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Penelope J Slater,1 Anthony R Herbert,2,3 Sarah J Baggio,2 Leigh A Donovan,2 Alison M McLarty,2 Julie A Duffield,4 Lee-anne C Pedersen,2,3 Jacqueline K Duc,2 Angela M Delaney,2 Susan A Johnson,2 Melissa G Heywood,5 Charlotte A Burr6 On behalf of Quality of Care Collaborative Australia 1Oncology Services Group, Queensland Children’s Hospital, Children’s Health Queensland, South Brisbane, QLD, Australia; 2Paediatric Palliative Care Service, Queensland Children’s Hospital, Children’s Health Queensland, QLD, Australia; 3Centre for Children’s Health Research at Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD, Australia; 4Paediatric Palliative Care Service, Women’s and Children’s Health Network, Adelaide, SA, Australia; 5Victorian Paediatric Palliative Care Program, The Royal Children’s Hospital, Melbourne, VIC, Australia; 6Western Australia Paediatric Palliative Care Service, Perth Children’s Hospital, Perth, WA, Australia Purpose: The Quality of Care Collaborative Australia (QuoCCA) provided pediatric palliative care education across Australia with the aim of improving the quality of services. The education was delivered through a collaboration of six tertiary pediatric palliative care services, through funding for Nurse Educators, Medical Fellows, a National Allied Health Educator, and national project staff.Methods: Pre- and post-education surveys were completed by participants immediately following the education, and confidence and knowledge were measured along nine domains related to the care of the child and family, including managing a new referral, symptom management, medications, preparing the family, and using local agencies.Results: Education was provided to over 5,500 health and human service professionals in 337 education sessions across Australia between May 2015 and June 2017. Paired pre- and postsurveys were completed by 969 participants and showed a significant improvement in all the domains measured. Those with no experience in caring for children receiving palliative care showed greater improvement following QuoCCA education compared to those with experience, although the latter had higher scores both before and after education. Similarly, those with no previous education showed greater improvement, but those with previous education showed higher scores overall. Participants in full-day and half-day sessions showed greater improvement than those in short day sessions. Thus, the dosage of education in the length of the sessions and prior attendance impacted knowledge and confidence. Topics requested by the participants were analyzed. Educator learnings were that education was more effective when tailored to the needs of the audience, was interactive, and included story-telling, case studies, and parent experiences.Conclusion: These results encouraged the continuation of the provision of education to novice and experienced professionals who care for children with a life-limiting condition, leading to higher levels of confidence and knowledge. The learnings from this evaluation will be transferred into the second round of funding for the national QuoCCA education project. The next stage will focus on developing simulation and interactive training, accessible training modules, and videos on a national website. Keywords: training, evaluation, health care, education dosage, confidence

Abstract Piezoelectric materials show potential to harvest the ubiquitous, abundant, and renewable energy associated with mechanical vibrations. However, the best performing piezoelectric materials typically contain lead which is a carcinogen. Such lead-containing materials are hazardous and are being increasingly curtailed by environmental regulations. In this study, we report that the lead-free chalcogenide perovskite family of materials exhibits piezoelectricity. First-principles calculations indicate that even though these materials are centrosymmetric, they are readily polarizable when deformed. The reason for this is shown to be a loosely packed unit cell, containing a significant volume of vacant space. This allows for an extended displacement of the ions, enabling symmetry reduction, and resulting in an enhanced displacement-mediated dipole moment. Piezoresponse force microscopy performed on BaZrS3 confirmed that the material is piezoelectric. Composites of BaZrS3 particles dispersed in polycaprolactone were developed to harvest energy from human body motion for the purposes of powering electrochemical and electronic devices.

Protected areas in Nigeria are important ecosystems for carbon storage. The aim of this study was to estimate and map tree aboveground biomass (TAGB) and carbon (TAGC) within a tropical forest in Nigeria. Stepwise regression analysis was implemented to develop models for predicting TAGB in the forest stand, by integrating field TAGB data with Landsat 8 OLI data. Spectral variables used in the analysis include spectral bands, vegetation indices, tasseled cap indices and principal components. Model validation was performed using independent sample plots. The results showed that incorporating more than one category of spectral variables improved the prediction of TAGB. The best-fit model was applied to map the spatial distribution of TAGB and TAGC. The TAGC was estimated as 52.3% of TAGB, based on the average carbon content of tree species derived in this study. Average TAGB and TAGC estimates for the forest stand were 373.1 ± 165.4 t ha−1 and 194 ± 82.7 t ha−1, respectively. Reliable estimates of TAGB and TAGC for the forest reserve were obtained. This study provides important information required to manage the forest stand for optimal carbon sequestration. [ABSTRACT FROM AUTHOR]

An experiment was conducted at the High Intensity γ-ray Source (HIγS) facility at the Triangle Universities Nuclear Laboratory (TUNL) in Durham, NC, USA to measure the cross-section of the key astrophysical thermonuclear reaction 12C(α,γ)16O by means of its inverse photo-disintegration process. A high-intensity monochromatic γ-ray beam interacted with the CO2 gas in the active volume of the Warsaw active target TPC detector. The reaction products were detected and their momenta reconstructed, so to also determine angular correlations. Data were collected at 15 beam energies ranging from 8.51 to 13.9 MeV. Preliminary results are presented.

