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To compare the amplitude changes in motor evoked potentials (MEP) with reversal of residual neuromuscular blockade using sugammadex or placebo in patients with cervical myelopathy. In this prospective randomized double-blind, placebo-controlled crossover trial, 38 patients with cervical myelopathy undergoing posterior cervical decompression and fusion were randomized to either sugammadex (2mg/kg) or placebo. The primary outcome measure was the increase in amplitude of the MEP in the first dorsal interossei (FDI) muscle at 3 min. Mann-Whitney U test was used to analyze the primary outcome measure. There was a significant increase in the amplitude of MEP at 3 min with sugammadex when compared to placebo group. The median (IQR) increase in MEP amplitude (μV) at 3 min from the left FDI in sugammadex and placebo group was 652.9 (142:1650) and 20.6 (−183.5:297.5) (p

Escherichia coli bacteria sensors have been broadly developed broadly to overcome a diarrheal disease caused by Escherichia coli on poor hygienic water. Sensing layer, as a main part of the sensor, contacts directly to the analyte on sensors system. Some materials were costly and harmful to detect bacteria. Potentially, graphene is a natural carbon derivative with some excellence properties; easy synthesis, and biocompatible. Hence, the quality of the SiO2/graphene sensing layer was conducted through optical, physical, and electrical characterization to analyze biocompatibility, repeatability, and selectivity. The result showed that Escherichia coli bacterial growth was found around SiO2/graphene after bacterial exposure indicating a biocompatible material. Raman peak also pointed the fingerprint of graphene after 25 times Escherichia coli exposure through G (1584.52 cm–1) and 2D peak (2701.5 cm–1) promising as a repeatable material. The ID/IG ratio increased by the time the bacteria exposure times increased indicating a withstand material from defects and or disorders after bacteria exposure. Through I/V meter, the increasing number of Escherichia coli could increase the resistance value of SiO2/graphene. This sensing layer could detect the presence of Escherichia coli in limit of detection 16 CFU/mL.

The importance of psychological support for orthognathic patients has taken an increasing precedence over recent years and is embedded in orthognathic commissioning guidelines. Furthermore, attention towards mental health-related conditions and their management is of prime importance and continues to be a key area of focus within healthcare settings. With this in mind, this paper aims to outline our experience of establishing a need for and subsequently securing funding to establish a clinical psychology service within an existing orthognathic service in the NHS. The information outlined may be of benefit to orthognathic teams seeking to secure such psychological support within their respective units.

AIMS: Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre-including noncontrast CT, CT perfusion, and CT angiography-may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. METHODS: Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. RESULTS: A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. CONCLUSION: Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH. ispartof: CNS NEUROSCIENCE & THERAPEUTICS vol:26 issue:3 pages:367-373 ispartof: location:England status: published

This research aimed to determine the correlation and to find the best regression model for predicting semen quality (semen volume, individual motility, and sperm concentration) based on age and body weight in Limousin bulls. This research was conducted in December 2019 in Artificial Insemination Center, Lembang, West Java. The method used was a survey with census data collection, namely all Limousin bulls with semen collected were used in this study. The data were analyzed for correlation and simple and multiple regression using R program. The results showed that the average of age, body weight, semen volume, individual motility and sperm concentration were 58.36 ± 40.19 months, 807.12 ± 91.59 kg, 5.86 ± 1.31 ml, 67.59 ± 4.11%, and 1006.23 ± 145.28 million/ml, respectively. Age with semen volume, body weight with semen volume, and combination of age and body weight with semen volume, had a medium positive correlation (P

In vertebrates, the anterior pituitary plays a crucial role in regulating several essential physiological processes via the secretion of at least seven peptide hormones by different endocrine cell types. Comparative and comprehensive knowledge of the spatial distribution of those endocrine cell types is required to better understand their physiological functions. Using medaka as a model and several combinations of multi-color fluorescence in situ hybridization, we present the first 3D atlas revealing the gland-wide distribution of seven endocrine cell populations: lactotropes, thyrotropes, Lh and Fsh gonadotropes, somatotropes, and pomca-expressing cells (corticotropes and melanotropes) in the anterior pituitary of a teleost fish. By combining in situ hybridization and immunofluorescence techniques, we deciphered the location of corticotropes and melanotropes within the pomca-expressing cell population. The 3D localization approach reveals sexual dimorphism of tshba-, pomca-, and lhb-expressing cells in the adult medaka pituitary. Finally, we show the existence of bi-hormonal cells co-expressing lhb-fshb, fshb-tshba and lhb-sl using single-cell transcriptomics analysis and in situ hybridization. This study offers a solid basis for future comparative studies of the teleost pituitary and its functional plasticity.

