently available data. Methods We performed an electronic search in PubMed/Medline and checked reference lists. We included studies in English on long-term sequelae of chikungunya in adults and on long-term sequelae of congenital infection from 2000 to 2016. Case reports, reviews and studies with a follow-up shorter than 6 weeks were excluded. Results In total, 37 studies were included; with follow-up periods ranging from 1.5 to 72 months. Most studies were questionnaire-based studies only, in which clinical diagnoses such as arthritis, alopecia and depression were mostly recorded without professional verification. Persisting arthralgia/arthritis (arthralgia/joint stiffness plus joint swelling) was the most frequent problem encountered. Further frequently mentioned sequelae were alopecia and depression. Quality of life was reduced in many for months to years after the acute phase of chikungunya. Female gender, older age, some co-morbidities and the severity of the acute phase were associated with persistent arthralgia. Congenital infection was associated with neurocognitive dysfunctioning in early childhood. Conclusion Chikungunya leads to (self-perceived) long-term sequelae in a considerable proportion of patients, impacting significantly on quality of life. Long-term chikungunya sequelae must be taken into account when dealing with this disease because of its important effect on public and individual health. Prospective large-scale, long-term studies with objective assessment of signs and symptoms attributed to the disease are needed to optimally quantify and qualify these problems. [ABSTRACT FROM AUTHOR]

Armed conflict increases people's vulnerability to climate extremes. Since many of these climate extremes are predictable beforehand, Early Warning Early Action (EWEA) can help protect people's lives, livelihoods, and wellbeing. While such EWEA systems exist in several countries, there is limited scientific knowledge about EWEA in conflict-affected countries where communities experience the compounding effects of both disaster and conflict risks. By doing a retrospective analysis of the most severe disaster events and historical forecast information, this paper examines whether global forecast models predicted historical floods in conflict-affected regions and whether forecast information was communicated for droughts . It analyses the historical forecast availability and communication for the most severe disaster events in 20 countries affected by protracted conflict over the last 20 years. These 72 disaster events were reported to affect approximately 150 million individuals and more than 150,000 were reported dead. The results show that heavy rainfall was predicted in advance for 48 out of 50 flood events, with lead times of more than three days and probabilities between 10 and 90%. In addition, in 16 out of 20 major drought events a low rainfall forecast was communicated in advance of the disaster declaration. We conclude that forecasts exist and could be used to provide early warnings in conflict-affected areas. Further research is needed as to what extent forecast warnings did lead to early action to protect populations affected by conflict. [ABSTRACT FROM AUTHOR]

The aim of this study was to propose a classification for unilateral cleft lip and palate (UCLP) malformations based on cone beam computed tomography (CBCT) images, as well as to estimate the amount of bone necessary for grafting, and to evaluate the relationship of this volume with scores obtained using the classification. CBCT images of 33 subjects with UCLP were evaluated according to gap, arch, nasal, and dental parameters (GAND classification). Additionally, these defects were segmented and the amount of graft needed for alveolar bone grafting was estimated. The reproducibility of GAND classification was analyzed by weighted kappa test. The association of volume assessment with the classification (gap and nasal parameters) was verified using analysis of variance, while the intra-observer agreement was analyzed using the intra-class correlation coefficient. The intra-observer reproducibility of the classification ranged from 0.29 to 0.92 and the inter-observer agreement ranged from 0.29 to 0.91. There were no statistically significant values when evaluating the association of the volume with the classification ( P > 0.05). The GAND classification is a novel system that allows the quick estimation of the extent and complexity of the cleft. It is not possible to estimate the amount of bone needed for alveolar bone grafting based on the classification; individualized surgical planning should be done for each patient specifically. [ABSTRACT FROM AUTHOR]

During the first trimester, normal placental development occurs in a low oxygen environment that is known to stimulate angiogenesis via upregulation of vascular endothelial growth factor (VEGF). Expression of the placental renin-angiotensin system (RAS) is highest in early pregnancy. While the RAS and oxygen both stimulate angiogenesis, how they interact within the placenta is unknown. We postulated that low oxygen increases expression of the proangiogenic RAS pathway and that this is associated with increased VEGF in a first trimester human trophoblast cell line (HTR-8/SVneo). HTR-8/SVneo cells were cultured in one of three oxygen tensions (1%, 5% and 20%). RAS and VEGF mRNA expression were determined by qPCR. Prorenin, angiotensin converting enzyme (ACE) and VEGF protein levels in the supernatant, as well as prorenin and ACE in cell lysates, were measured using ELISAs. Low oxygen significantly increased the expression of both angiotensin II type 1 receptor (AGTR1) and VEGF (both P < 0.05). There was a positive correlation between AGTR1 and VEGF expression at low oxygen (r = 0.64, P < 0.005). Corresponding increases in VEGF protein were observed with low oxygen (P < 0.05). Despite no change in ACE1 mRNA expression, ACE levels in the supernatant increased with low oxygen (1% and 5%, P < 0.05). Expression of other RAS components did not change. Low oxygen increased AGTR1 and VEGF expression, as well as ACE and VEGF protein levels, suggesting that the proangiogenic RAS pathway is activated. This highlights a potential role for the placental RAS in mediating the proangiogenic effects of low oxygen in placental development. [ABSTRACT FROM AUTHOR]