To assess cabergoline's efficacy at decreasing lactation after second-trimester abortion or loss. This is a double-blinded, block-randomized superiority trial (IRB approved, NCT04701333) comparing cabergoline 1mg once to placebo for preventing bothersome breast engorgement after second-trimester uterine evacuation. April 2021-June 2022, we enrolled pregnant people 18-28-weeks gestation, English- or Spanish-speaking, without contraindication to the study drug. Participants completed a validated, piloted, electronic survey at baseline and through two weeks post-procedure assessing breast symptoms, side-effects, and bother at each time point. Our primary outcome is breast symptoms on day 4; we planned to enroll 80 patients to show a 30% difference in breast symptoms (80% power, α = 0.049). A sub-group of participants returned for serum prolactin levels. After screening 150 patients, we enrolled 73 participants. Baseline demographics were balanced between groups: median gestational age 21 weeks (range: 18-26), 56% nulliparous, 35% self-identified as Hispanic, 37% with public insurance. At baseline, reported breast symptoms were similar between groups. At day 4, significantly fewer participants receiving cabergoline reported any symptoms compared to placebo (27.8% vs 97.0%, p<0.0001) and fewer reported significant bother (2.8% vs 29.7%, p=0.002). These differences persisted through day 14. Reported side-effects (p=0.31) were similar between groups: most common were constipation (44%), fatigue (32%), and headache (29%). Serum prolactin was similar at baseline. On day 4, mean serum prolactin was 6.5ng/mL (std dev 2.2) for those receiving cabergoline and 18.0ng/mL (std dev 5.9) for placebo (p=0.04). Cabergoline is an effective strategy to prevent breast symptoms following second-trimester abortion or loss. [ABSTRACT FROM AUTHOR]

Business intelligence systems participate to deliveran accurate and useful information to decision makers in marketing division of bakeries manufacture. The purpose of this study was to design business intelligence model to analyze the marketing product, design the data mining model, measure and analyze the marketing process of the product they sell. The methodology of this research wasto analyze system requirements, design unified modeling language, make process extract, transform, and load, designdata warehouse, and data mining that integrated with the on line analytical process cube webbased. The business intelligence model produced was a marketing data mining model and on line analytical process cube. The result from on line analytical process cube was the data warehouse of transaction in R Bakery. In designing the data mining, K-means clustering method was used. The results from data mining k-means clustering were there were 83% cluster 1 and 17% cluster 2. Cluster 1 wasthecategorize for low leftover breads and cluster 2 was the categorize for high leftover breads. The model cube recency, frequency, and monetary and customer lifetime value resulted ranked out of the most amount of sales in R Bakery.

Behavioral economics aspires to replace the agents of neoclassical economics with living, breathing human beings. Here, the author argues that behavioral economics, like its neoclassical counterpart, often neglects the role of active sense-making that motivates and guides much human behavior. The author reviews what is known about the cognitive science of sense-making, describing three kinds of cognitive tools—hypothesis-inference heuristics, stories, and intuitive theories—that people use to structure and understand information. He illustrates how these ideas from cognitive science can illuminate puzzles in economics, such as decision under Knightian uncertainty, the dynamics of economic (in)stability, and the voters’ preferences over economic policies. He concludes that cognitive science more broadly can enhance the explanatory and predictive quality of behavioral economic theories.

Context: In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-leg CUS may exclude proximal and distal DVT in a single evaluation.Objective: To determine the risk of venous thromboembolism after withholding anticoagulation in patients with suspected lower extremity DVT following a single negative whole-leg CUS result.Data Sources: MEDLINE, EMBASE, CINAHL, LILACS, Cochrane, and Health Technology Assessments databases were searched for articles published from January 1970 through November 2009. Supplemental searches were performed of Internet resources, reference lists, and by contacting content experts.Study Selection: Included studies were randomized controlled trials and prospective cohort studies of patients with suspected DVT and a negative whole-leg CUS result who did not receive anticoagulant therapy, and were followed up at least 90 days for venous thromboembolism events.Data Extraction: Two authors independently reviewed and extracted data regarding a single positive or negative whole-leg CUS result, occurrence of venous thromboembolism during follow-up, and study quality.Results: Seven studies were included totaling 4731 patients with negative whole-leg CUS examinations who did not receive anticoagulation. Of these, up to 647 patients (13.7%) had active cancer and up to 725 patients (15.3%) recently underwent a major surgery. Most participants were identified from an ambulatory setting. Venous thromboembolism or suspected venous thromboembolism-related death occurred in 34 patients (0.7%), including 11 patients with distal DVT (32.4%); 7 patients with proximal DVT (20.6%); 7 patients with nonfatal pulmonary emboli (20.6%); and 9 patients (26.5%) who died, possibly related to venous thromboembolism. Using a random-effects model with inverse variance weighting, the combined venous thromboembolism event rate at 3 months was 0.57% (95% confidence interval, 0.25%-0.89%).Conclusion: Withholding anticoagulation following a single negative whole-leg CUS result was associated with a low risk of venous thromboembolism during 3-month follow-up. [ABSTRACT FROM AUTHOR]