Corticotropin-Releasing Factor (CRF) is one of the main mediators of the Hypothalamic-Pituitary–Interrenal (HPI) axis to stress response. In Atlantic salmon, a comparative understanding of the crf1 paralogs role in the stress response is still incomplete. Our database searches have identified four crf1 genes in Atlantic salmon, named crf1a1, crf1a2, crf1b1 and crf1b2. Brain distribution analysis revealed that the four crf1 paralogs were widely distributed, and particularly abundant in the telencephalon, midbrain, and hypothalamus of Atlantic salmon post-smolts. To increase the knowledge on crf1-mediated response to stress, Atlantic salmon post-smolts were exposed to either repeated chasing, hypoxia or a combination of chasing and hypoxia for eight days, followed by a novel-acute stressor, confinement. Cortisol, glucose, lactate, and creatinine levels were used as markers for the stress response. The crf1 paralogs mRNA abundance showed to be dependent on the stress exposure regime. Both crf1 mRNA levels in the telencephalon and crf1a1 mRNA levels in the hypothalamus showed similar response profiles to the serum cortisol levels, i.e., increasing levels during the first 24 h after stress exposure followed by a decline during the eight-day exposure. The similar trend between crf1 and cortisol disappeared once exposed to the novel-acute stressor. There was a minor response to stress for both crf1b1 and crf1b2 in the hypothalamus, while no changes at mRNA level were observed in the hypothalamic crf1a2 under the different stress conditions. No or weak relationship was found between the crf1 paralogs mRNA expression and the other serum stress-indicators analysed. In summary, our data provide novel insights on the dynamic of the HPI axis activation in Atlantic salmon, and thus underline the involvement of the crf1 paralogs as additional factors in the regulation of the stress response in this species. Likewise, the data highlight the importance of analysing all crf1 paralogues response to a stress-condition, in particular in this premature knowledge stage of their functionality. Further analysis and a more detailed time-point series will help to elucidate the response of the HPI axis and the link of crf1 paralogs in the stress response mechanism. publishedVersion

The pituitary gland controls many important physiological processes in vertebrates, including growth, homeostasis, and reproduction. As in mammals, the teleost pituitary exhibits a high degree of plasticity. This plasticity permits changes in hormone production and secretion necessary to meet the fluctuating demands over the life of an animal. Pituitary plasticity is achieved at both cellular and population levels. At the cellular level, hormone synthesis and release can be regulated via changes in cell composition to modulate both sensitivity and response to different signals. At the cell population level, the number of cells producing a given hormone can change due to proliferation, differentiation of progenitor cells, or transdifferentiation of specific cell types. Gonadotropes, which play an important role in the control of reproduction, have been intensively investigated during the last decades and found to display plasticity. To ensure appropriate endocrine function, gonadotropes rely on external and internal signals integrated at the brain level or by the gonadotropes themselves. One important group of internal signals is the sex steroids, produced mainly by the gonadal steroidogenic cells. Sex steroids have been shown to exert complex effects on the teleost pituitary, with differential effects depending on the species investigated, physiological status or sex of the animal, and dose or method of administration. This review summarizes current knowledge of the effects of sex steroids (androgens and estrogens) on gonadotrope cell plasticity in teleost anterior pituitary, discriminating direct from indirect effects.

PURPOSE: To ascertain the complications arising from open reduction and internal fixation of mandibular fractures and to elucidate if different osteosynthesis plating systems vary in treatment outcome. MATERIALS AND METHODS: This is a retrospective study. Parameters such as patient data, injury details, osteosynthesis implant system information, stability of fracture fragments, occlusion and complications were evaluated at different time intervals and logistic regression applied to determine the association of these factors with complications. RESULTS: Five hundred and ninety-three patients with mandibular fractures were included in this study (male 87.9% and female 12.1%), age range of 13–72 years (median = 22 years). Most fractures were caused by motor vehicle accidents (85.8%), assault (6.2%) and falls (4.7%). Parasymphyseal fractures were the most common (50.1%), followed by angle (35.2%) and body of mandible (25%). Median time interval between injury and intervention was 7 days (IQR 4–10). Median duration of follow-up from date of surgery was 72 days (IQR 30–230). 76.9% (456) were completely free of complications. Most complications (46%) occurred in the intermediate post-surgical period (1–6 weeks). Median interval period between surgery and complication was 15 days (IQR 7–67.5). Nerve injury and surgical site infection were the most common complications at 6.7% and 5.7%, respectively. There was a significant difference between the plating system in terms of complication outcome (p = 0.017). CONCLUSION: Whilst the miniplate dimensions may be similar across different manufacturers, the complication outcome may differ between systems.