Against a background of discourses that link economic vitality of city-centres, consumption and safety to greater need for surveillance and policing, the current study takes particular interest in the city-centre night-time economy (NTE). This is a distinctive space–time where significant increases in surveillance and policing can be witnessed across cities in Europe and beyond. It is not evident, however, if and to what extent such interventions increase subjectively experienced safety and reduce fear of crime among people visiting city-centre bars and clubs on their nights out. Drawing on existing literatures on the NTE in cities, emotional geography, studies of surveillance and policing and the authors’ previous research, this study develops a ‘thicker’ and situational quantitative approach to examining the effects on subjectively experienced safety of different manifestations of surveillance and policing in the NTE context. The visible proximity of police officers and door staff of bars and clubs are shown to have stronger effects on experienced safety than the positioning of CCTV and whether their footage is watched live or not. Nonetheless, the effects of surveillance and policing on experienced safety are rather complex insofar that they are to a considerable extent relational in nature and also ambiguous. For instance, a key difference between police and door staff is that police officers are more often seen as a friend of everybody and their presence as enhancing experienced safety; responses to door staff are more ambiguous and differentiated along lines of ethnicity. It is also demonstrated that surveillance and policing reduce rather than enhance experienced safety for a minority of the study participants. [ABSTRACT FROM AUTHOR]

Abstract: This paper problematises public artopia, in other words the collection of claims in academic literature concerning the allegedly physical-aesthetic, economic, social, and cultural-symbolic roles of art in urban public space. On the basis of interviews with public-art producers (artists, public officials, investors, and participating residents) in a flagship and a community-art project in Amsterdam, we analyse the situatedness of their public-art claims according to actors’ roles, geographical context, and time. The research suggests that public-art theory and policy suffer from three deficiencies. Theoretical claims about public-art and policy discourse feature, first, a failure to recognise different actors’ perspectives: claims fail to locate situated knowledges that are intrinsically (re)constituted by actors’ roles articulating with one another in time and space. Second is the lack of geographical contextuality: claims do not elaborate appropriately on distinct discourses about art projects’ spatial settings. Third is the lack of temporal perspective. Claims neglect the practice of public-art realisation: that is, the evolution of claims and claim coalitions over the time horizon of the art projects: preparation, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

Familial asphyxiating thoracic dystrophy (ATD), also known as Jeune''s syndrome, is a rare autosomal recessive disorder with variable severity and multiple musculo-skeletal manifestations. Respiratory distress may be severe, resulting in death during infancy. Surgical repair techniques have typically involved median sternotomy (with graft interposition), resulting in poor outcomes. Acquired ATD may rarely result from impairment of chest wall growth following “open” (Ravitch-type) repair of pectus excavatum or carinatum deformities. Symptomatic patients may have profound restriction of pulmonary function. Repair techniques typically involve re-do Ravitch-type procedures or median sternotomy with rib graft interposition. Mild to moderate improvements in pulmonary function tests have been documented. [Copyright &y& Elsevier]

This paper explores the value of using community risk assessments (CRAs) for climate change adaptation. CRA refers to participatory methods to assess hazards, vulnerabilities and capacities in support of community-based disaster risk reduction, used by many NGOs, community-based organizations, and the Red Cross/Red Crescent. We review the evolution of climate change adaptation and community-based disaster risk reduction, and highlight the challenges of integrating global climate change into a bottom-up and place-based approach. Our analysis of CRAs carried out by various national Red Cross societies shows that CRAs can help address those challenges by fostering community engagement in climate risk reduction, particularly given that many strategies to deal with current climate risks also help to reduce vulnerability to climate change. Climate change can also be explicitly incorporated in CRAs by making better use of CRA tools to assess trends, and by addressing the notion of changing risks. However, a key challenge is to keep CRAs simple enough for wide application. This demands special attention in the modification of CRA tools; in the background materials and trainings for CRA facilitators; and in the guidance for interpretation of CRA outcomes. A second challenge is the application of a limited set of CRA results to guide risk reduction in other communities and to inform national and international adaptation policy. This requires specific attention for sampling and care in scaling up qualitative findings. Finally, stronger linkages are needed between organizations facilitating CRAs and suppliers of climate information, particularly addressing the translation of climate information to the community level. [Copyright &y& Elsevier]

