Search

Background:The scale of the 2022 global mpox (formerly known as monkeypox) outbreak has been unprecedented. In less than 6 months, non-endemic countries have reported more than 67 000 cases of a disease that had previously been rare outside of Africa. Mortality has been reported as rare but hospital admission has been relatively common. We aimed to describe the clinical and laboratory characteristics and outcomes of individuals admitted to hospital with mpox and associated complications, including tecovirimat recipients. Methods:In this cohort study, we undertook retrospective review of electronic clinical records and pathology data for all individuals admitted between May 6, and Aug 3, 2022, to 16 hospitals from the Specialist and High Consequence Infectious Diseases Network for Monkeypox. The hospitals were located in ten cities in England and Northern Ireland. Inclusion criteria were clinical signs consistent with mpox and MPXV DNA detected from at least one clinical sample by PCR testing. Patients admitted solely for isolation purposes were excluded from the study. Key outcomes included admission indication, complications (including pain, secondary infection, and mortality) and use of antibiotic and anti-viral treatments. Routine biochemistry, haematology, microbiology, and virology data were also collected. Outcomes were assessed in all patients with available data. Findings:156 individuals were admitted to hospital with complicated mpox during the study period. 153 (98%) were male and three (2%) were female, with a median age of 35 years (IQR 30–44). Gender data were collected from electronic patient records, which encompassed full formal review of clincian notes. The prespecified options for data collection for gender were male, female, trans, non-binary, or unknown. 105 (71%) of 148 participants with available ethnicity data were of White ethnicity and 47 (30%) of 155 were living with HIV with a median CD4 count of 510 cells per mm3(IQR 349–828). Rectal or perianal pain (including proctitis) was the most common indication for hospital admission (44 [28%] of 156). Severe pain was reported in 89 (57%) of 156, and secondary bacterial infection in 82 (58%) of 142 individuals with available data. Median admission duration was 5 days (IQR 2–9). Ten individuals required surgery and two cases of encephalitis were reported. 38 (24%) of the 156 individuals received tecovirimat with early cessation in four cases (two owing to hepatic transaminitis, one to rapid treatment response, and one to patient choice). No deaths occurred during the study period. Interpretation:Although life-threatening mpox appears rare in hospitalised populations during the current outbreak, severe mpox and associated complications can occur in immunocompetent individuals. Analgesia and management of superimposed bacterial infection are priorities for patients admitted to hospital.

Objectives This study aimed to explore echocardiographic characteristics of phospholamban (PLN) p.Arg14del mutation carriers to investigate whether structural and/or functional abnormalities could be identified before onset of symptoms. Background Carriers of the genetic PLN p.Arg14del mutation may develop arrhythmogenic and/or dilated cardiomyopathy. Overt disease is preceded by a pre-symptomatic phase of variable length in which disease expression seems to be absent. Methods PLN p.Arg14del mutation carriers with an available echocardiogram were included. Mutation carriers were classified as pre-symptomatic if they had no history of ventricular arrhythmias (VAs), a premature ventricular complex count of Results The final study population consisted of 281 PLN p.Arg14del mutation carriers, 139 of whom were classified as pre-symptomatic. In comparison to control subjects, pre-symptomatic mutation carriers had lower global longitudinal strain and higher LV mechanical dispersion (both p Conclusions Global and regional LV mechanical alterations in PLN p.Arg14del mutation carriers precede arrhythmic symptoms and overt structural disease. Pre-symptomatic mutation carriers with normal deformation patterns in the apex are at low risk of developing VA within 3 years, whereas mutation carriers with apical PSS appear to be at higher risk.

Targeted green light photostimulation during the last stage of broiler incubation increases expression of the somatotropic axis. The purpose of this study was to further shorten the in ovo green light photostimulation and determine the critical age for photostimulation in broilers embryos, as a future strategy for broiler incubation. Fertile broilers eggs (n = 420) were divided into 5 treatment groups. The first group was incubated under standard conditions (in the dark) as the negative control group. The second was incubated under intermittent monochromatic green light using light-emitting diode lamps with an intensity of 0.1 W/m2 at shell level from embryonic day (ED) 0 of incubation until hatch, as a positive control. The third, fourth, and fifth groups were incubated under intermittent monochromatic green light from ED 15, 16, and 18 of incubation, respectively, until hatch. All treatment groups showed elevated somatotropic axis expression compared with the negative control, with the group incubated under monochromatic green light from ED 18 until hatch showing results closest to the positive control. This suggests that broiler embryos can be exposed to in ovo green light photostimulation from a late stage of incubation (when transferring the eggs to the hatchery) and exhibit essentially the same outcome as obtained by photostimulation during the entire incubation period.