The accelerated, second-degree option, entry-into-practice master's of nursing degree poses a unique educational opportunity to place more highly qualified nurses at the bedside. The authors discuss one school of nursing's program and lessons learned after reviewing data collected on program implementation over a 3-year period. [ABSTRACT FROM AUTHOR]

Previous studies of emotion recognition suggest that detection of disgust relies on processing within the basal ganglia and insula. Research involving individuals with symptomatic and pre-diagnostic Huntington's disease (HD), a disease with known basal ganglia atrophy, has generally indicated a relative impairment in recognizing disgust. However, some data have suggested that recognition of other emotions (particularly fear and anger) may also be affected in HD, and a recent study found fear recognition deficits in the absence of other emotion-recognition impairments, including disgust. To further examine emotion recognition in HD, we administered a computerized facial emotion recognition task to 475 individuals with the HD CAG expansion and 57 individuals without. Logistic regression was used to examine associations of emotion recognition performance with estimated proximity to clinical diagnosis (based on CAG repeat length and current age) and striatal volumes. Recognition of anger, disgust, fear, sadness and surprise (but not happiness) was associated with estimated years to clinical diagnosis; performance was unrelated to striatal volumes. Compared to a CAG-normal control group, the CAG-expanded group demonstrated significantly less accurate recognition of all negative emotions (anger, disgust, fear, sadness). Additionally, participants with more pronounced motor signs of HD were significantly less accurate at recognizing negative emotions than were individuals with fewer motor signs. Findings indicate that recognition of all negative emotions declines early in the disease process, and poorer performance is associated with closer proximity to clinical diagnosis. In contrast to previous results, we found no evidence of relative impairments in recognizing disgust or fear, and no evidence to support a link between the striatum and disgust recognition. [ABSTRACT FROM AUTHOR]

Background: Pain after vaginal delivery may result from episiotomy, perineal laceration, or uterine involution. Many women have indwelling epidural catheters in place at delivery. We hypothesized that a small dose of epidural morphine would be an effective strategy for postpartum analgesia.Methods: Eighty-one healthy parturients receiving epidural analgesia for labor were enrolled. Patients were randomized in double-blind fashion to 1 of 3 groups: all groups received a 4-mL volume of epidural solution consisting of saline (group 1, control), 1 mg (group 2), or 2 mg morphine (group 3) after vaginal delivery. During the first 24 hours postpartum, patients were evaluated for the amount of oral pain medication requested; visual analog scale scores for pain at rest and with movement; satisfaction with postpartum pain treatment; and opioid side effects including nausea, pruritus, urinary retention, and respiratory depression.Results: Patients who received 2 mg of epidural morphine used an average of 0.7 (0-1, interquartile range) opioid-containing pain pills (acetaminophen with codeine or oxycodone) compared with 1.2 (0-2) in the 1-mg group and 1.9 (0-3) in the control group ( P = .07). There was a statistically significant difference in oral drug usage between those who received epidural morphine and those who did not ( P < .03). There were no differences in side effects except that at 12 hours postpartum there was an increase in Foley catheterization in the 1-mg morphine group ( P = .007).Conclusions: These results suggest that epidural morphine decreases the need for oral pain medication in the first 24 hours postpartum. No significant dose-dependent side effects were found. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to classify brands of bottled water by manufacturer assigned labeling to verify the concentration of fluoride for those brands that claim to contain fluoride, and to determine the existence and concentration of fluoride for those brands that do not cite fluoride or list it as undetermined on the product label. METHODS: A convenience sample of bottled drinking waters (N = 65) sold throughout the state of West Virginia was obtained for this study. Among the 65 brands, six different types of water were identified based on common wording displayed on the package. A sample (150 mL) was taken from each brand of water. Each sample was analyzed using an Orion EA940 microprocessor which calculates the fluoride concentration of a given sample. All analyses of bottled waters were reported using an inorganic chemistry laboratory report. RESULTS: Results, reported in frequencies and percentages, indicate that only 12.3% (N = 8) of the brands tested contained an optimal level of fluoride (0.6 to 1.2 parts per million); 95% of the bottled water analyzed did not list fluoride; 1.1% (N = 7) of the bottled waters analyzed were obtained from municipal sources; and of the sixty-five brands tested, only three brands contained a fluoride concentration consistent with that listed on the label or as identified by the manufacturer. CONCLUSIONS: Several main points can be summarized: 1) solely drinking bottled water may not provide sufficient fluoride to maintain optimal dental health; 2) most bottled waters contain low concentrations of fluoride and therefore, in and of themselves are not a risk for fluorosis; and 3) bottled waters are named and packaged in a variety of ways; however, their composition is virtually the same. [ABSTRACT FROM AUTHOR]