Background: Allergic asthma is associated with chronic airway and systemic immune responses. Systemic responses include priming of peripheral blood eosinophils, which is enhanced after allergen challenge. In a subpopulation of asthmatic subjects, neutrophils are associated with bronchial inflammation. Objective: We sought to monitor systemic granulocyte priming in allergic asthmatic subjects as a consequence of chronic and acute inflammatory signals initiated by allergen challenge. Methods: Blood was taken at baseline and 6 to 24 hours after allergen challenge in asthmatic subjects with and without late asthmatic responses. Systemic granulocyte priming was studied by using expression of cellular markers, such as α-chain of Mac-1 (αm)/CD11b, L-selectin/CD62L, and an activation epitope present on FcγRII/CD32 recognized by monoclonal phage antibody A17. Results: Eosinophils of asthmatic subjects have a primed phenotype identified by cell-surface markers. Neutrophils of these patients were subtly primed, which was only identified after activation with N-formyl-methionyl-leucyl-phenylalanine. After allergen challenge, an acute increase in eosinophil priming characterized by enhanced expression of activated FcγRII was found in patients experiencing a late asthmatic response and not in patients with a single early asthmatic response. In contrast, expression of αm/CD11b and L-selectin on granulocytes was not different between control and asthmatic subjects and was not affected by allergen challenge. Interestingly, expression of both adhesion molecules was positively correlated, and αm expression on eosinophils and neutrophils correlated positively with bronchial hyperresponsiveness. Conclusion: Different phases, phenotypes, or both of allergic asthma are associated with distinct priming profiles of inflammatory cells in peripheral blood. Clinical implications: Insight in differences of systemic innate responses will lead to better definition of asthma subtypes and to better designs of new therapeutic options. [Copyright &y& Elsevier]

An improved in vitro method for the evaluation of antacids for use with standard equipment is described. The method is a modification of an older method (RIGO method) and has in vivo relevance. The improved method uses USP dissolution test apparatus 2 with a stirring rate of 125 rpm in combination with a computerized automatic burette. The test solution is 250 ml 0.02 M HCl. A total of 20 min after addition of an antacid to the test solution titration starts at a constant speed of 2.0 ml/min 0.1 M HCl. The proposed acceptance criteria for a waiver for clinical studies are: pH after 4 min not less than 2.5 to ensure a rapid onset of effect, pH after 20 min not exceeding 7.0 to ensure that the pH in the stomach remains within physiological values, buffering capacity between pH 2.5 and 4.5 not less than 8 meq/dose and neutralizing capacity not less than 10 meq/dose to ensure sufficient efficacy within the physiological range. The improved method has been validated with respect to robustness to variations in sample preparation, repeatability and intermediate precision and has been cross-validated versus the RIGO method. The improved method has been found to be rather insensitive to variations in sample pretreatment and at least equivalent to the RIGO method. [Copyright &y& Elsevier]

Frailty has been associated with postoperative complications and mortality across surgical specialties, including vascular surgery. However, the influence of frailty on postoperative functional outcomes is unclear. We sought to determine the influence of frailty on functional outcomes after open or endovascular vascular procedures in patients with peripheral arterial disease. This systematic review was conducted according to the PRISMA guidelines. Eligible articles were identified through database searches of Pubmed and EMBASE in April 2017. Studies reporting on frailty and functional outcomes after vascular interventions for peripheral artery disease (PAD) were included. Outcomes of interest were dependency in activities of daily living (ADL), dependent mobility, discharge destination, disability-free survival, and quality of life. Individual studies were assessed for quality and risk of bias using the Quality in Prognosis Studies tool. Eight studies met the eligibility criteria and were included. The risk of bias was low in two studies, intermediate in three studies, and high in three studies. Methods for frailty assessment were different for each study. Frailty was a predictor for discharge to a higher level of care, dependent mobility, and dependency in ADL after vascular procedures for PAD. Both frailty models and individual frailty characteristics seem to be associated with these adverse functional outcomes. Despite a limited amount of literature and an overall intermediate quality of the included studies, this systematic review shows an association between frailty and adverse functional outcomes after peripheral arterial procedures for PAD, including discharge to a care facility, dependent mobility, and a decline in ADL functioning. [ABSTRACT FROM AUTHOR]