Objective: To determine the effects of exercise on individual cardiometabolic syndrome (CMS) risk factors in adults with chronic spinal cord injury (SCI). Data Sources: English language searches of PubMed, Web of Science, EMBASE, and Scopus (January 1, 1970, to July 31, 2019). Study Selection: Articles were included if they met the following criteria: (1) original articles with statistical analysis, (2) participants were adults with a SCI sustained ≥1 year ago, (3) exercise intervention duration ≥2 weeks, and (4) included any CMS risk factor as an outcome. Data Extraction: The methodological quality of articles was assessed using the Downs and Black score. Data Synthesis: Sixty-five studies were included for the final analysis, including 9 studies classified as high quality (≥66.7%), 35 studies classified as fair quality (50%-66.6%), and 21 studies classified as low quality (75% maximum heart rate) appears to improve waist circumference and hepatic insulin sensitivity but appears insufficient for improving fasting glucose, lipid profile, or resting blood pressure. The addition of RT to upper body aerobic exercise may elicit favorable changes in the lipid profile. More high-quality studies are needed to confirm if FES cycling is effective at improving peripheral insulin sensitivity.

Low-egg-producing hens (LEPH) ovulate less frequently than high-egg-producing hens (HEPH) and exhibit differences in mRNA levels for components of the hypothalamo–pituitary–gonadal (HPG) axis, suggesting differential responsiveness to trophic stimulation. Ovulation frequency is governed by the production of the pituitary gonadotropins and feedback of the ovarian follicle steroid hormones, which are regulated by HPG axis stimulation and inhibition at the hypothalamic level. The pituitary and follicle cells from LEPH and HEPH were subjected to in vitro hormonal treatments to stimulate or inhibit the HPG axis, followed by expression analysis of mRNA levels for HPG axis genes and radioimmunoassays for steroid hormone production. Statistical analysis was performed using the mixed models procedure of SAS. The pituitary cells from HEPH showed upregulation of genes associated with ovulation stimulation, whereas cells from LEPH showed upregulation of genes associated with inhibition of ovulation. High-egg-producing hens’ follicle cells displayed a higher sensitivity and responsiveness to gonadotropin treatment. Level of egg production impacted ovulation-related gene expression in the pituitary cells as well as steroid hormone production in the follicle cells, with HEPH displaying a greater positive response to stimulation. These findings indicate that differences in egg production among turkey hens likely involve differential responsiveness of the cells within the HPG axis.

Background context The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. Study design This is a guideline summary review. Methods This guideline is the product of the Low Back Pain Work Group of NASS’ Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. Results Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. Conclusions The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx

Leucine, nutrient signal and substrate for the branched chain aminotransferase (BCAT) activates the mechanistic target of rapamycin (mTORC1) and regulates autophagic flux, mechanisms implicated in the pathogenesis of neurodegenerative conditions such as Alzheimer's disease (AD). BCAT is upregulated in AD, where a moonlighting role, imparted through its redox-active CXXC motif, has been suggested. Here we demonstrate that the redox state of BCAT signals differential phosphorylation by protein kinase C (PKC) regulating the trafficking of cellular pools of BCAT. We show inter-dependence of BCAT expression and proteins associated with the P13K/Akt/mTORC1 and autophagy signalling pathways. In response to insulin or an increase in ROS, BCATc is trafficked to the membrane and docks via palmitoylation, which is associated with BCATc-induced autophagy through PKC phosphorylation. In response to increased levels of BCATc, as observed in AD, amyloid β (Aβ) levels accumulate due to a shift in autophagic flux. This effect was diminished when incubated with leucine, indicating that dietary levels of amino acids show promise in regulating Aβ load. Together these findings show that increased BCATc expression, reported in human AD brain, will affect autophagy and Aβ load through the interdependence of its redox-regulated phosphorylation offering a novel target to address AD pathology.

Scholarly investigations into household food waste have advanced our knowledge of its determinants by focusing on food management behaviors (FMB) and by using the theory of planned behavior (TPB). Drawing on literature from environmental psychology, we created and tested a comprehensive framework that not only encompasses TPB and FMB, but also individual goals and values, which, we argue, can advance understanding of why people waste food. Using a two-wave survey design with a quasi-representative sample of the UK population (N = 1,336 participants), we tested our framework with Structural Equation Modelling (SEM). Broadly, results indicated support for our framework in that individual values were associated with short-term cognitions and participants’ goals, particularly the goal to behave responsibly, which were in turn associated with FMB and intentions; these, finally, were associated with self-reported food waste. Overall, our results indicate that food waste is the result of different cognitive and behavioral processes.

Reef-protected beaches are vulnerable to the effects of sea level rise and degradation of their associated fringing reefs. The SWAN hydrodynamic wave model is combined with classical theory describing the planform of beaches in equilibrium with the wave forcing to estimate the reef top hydrodynamics and the shoreline configuration in the lee of the reefs. Open access Bayesian Belief Networks with high accuracy and simple user interfaces have been built to communicate the results. The BBN enable end users to access all the model results and to compare different scenario to determine how changes in the wave climate or reef elevation change the shoreline configuration. The results show that recession of the shoreline in the lee of fringing reefs due to sea level rise may be much greater than that expected on open coast beaches. Loss of reef flat elevation can also lead to severe shoreline erosion.

