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Background: Surgery can lead to significant muscle loss, which increases recovery time and associates with increased mortality. Muscle loss is not uniform, with some patients losing significant muscle mass and others losing relatively little, and is likely to be accompanied by marked changes in circulating metabolites and proteins. Determining these changes may help understand the variability and identify novel therapeutic approaches or markers of muscle wasting. Methods: To determine the association between muscle loss and circulating metabolites, we studied 20 male patients (median age, 70.5, interquartile range, 62.5–75) undergoing aortic surgery. Muscle mass was determined before and 7 days after surgery and blood samples were taken before surgery, and 1, 3, and 7 days after surgery. The circulating metabolome and proteome were determined using commercial services (Metabolon and SomaLogic). Results: Ten patients lost more than 10% of the cross‐sectional area of the rectus femoris (RFCSA) and were defined as wasting. Metabolomic analysis showed that 557 circulating metabolites were altered following surgery (q < 0.05) in the whole cohort and 104 differed between wasting and non‐wasting patients (q < 0.05). Weighted genome co‐expression network analysis, identified clusters of metabolites, both before and after surgery, that associated with muscle mass and function (r = −0.72, p = 6 × 10−4 with RFCSA on Day 0, P = 3 × 10−4 with RFCSA on Day 7 and r = −0.73, P = 5 × 10−4 with hand‐grip strength on Day 7). These clusters were mainly composed of acyl carnitines and dicarboxylates indicating that pre‐existing mitochondrial dysfunction contributes to muscle loss following surgery. Surgery elevated cortisol to the same extent in wasting and non‐wasting patients, but the cortisol:cortisone ratio was higher in the wasting patients (Day 3 P = 0.043 and Day 7 P = 0.016). Wasting patients also showed a greater increase in circulating nucleotides 3 days after surgery. Comparison of the metabolome with inflammatory markers identified by SOMAscan® showed that pre‐surgical mitochondrial dysfunction was associated with growth differentiation factor 15 (GDF‐15) (r = 0.79, P = 2 × 10−4) and that GDF‐15, interleukin (IL)‐8), C‐C motif chemokine 23 (CCL‐23), and IL‐15 receptor subunit alpha (IL‐15RA) contributed to metabolic changes in response to surgery. Conclusions: We show that pre‐existing mitochondrial dysfunction and reduced cortisol inactivation contribute to muscle loss following surgery. The data also implicate GDF‐15 and IL‐15RA in mitochondrial dysfunction. [ABSTRACT FROM AUTHOR]

Background: Frailty is the pre‐eminent exigency of aging. Although frailty‐related impairments are preventable, and multidomain interventions appear more effective than unimodal ones, the optimal components remain uncertain. Methods: We devised multidomain interventions against physical and cognitive decline among prefrail/frail community‐dwelling ≥65‐year‐olds and evaluated these in complementary cluster‐randomized trials of efficacy and participant empowerment. The Efficacy Study compared ~3‐monthly telephone consultations vs. 16, 2 h sessions/year comprising communally partaken physical and cognitive training plus nutrition and disease education; the Empowerment Study compared the standard Efficacy Study multidomain intervention (Sessions 1–10) vs. an enhanced version redesigned to empower and motivate individual participants. Changes from baseline in physical, functional, and cognitive performance were measured after 6 and 12 months in the Efficacy Study and after 6 months in the Empowerment Study, with post‐intervention follow‐up at 9 months. Primary outcomes are as follows: Cardiovascular Health Study frailty score; gait speed; handgrip strength; and Montreal Cognitive Assessment (MoCA). Secondary outcomes are as follows: instrumental activities of daily living; metabolic equivalent of task (MET); depressed mood (Geriatric Depression Scale‐5 ≥2); and malnutrition (Mini‐Nutritional Assessment short‐form ≤11). Intervention effects were analyzed using a generalized linear mixed model. Results: Efficacy Study participants (n = 1082, 40 clusters) were 75.1 ± 6.3 years old, 68.7% women, and 64.7% prefrail/frail; analytic clusters: 19 intervention (410/549 completed) vs. 21 control (375/533 completed). Empowerment Study participants (n = 440, 14 clusters) were 75.9 ± 7.1 years old, 83.6% women, and 56.7% prefrail/frail; analytic clusters: seven intervention (209/230 completed) vs. seven control (189/210 completed). The standard and enhanced multidomain interventions both reduced frailty and significantly improved aspects of physical, functional, and cognitive performance, especially among ≥75‐year‐olds. Standard multidomain intervention decreased depression [odds ratio 0.56, 95% confidence interval (CI) 0.32, 0.99] and malnutrition (odds ratio 0.45, 95% CI 0.26, 0.78) by 12 months and improved concentration at Months 6 (0.23, 95% CI 0.04, 0.42) and 12 (0.46, 95% CI 0.22, 0.70). Participant empowerment augmented activity (4.67 MET/h, 95% CI 1.64, 7.69) and gait speed (0.06 m/s, 95% CI 0.00, 0.11) at 6 months, with sustained improvements in delayed recall (0.63, 95% CI 0.20, 1.06) and MoCA performance (1.29, 95% CI 0.54, 2.03), and less prevalent malnutrition (odds ratio 0.39, 95% CI 0.18, 0.84), 3 months after the intervention ceased. Conclusions: Pragmatic multidomain intervention can diminish physical frailty, malnutrition, and depression and enhance cognitive performance among community‐dwelling elders, especially ≥75‐year‐olds; this might supplement healthy aging policies, probably more effectively if participants are empowered. [ABSTRACT FROM AUTHOR]