PURPOSE: To discover what teachers perceive to be contributing factors to violence in schools. STUDY DESIGN AND METHODS: Open-ended questions were asked of a convenience sample of teachers ( = 396) during an in-service education program on school violence. The teachers were in a semi-rural school district in a Mid-Atlantic state. Answers were analyzed using content analysis; all responses were reviewed and important themes were extracted. Identified themes were then placed into suitable categories and studied to determine relationships. RESULTS: Of the surveys analyzed ( = 239), 13 themes were identified. The three categories which then identified probable causes of school violence were (1) lack of knowledge, (2) lack of support, and (3) inadequate safety measures. CLINICAL IMPLICATIONS: Nurses can use the results of this study in multiple ways. One is to help parents understand their role in preventing school violence. Because violence in the home and violence in the media seem to foster violent acting-out behavior, nurses can teach parents about these correlations and seek solutions such as the elimination of family violence, and monitoring television viewing and video games. Nursing assessments of school-aged children and their families can include these elements. School nurses in particular can use these study results as an opportunity to develop interventions for students, teachers, and families that stress knowledge building about impulse control, anger management, appropriate parenting, and early intervention for at-risk children. [ABSTRACT FROM AUTHOR]

The extracellular matrix (ECM) is known to play an important role in the health of cells and tissues. Not only are chemical signals transmitted via bonds and tightly controlled diffusion, but the structure of the ECM also provides important physical signaling for the cells attached to it. The structure is composed of a mesh of fibrous proteins, such as collagen, embedded in a hydrated gel matrix of glycosaminoglycans. To study cell behavior with respect to the combined morphology and mechanics of such matrices is not currently possible with the types of 3D cell culture matrices available. Most of the cell culture matrices are single-phase bio- or polymeric hydrogels. Therefore, here we developed a continuous hybrid manufacturing process to make fiber-reinforced composite hydrogels. A far field electrospinning process was used to deposit the fibrous component with the aid of guiding electrodes; and a gravity-assisted, droplet-based system controlled the rate of addition of the cell-laden hydrogel component. The addition of the fibrous component slightly increased the elastic modulus of the pure hydrogel. The cells that were embedded into the fiber-reinforced hydrogels were viable for 8 days. The cells were randomly placed in the matrix such that some had no contact to the fibers and others were initially in proximity to fibers. The cells with no contact to fibers grew into spheroidal clusters within the hydrogel, and those in proximity to the fibers spread out and grew along the fibers showing that the fiber-reinforced hydrogels are able to control cell behavior with morphological cues.