In order to meet the projected demand for biomass feedstocks, multiple sources will be needed. Biomass feedstocks are often have a high degree of variability with regards to important properties such as ash, moisture, and energy content. The efficiency of conversion processes may be sensitive to this variability; thus, strategies are needed to ensure that consistent and reliable feedstocks are produced that meet end-user specifications. The objective of this study was to examine the effect of source, blending and hot water extraction (HWE) on the quality of wood pellets. Debarked maple biomass was blended at various rates with whole stem harvested willow, HWE willow, and HWE maple biomass, made into pellets and then compared to existing ISO (17225) pellet standards. Untreated willow pellets were unable to consistently meet key specifications such as ash and moisture. However, pellets blended with either HWE willow, maple or HWE maple at rates between 20 and 50 percent willow still met the most stringent requirements. HWE decreased the ash content of willow below 1% and was on par with untreated maple. HWE increased the energy content of pellets in this study approximately 1 MJ kg−1. Blending and HWE have the potential to decrease variation in feedstock for pellet production and expand the range of material that can be used while still meeting standards for quality. Technologies for rapidly assessing feedstock properties at the front or back end will be needed to maximize the benefits of these two strategies when more variable feedstocks are used.

Objective To determine support for a tax on sugar-sweetened beverages (SSBs) among young Australian adults and the potential impact on SSB consumption if a tax is introduced. Methods Cross-sectional convenience survey of Australians aged 18-30 years sampled in the City of Greater Geelong, Australia, in November-December 2017. Results A total of 1,793 responses were recorded. Overall, 48% supported a tax on SSBs, which increased to 74% and 72% if tax revenue was allocated to subsidising fruit and vegetables or funding community exercise facilities, respectively. If a tax of $0.40/100g of sugar were introduced, 53% of participants would reduce their SSB consumption and most of this group (63%) reported that they would consume more water instead. Participants who consumed SSBs more frequently were less likely to support a tax or reduce their consumption. Gender, obesity and SES were not associated with support for a tax. Conclusions Most young adults supported the idea of a tax on SSBs if tax revenue would be used to support healthy eating or physical activity. If a tax was introduced, most indicated that they would reduce their SSB consumption and substitute water for SSBs. Implications for public health: Policymakers can expect support from young people should an SSB tax be introduced in Australia.

This paper assesses the accuracy of seven empirical models and an explicit Gene-Expression Programming (GEP) model to predict wave runup against a large dataset of runup observations. Observations consist of field and laboratory measurements and include a wide array of beach types with varying sediment sizes (from fine sand to cobbles) and bed roughness (from smooth steel to asphalt). We show that the best performing models in the literature are prone to significant errors (minimum RMSE of 1.05 m and NMSE of 0.23) when used with unseen data, i.e., uncalibrated models; however, overall error values and correlations are significantly reduced when models are optimised for the dataset. The best performing empirical models use a Hunt type scaling with an additional parameter for wave induced setup. The predictive ability of the explicit GEP model, which better captures the complex nonlinear effects of the key factors on the wave runup length, resulted in a statistically significant improvement in predictive capacity in comparison to all other empirical models assessed here, even on unseen data. Wave height, wavelength, and beach slope are shown to be the three primary factors influencing wave runup, with grain size/bed roughness having a smaller, but still significant influence on the runup. The r2 of the best optimised existing models (which takes the form of Holman (1986) and Atkinson et al. (2017) their M2 model) was 0.77, with a RMSE of 0.85 m. These were improved to an r2 of 0.82 (6% increase) and RMSE of 0.75 m (12% decrease) in the GEP-based model. The sensitivity of the proposed GEP-based model to each input variable is assessed via a partial derivative sensitivity analysis. The results demonstrate a higher sensitivity in the model to small values of each input and that wave steepness and beach slope are the primary factors influencing wave runup.

Considering the current obesity epidemic is due in large part to an energy imbalance, it is crucial to explore biological mechanisms that mediate palatable high energy food intake and physical activity behavior levels. Previous research demonstrates a unique sex dependent influence of physical activity on diet preference, specifically changes in palatable high-fat diet intake. Therefore, factors of motivation may be underlying the differential effect of physical activity in male and female rats on their diet preference. The present study extends this hypothesis by assessing diet preference in male and female Wistar rats selectively bred for high (HVR) and low (LVR) levels of voluntary wheel running distances. HVR and LVR rats were housed under either sedentary (SED) or voluntary wheel running access (RUN) conditions for the duration of the study. Following a 1 week acclimation period to these conditions, standard chow was replaced with concurrent ad libitum access to a choice of 3 pelleted diets (high-fat, high-sucrose, and high-corn starch); all 3 were provided in the home cage. Body weight, running distance, and intake of each diet was measured daily. At the conclusion of the 4 week diet preference test, animals were sacrificed and ventral striatum tissue was collected for later analysis. Results demonstrated intake patterns of diets were uniquely influenced by physical activity dependent on both the sex and the selectively bred line of rat. In addition, reward related ventral striatal mRNA expression was also dependent on both the sex and the selectively bred line of rat. Overall, the pattern of both behavioral and mRNA results suggest that voluntary wheel running behavior differentially mediates palatable diet consumption in males and females. Considering the pervasive abundance of both physical inactivity, combined with over-consumption of energy dense palatable diets, it is vital to understand the nature of these behavioral interactions.