Background: Camicinal is a novel, nonmacrolide, motilin receptor agonist that accelerates gastric emptying in critically ill patients with established feed intolerance. The primary question was whether the preemptive administration of camicinal increased the provision of enteral nutrition (EN) to critically ill patients with risk factors that predisposed to feed intolerance.Methods: This was an international, multicenter, parallel-group, blinded, randomized controlled trial. Patients at risk for feed intolerance, defined as receiving moderate to high doses of vasopressors or opiates, or admitted because of multiple traumatic injuries or with brain injury, received either enteral camicinal 50 mg or placebo daily for a maximum of 7 days, along with EN administered according to a standardized feeding protocol. The primary outcome was the daily adequacy of enteral feed delivered, as assessed by percentage of goal volume (delivered/prescribed × 100) before development of intolerance.Results: Eighty-four patients participated. The administration of camicinal did not result in a statistically significant clinical difference in the daily average percentage goal volume delivered (camicinal vs placebo: 77% [95% confidence interval: 71, 83] vs 68% (58, 78); mean difference 9% [-5, 23]; P = 0.21). Similarly, there were no differences in the percentage goal calories (76% [65, 88] vs 68% [60, 77]) and protein (76% [66, 86] vs 70% [61, 80]) administered, or the incidence of feed intolerance (15% vs 14%).Conclusion: The incidence of feed intolerance was low in both groups. In this cohort the preemptive administration of enteral camicinal did not significantly augment the provision of goal EN. [ABSTRACT FROM AUTHOR]

The notion of dark networks has recently received attention in the literature on policy network analysis. Dark networks are defined as illegal and covert, in contrast to bright networks which are legal and overt. In this article, we suggest a third category – grey networks – which are characterised by their use of secrecy and concealment despite their ostensibly legal status. These networks are subject to contradictory imperatives. They employ methods that cannot be openly acknowledged within the larger legal and social framework in which they function. In this article, we illustrate this concept through an interview‐based study of Australia's immigration detention network. This network enacts a deterrence policy which has been widely condemned as breaching Australia's obligations under international law. At the same time, it is required to maintain a façade of lawfulness and respect for human rights. [ABSTRACT FROM AUTHOR]

As global climate change drives the demise of tropical reef ecosystems, attention is turning to the suitability of refuge habitat. For the Great Barrier Reef, are there historically stable southern refugia where corals from the north might migrate as climate changes? To address this question, we present a precise chronology of marginal coral reef development from Moreton Bay, southeast Queensland, Australia. Our chronology shows that reef growth was episodic, responding to natural environmental variation throughout the Holocene, and that Moreton Bay was inhospitable to corals for about half of the past 7000 years. The only significant change in coral species composition occurred between ∼200 and ∼50 years ago, following anthropogenic alterations of the bay and its catchments. Natural historical instability of reefs, coupled with environmental degradation since European colonization, suggests that Moreton Bay offers limited potential as refuge habitat for reef species on human time scales. [ABSTRACT FROM AUTHOR]