Tujuan dari penelitian ini adalah bagaimana caranya memilih komposisi dari campuran buburan kertas sehingga posisi optimum dapat tercapai, dengan tercapainya komposisi optimum tersebut diharapkan dapat meningkatkan kualitas kertas yang diproduksi.Adapun komposisi buburan kertas yang ingin dicapai adalah konsistensi sebesar untuk campuran ,pada campuran satu, tingkat freeness sebesar pada campuran dua dan tingkat internal bonding sebesar pada campuran tiga. Percobaan dilakukan dengan metoda mixture experiment untuk sampel percobaan buburan kertas sebanyak 500 gr. Titik percobaan dibangkitkan dengan software minitab sebanyak 14 titik percobaan.Adapun komposisi campuran yang optimal diperoleh untuk total campuran diperoleh sebesar 71.23 % ( 356.15 gr) Waste Paper, 8.72% (43.55gr) Pulp (NUKP), 3.54% (17.7 gr) Air, 5.7%(28.5 gr) Rosin, 3.29 % (16.4 gr) Aluminium Sulfat ( Al2(SO4)3), dan 7.55 %(37.75gr) Starch. Dengan komposisi tersebut akan dihasilkan produk yang memenuhi spesifikasi yang telah ditetapkan perusahaan. Berdasarkan pengukuran kapabilitas proses campuran satu, pada kertas kraft liner 150 gsm di perusahaan untuk tingkat konsistensi, adalah sebesar 0.47 dan setelah dilakukan percobaan yang optimal, berubah menjadi 1.11 berarti terdapat peningkatan sebesar 136.7 %.Pada campuran dua untuk tingkat freeness adalah 0.45 berubah menjadi 1.14 berarti meningkat sebesar 153.3 %, sedangkan pada campuran tiga untuk tingkat internal bonding dari 0.55 berubah menjadi 1.15 berarti meningkat sebesar 109 %. Kata kunci: mixture experiment; konsistensi; freeness; internal bonding Abstract The aim of the research are how to choose composition from pulp paper mix, so that optimum position can be achieved, with the achievement of optimum composition, it can be expected to increase quality of paper production.While the pulp paper composition to achieve are consistency as big as for mixing on first mix, freeness level as big as on second mix and internal bonding as big as on third mix. Trial is done with mixture experiment method for pulp paper, trial sample as big as 500 gr.trial point raised with minitab software as big as 14 trial point.While optimal mix composition obtain as big as 71.23% (16.4 gr) Waste Paper, 8.72%(43.55gr) Pulp(NUKP), 3.54%(17.7gr)Water ,5.7%(28.5 gr) Rosin, 3.29%(16.4 gr) Aluminium Sulfat(Al2(SO4)3) and 7.55% (37.75 gr) Starch.With the composition will produced a product that meet the specification the company set. Based on process capability first mix,on kraft liner 150 gsm paper in the company for consistency level are 0.47 and after optimal trial been done turn to 1.11, it means there is an increasing as big as 136.7 %, on second mix for freeness level is 0.45 turn in 1.14 it means there is an increasing as big as 153,3 %, and third mix for internal bonding from 0.55 turn to 1.15 it is means there is an increasing as big as 109%. Keywords : mixture experiment; consistency; freeness; internal bonding

Discusses theories of complexity and their relevance to the field of palliative care. Effect of the presence of unpredictability in complex biological and physical systems on initiating palliative care to patients; Factors affecting needs of a patient; Importance of complexity theories in palliative care research.

Abstract Background The presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period. Aim The study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia. Methods A qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively. Findings There are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression. Conclusion Identifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby. Recommendation Strategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia.

Abstract Background Arthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life. Historically conservative treatments involve the use of a toe prop with the intended aim of reducing plantar pressure from the apex of the digit. However, the effect of toe prop treatment on plantar digital pressure has not been investigated. Method Twenty two subjects were recruited with lesser digital deformities and associated apical skin lesions. Individual pressure sensors were placed on the apices of the lesser toes and pressure was recorded under three toe prop conditions (leather, gel and silicone mould). A modified comfort index was utilised to assess the comfort of each condition. Results Significant difference (p nd toe when using the gel (p p nd toe when using gel (p p Conclusion As compared to the leather and silicone mould toe props, gel toe props were found to be the most effective for reducing peak pressure and pressure time integral on the apex of the second digit in patients with claw or hammer toe deformity.

Abstract Background Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models. Discussion Technological advances, including improvements in computing capability, are facilitating the development and use of models such as DAMs for health service planning. However, given the current scepticism among many stakeholders, encouraging informed critique and promoting trust in models to aid health service planning is vital, for example by making available and explicit the methods and assumptions underlying each model, associated limitations, and the process of validation. This can be achieved by consultation and training with the intended users, and by allowing access to the workings of the models, and their underlying assumptions (e.g. via the internet), to show how they actually work. Summary Constructive discussion and education will help build a consensus on the purposes of STI services, the need for service planning to be evidence-based, and the potential for mathematical tools like DAMs to facilitate this.

Abstract Background Hazardous air pollutant exposures are common in urban areas contributing to increased risk of cancer and other adverse health outcomes. While recent analyses indicate that New York City residents experience significantly higher cancer risks attributable to hazardous air pollutant exposures than the United States as a whole, limited data exist to assess intra-urban variability in air toxics exposures. Methods To assess intra-urban spatial variability in exposures to common hazardous air pollutants, street-level air sampling for volatile organic compounds and aldehydes was conducted at 70 sites throughout New York City during the spring of 2011. Land-use regression models were developed using a subset of 59 sites and validated against the remaining 11 sites to describe the relationship between concentrations of benzene, total BTEX (benzene, toluene, ethylbenzene, xylenes) and formaldehyde to indicators of local sources, adjusting for temporal variation. Results Total BTEX levels exhibited the most spatial variability, followed by benzene and formaldehyde (coefficient of variation of temporally adjusted measurements of 0.57, 0.35, 0.22, respectively). Total roadway length within 100 m, traffic signal density within 400 m of monitoring sites, and an indicator of temporal variation explained 65% of the total variability in benzene while 70% of the total variability in BTEX was accounted for by traffic signal density within 450 m, density of permitted solvent-use industries within 500 m, and an indicator of temporal variation. Measures of temporal variation, traffic signal density within 400 m, road length within 100 m, and interior building area within 100 m (indicator of heating fuel combustion) predicted 83% of the total variability of formaldehyde. The models built with the modeling subset were found to predict concentrations well, predicting 62% to 68% of monitored values at validation sites. Conclusions Traffic and point source emissions cause substantial variation in street-level exposures to common toxic volatile organic compounds in New York City. Land-use regression models were successfully developed for benzene, formaldehyde, and total BTEX using spatial indicators of on-road vehicle emissions and emissions from stationary sources. These estimates will improve the understanding of health effects of individual pollutants in complex urban pollutant mixtures and inform local air quality improvement efforts that reduce disparities in exposure.