Traditional methods of teaching anatomy to undergraduate medical and veterinary students are being challenged and need to adapt to modern concerns and requirements. There is a move away from the use of cadavers to new technologies as a way of complementing the traditional approaches and addressing resource and ethical problems. Haptic (touch) technology, which allows the student to feel a 3D computer-generated virtual environment, provides a novel way to address some of these challenges. To evaluate the practicalities and usefulness of a haptic simulator, first year veterinary students at the Royal Veterinary College, University of London, were taught basic bovine abdominal anatomy using a rectal palpation simulator: 'The Haptic Cow.' Over two days, 186 students were taught in small groups and 184 provided feedback via a questionnaire. The results were positive; the majority of students considered that the simulator had been useful for appreciating both the feel and location of key internal anatomical structures, had helped with their understanding of bovine abdominal anatomy and 3D visualization, and the tutorial had been enjoyable. The students were mostly in favor of the small group tutorial format, but some requested more time on the simulator. The findings indicate that the haptic simulator is an engaging way of teaching bovine abdominal anatomy to a large number of students in an efficient manner without using cadavers, thereby addressing some of the current challenges in anatomy teaching. Anat Sci Educ 2: 280-285, 2009. © 2009 American Association of Anatomists [ABSTRACT FROM AUTHOR]

The article reports on meteorological controls on sand transport and dune morphology in Victoria Valley, Antarctica. It states that the hyperarid polar desert of the McMurdo Dry Valleys contains an abundance of aeolian sedimentary deposits, providing a setting of evaluating cold climate aeolian processes and dune morphology. It was identified that sand transport in this location was influenced by interparticle cohesion, topographically modified foehn southwesterly winds, and diurnal variations in the speed of thermally driven easterly valley winds because of solar heating by 'night.'

Little is known about the role of meiotic recombination processes such as unequal crossover in driving instability at tandem repeat DNA. Methods have therefore been developed to detect meiotic crossovers within two different GC-rich minisatellite repeat arrays in humans, both in families and in sperm DNA. Both loci normally mutate in the germline by complex conversion-like transfer of repeats between alleles. Analysis shows that inter-allelic unequal crossovers also occur at both loci, although at low frequency, to yield simple recombinant repeat arrays with exchange of flanking markers. Equal crossovers between aligned alleles, resulting in recombinant alleles but without change in repeat copy number, also occur in sperm at a similar frequency to unequal crossovers. Both crossover and conversion show polarity in the repeat array and are co-suppressed in an allele showing unusual germline stability. This provides evidence that minisatellite conversion and crossover arise by a common mechanism, perhaps by alternative processing of a meiotic recombination initiation complex, and implies that minisatellite instability is a by-product of meiotic recombination in repeat DNA. While minisatellite recombination is infrequent, crossover rates indicate that the unstable end of a human minisatellite can act as a recombination warm-spot, even between sequence­heterologous alleles. [ABSTRACT FROM AUTHOR]

The article examines the impact of social media on the medical profession and medical care as of June 2018. The negative effects of social media on medicine include patient privacy and confidentiality violations while the benefits include decreasing the knowledge translation gap between patients and healthcare professionals. It also stresses the importance for healthcare professionals to maintain patient confidentiality and behave professionally on social media.

Veterinary students at the Royal Veterinary College, University of London learn about bovine abdominal anatomy using a virtual reality simulator, the Haptic Cow. A haptic device is positioned inside a fiberglass model of the rear-half of a cow, allowing students to palpate virtual abdominal structures via a robotic arm. The Haptic Cow helps to address some of the practical and ethical issues around sourcing and using cadavers and live animals in teaching. Kinnison and her co-authors discuss use of this simulator in anatomy classes in the current issue of ASE. [ABSTRACT FROM AUTHOR]