Abstract Background Dupuytren's contracture (DC) is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC. Methods To achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group). These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments). Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02), hierarchical clustering, concordance mapping and Venn diagram. Results We found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that a collagen-rich environment differentially alters gene expression in these cells. In addition, Ingenuity pathway analysis of the specific biological pathways that differentiate DC-derived cells from carpal tunnel-derived cells has identified the potential involvement of microRNAs in this fibroproliferative disorder. Conclusions These data show that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected palmar fascia in DC patients are highly similar, and differ significantly from the transcriptomic profiles of fibroblasts from the palmar fascia of patients undergoing carpal tunnel release.

Abstract Background Daptomycin non-susceptible enterococci (DNSE) are emerging as an important cause of healthcare-associated infection, however little is known about the epidemiology of DNSE. At the University of Iowa Hospitals and Clinics (UIHC) an increase in the frequency of patients infected and/or colonized with DNSE has occurred. The goals of this study were to evaluate potential factors associated with the development of DNSE colonization and/or infection and to compare the characteristics of patients with prior daptomycin exposure to those without prior daptomycin exposure. Methods The study is a retrospective case-series involving all patients with DNSE infection and/or colonization at UIHC, a 734-bed academic referral center, from June 1, 2005 to June 1, 2011. Results The majority of patients with DNSE colonization and/or infection had prior daptomycin exposure (15 of 25; 60%), a concomitant gastrointestinal process (19 of 25; 76%), or were immunosuppressed (21 of 25; 84%). DNSE infection was confirmed in 17 of 25 (68%) patients, including 9 patients with bacteremia. Twelve of 17 (71%) patients with DNSE infection had prior daptomycin exposure, including 7 of 9 (78%) patients with bacteremia. Compared to patients without prior daptomycin exposure, patients with prior daptomycin exposure were less likely to harbor E. faecalis (0% vs. 33%; p = 0.019). A high proportion of patients (10 of 25; 40%) died during their hospitalizations. Most enterococcal isolates were E. faecium (86%), and were vancomycin-resistant (72%). Molecular typing revealed a diverse population of DNSE. Conclusions Prior daptomycin exposure, immunosuppression, and/or a concomitant gastrointestinal process, may be associated with the development of DNSE. PFGE revealed a diverse population of DNSE, which along with both increasing numbers of DNSE detected yearly and increasing annual rates of daptomycin usage, suggests the emergence of DNSE under antimicrobial pressure.

Abstract Background Adult mammalian tissues heal injury to the skin with formation of scar; this process quickly seals an injured area, however, excessive scar formation can become a source of persistent pathology, interfering with multiple vital functions. In contrast, mammalian fetal tissue can heal without scar formation. We previously sought to model scarless healing in a rabbit fetal skin wound and identified gene products differentially expressed during fetal wound healing through PCR suppression subtractive hybridization (PCR SSH). One of these transcripts, previously identified simply as clone 11, showed putative increased expression in wounded fetal skin. This study establishes its identity as Ero1L-alpha and confirms its elevated expression in healing fetal wounds. Findings After obtaining further sequence by 5' rapid amplification of cloned ends (RACE) we find that clone 11 is Ero1L-alpha. We determined that clone 11, a differentially expressed transcript in fetal wound healing, comprises the 3' untranslated region (UTR) of an approximately 4 kb transcript in rabbit tissues that corresponds to Ero1L-alpha. We showed that Ero1L-alpha is expressed predominantly as two transcripts in rabbit skin, namely a 1.6 kb transcript and the 4.0 kb transcript recovered in our PCR SSH screen via its 3' UTR sequence. However, a third transcript of 2.9 kb was also detected in Northern blots and was subsequently cloned and confirmed by 3' RACE. Knockdown of the clone 11 sequence in rabbit adult fibroblasts via siRNA resulted in significantly decreased Ero1L-alpha message expression. Increased expression of clone 11 (Ero1L-alpha) in a variety of cell types during the wound healing response was also confirmed by in situ hybridization. Conclusions Ero1L-alpha is one of the previously unknown clones identified in a PCR SSH screen for genes differentially expressed in fetal wounded tissue. In situ hybridization confirms that Ero1L-alpha shows increased expression in multiple cell types after wounding of the fetal integument.

Abstract Background Myofibroblasts, a derived subset of fibroblasts especially important in scar formation and wound contraction, have been found at elevated levels in affected Dupuytren's tissues. Transformation of fibroblasts to myofibroblasts is characterized by expression of alpha- smooth muscle actin (α-SMA) and increased production of extracellular matrix (ECM) components, both events of relevance to connective tissue remodeling. We propose that increasing the activation of the cyclic AMP (cAMP)/protein kinase A signaling pathway will inhibit transforming growth factor-beta1 (TGF-β1)-induced ECM synthesis and myofibroblast formation and may provide a means to blunt fibrosis. Methods Fibroblasts derived from areas of Dupuytren's contracture cord (DC), from adjacent and phenotypically normal palmar fascia (PF), and from palmar fascia from patients undergoing carpal tunnel release (CTR; CT) were treated with TGF-β1 (2 ng/ml) and/or forskolin (10 μM) (a known stimulator of cAMP). Total RNA and protein extracted was subjected to real time RT-PCR and Western blot analysis. Results The basal mRNA expression levels of fibronectin- extra domain A (FN1-EDA), type I (COL1A2) and type III collagen (COL3A1), and connective tissue growth factor (CTGF) were all significantly increased in DC- and in PF-derived cells compared to CT-derived fibroblasts. The TGF-β1 stimulation of α-SMA, CTGF, COL1A2 and COL3A1 was greatly inhibited by concomitant treatment with forskolin, especially in DC-derived cells. In contrast, TGF-β1 stimulation of FN1-EDA showed similar levels of reduction with the addition of forskolin in all three cell types. Conclusion In sum, increasing cAMP levels show potential to inhibit the formation of myofibroblasts and accumulation of ECM components. Molecular agents that increase cAMP may therefore prove useful in mitigating DC progression or recurrence.

Abstract Background This paper presents the study protocol for a pragmatic randomised controlled trial to evaluate the impact of a school based program developed to prevent teenage pregnancy. The program includes students taking care of an Infant Simulator; despite growing popularity and an increasing global presence of such programs, there is no published evidence of their long-term impact. The aim of this trial is to evaluate the Virtual Infant Parenting (VIP) program by investigating pre-conceptual health and risk behaviours, teen pregnancy and the resultant birth outcomes, early child health and maternal health. Methods and Design Fifty-seven schools (86% of 66 eligible secondary schools) in Perth, Australia were recruited to the clustered (by school) randomised trial, with even randomisation to the intervention and control arms. Between 2003 and 2006, the VIP program was administered to 1,267 participants in the intervention schools, while 1,567 participants in the non-intervention schools received standard curriculum. Participants were all female and aged between 13-15 years upon recruitment. Pre and post-intervention questionnaires measured short-term impact and participants are now being followed through their teenage years via data linkage to hospital medical records, abortion clinics and education records. Participants who have a live birth are interviewed by face-to-face interview. Kaplan-Meier survival analysis and proportional hazards regression will test for differences in pregnancy, birth and abortion rates during the teenage years between the study arms. Discussion This protocol paper provides a detailed overview of the trial design as well as initial results in the form of participant flow. The authors describe the intervention and its delivery within the natural school setting and discuss the practical issues in the conduct of the trial, including recruitment. The trial is pragmatic and will directly inform those who provide Infant Simulator based programs in school settings. Trial registration ISRCTN24952438

Abstract Background Detection of bacterial nucleic acids in synovial fluid following total joint arthroplasty with suspected infection can be difficult; among other technical challenges, inhibitors in the specimens require extensive sample preparation and can diminish assay sensitivity even using polymerase chain reaction (PCR)-based methods. To address this problem a simple protocol for prior use of multiple displacement amplification (MDA) as an adjunct to PCR was established and tested on both purified S. aureus DNA as well as on clinical samples known to contain S. aureus nucleic acids. Findings A single round of MDA on purified nucleic acids resulted in a > 300 thousand-fold increase in template DNA on subsequent quantitative PCR (qPCR) analysis. MDA use on clinical samples resulted in at least a 100-fold increase in sensitivity on subsequent qPCR and required no sample preparation other than a simple alkali/heat lysis step. Mixed samples of S. aureus DNA with a 103 - 104-fold excess of human genomic DNA still allowed for MDA amplification of the minor bacterial component to the threshold of detectability. Conclusion MDA is a promising technique that may serve to significantly enhance the sensitivity of molecular assays in cases of suspected joint infection while simultaneously reducing the specimen handling required.

Abstract Problem Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management. Approach Management Sciences for Health (MSH) developed the Virtual Leadership Development Program (VLDP) with support from the United States Agency for International Development (USAID). The VLDP is a Web-based leadership development programme that combines face-to-face and distance-learning methodologies to strengthen the capacity of teams to identify and address health challenges and produce results. Relevant changes The USAID-funded Leadership, Management and Sustainability (LMS) Program, implemented by MSH, and the USAID-funded Capacity Project, implemented by IntraHealth, adapted the VLDP for HR managers to help them identify and address HR challenges that ministries of health, other public-sector organizations and nongovernmental organizations are facing. Local settings Three examples illustrate the results of the VLDP for teams of HR managers: 1. the Uganda Protestant and Catholic Medical Bureaus 2. the Christian Health Association of Malawi 3. the Developing Human Resources for Health Project in Uganda. Lessons learnt The VLDP is an effective programme for developing the management and leadership capacity of HR managers in health.

Abstract Background Oral cancer is as prevalent as cervical and testicular cancer in the United Kingdom. Nursing staff provide the oral health care for the patient population in hospital. Admission to hospital provides a 'window of opportunity' for oral cancer 'screening' via an oral health check during nursing clerking. This study aimed to investigate whether nursing staff are aware of risk factors for oral cancer, its clinical signs, and could therefore provide a 'screening' service for oral cancer. Method Through the use of a questionnaire we assessed 121 nursing staff on oral health check behaviour and attitudes; their knowledge of risk factors for oral cancer; their understanding of common clinical signs of oral cancer; and their undergraduate and postgraduate training in oral health and oral cancer. Results Over 80% thought oral health checks were important although only 49% performed this task regularly; approximately 70% identified smoking as a risk factor but less than 30% identified alcohol. Awareness of the clinical signs of oral cancer was low with 21% identifying white patches, 15% identifying ulceration and only 2% identifying red patches despite their malignant potential. Nurses within 3 years of qualification were significantly better at recognising risk factors for oral cancer than their colleagues, identifying a need for continuing postgraduate education on oral health and oral cancer. Sixty-one percent of nursing staff received oral healthcare as an undergraduate with 34 percent receiving postgraduate training. Conclusion An oral health check upon admission to hospital provides an opportunity for nurses to 'screen' for oral diseases including oral cancer and allows nurses a greater role in total patient care. Nurses' awareness of oral cancer risk factors and clinical signs was, however, poor. This study highlights a need for improved education of nurses on oral cancer to make the oral health check on admission viable for oral cancer screening.

Abstract Dupuytren's contracture (DC) is the most common inherited connective tissue disease of humans and is hypothesized to be associated with aberrant wound healing of the palmar fascia. Fibroblasts and myofibroblasts are believed to play an important role in the genesis of DC and the fibroproliferation and contraction that are hallmarks of this disease. This study compares the gene expression profiles of fibroblasts isolated from DC patients and controls in an attempt to identify key genes whose regulation might be significantly altered in fibroblasts found within the palmar fascia of Dupuytren's patients. Total RNA isolated from diseased palmar fascia (DC) and normal palmar fascia (obtained during carpal tunnel release; 6 samples per group) was subjected to quantitative analyses using two different microarray platforms (GE Code Link™ and Illumina™) to identify and validate differentially expressed genes. The data obtained was analyzed using The Significance Analysis of Microarrays (SAM) software through which we identified 69 and 40 differentially regulated gene transcripts using the CodeLink™ and Illumina™ platforms, respectively. The CodeLink™ platform identified 18 upregulated and 51 downregulated genes. Using the Illumina™ platform, 40 genes were identified as downregulated, eleven of which were identified by both platforms. Quantitative RT-PCR confirmed the downregulation of three high-interest candidate genes which are all components of the extracellular matrix: proteoglycan 4 (PRG4), fibulin-1 (FBLN-1) transcript variant D, and type XV collagen alpha 1 chain. Overall, our study has identified a variety of candidate genes that may be involved in the pathophysiology of Dupuytren's contracture and may ultimately serve as attractive molecular targets for alternative therapies.

Oral health is an integral part of general health. Previous research has shown that untreated oral conditions can result in increased rates of disease and nonbattle injury for deployed soldiers. The purpose of this study was to develop models for U.S. Army dental wellness and readiness using a multivariate regression analysis approach. Staffing levels and dental wellness and readiness rates were examined for the first three quarters of fiscal year 2002 at 40 Army installations. Full regression model equations were developed for percent dental wellness and readiness using location, time, dental provider types, and basic training installation as predictor variables. Both models were shown to be statistically significant, with wellness R2 = 0.37, F12,107 = 5.18, p < 0.001 and readiness R2 = 0.23, F12,107 = 2.65, p < 0.01. Further tests of specific predictor effects revealed that wellness was significantly associated with the specialties of general dentistry, hygienists, and oral surgery, and that readiness was significantly associated with region and the oral surgery specialty. Results may be useful for the U.S. Army to identify the best practices in an effort to optimize dental wellness and readiness. [ABSTRACT FROM AUTHOR]