Introduction: The danger of using biological warfare for mass destruction is a serious threat to this country. Thus, it is necessary that our health care services are prepared to efficiently manage any such unfortunate events that we may have to face in future. Physicians in the public and private sector of health services are the first point of contact between public and health services. Thus, the present study examines the awareness of medical physicians in Goa about biological terrorism to evaluate the need for further education in this field. Methods: The present cross-sectional study was conducted among the medical physicians in Goa using purposive sampling method. The self-administered questionnaire collected information regarding the qualification, work setting of the study participants and knowledge regarding biological terrorism. Data was entered and analysed using SPSS version 22. Descriptive statistics was utilized to study frequencies and proportion of various study variables. Results: Of the 200 study participants, 128 (64%) were Specialist doctors, 65 (32.5%) were General physicians, while 7 (3.5%) were Super-specialist doctors. Of the 200 study participants, 174 (87%) reported that they were aware of the use of biological agent for mass destruction of human lives. As much as 34 (17%) study participants could not list any agent of bioterrorism. Conclusion: The knowledge of medical physician in Goa regarding bioterrorism is low, which is a matter of concern as these medical professionals are the first point of contact for the patients affected by an attack of bioterrorism.

As the beekeeping industry develops, increases in honey yield is dependent on colony health. The honeybee gut bacteria originate from their natural habitat and food, nectar, pollen, and water intake. Extensive studies have been carried out to determine specific suitable probiotic bacteria for honeybees. The main goal of this research is to control diseases, not increase honey production; however, a healthier colony will certainly produce more honey. It has been shown that lactic acid bacteria isolated from honeybees has beneficial effects on bee health and reduces the prevalence of pathogens. Adding a mixture of Lactobacillus to the feed of larvae leads to a reduction in infection. Knowledge of molecular mechanisms of probiotics in protecting honeybee colonies against pathogens is important.

Objectives: There is a lack of evidence‐based psychological therapies for dementia and psychological distress. The study aimed to develop a compassion focused therapy intervention for people with dementia with depression and/or anxiety, and to assess its feasibility, acceptability, and utility. / Methods: A mixed methods multiple case series (n = 7) was used to assess the intervention's feasibility and changes in self‐compassion, mood, anxiety, and quality of life. Outcome measures were administered at pre‐intervention, midpoint, and post‐intervention. Data were analysed using reliable change and clinically significant change. Thematic analysis on post‐therapy interviews and session rating forms was used to assess acceptability and perceived change from the intervention. / Results: Over the course of the intervention, improvements in mood, anxiety, and self‐compassion were seen, and three of six participants moved out of the clinical depression range. Six participants were able to engage in soothing rhythm breathing, and five in discussion of self‐criticism and developing self‐compassion. Several participants and their carers described increased self‐compassion in response to cognitive decline. / Conclusions: Compassion focused therapy can be adapted to be delivered to people with dementia and low mood, anxiety, or other distress. The intervention may improve self‐compassion, mood, and anxiety. A larger pilot trial with a comparator group and follow‐up is needed to evaluate the intervention's effectiveness for people with dementia.

Tumour uptake value is a critical result in [F]FDG-PET/CT ([F]fluorodeoxyglucose) quantitative scans such as the dose prescription for radiotherapy and oncology. The quantification is highly dependent on the protocol of acquisition and reconstruction of the image, especially in low activity tumours. During adjusting acquisition and reconstruction protocols available in our Siemens Biograph mCT scanner for EARL (ResEARch 4 Life®) [F]FDG-PET/CT accreditation requirements, we developed reconstruction protocols which will be used in PET based radiotherapy planning able to reduce inter-/intra-institute variability in Standard Uptake Value (SUV) results, and to bring Recovery Coefficient to 1 as close as possible for Image Quality NEMA 2007 phantom. Primary and secondary tumours from two patients were assessed by four independent evaluators. The influence of reconstruction protocols on tumour clinical assessment was presented. We proposed the improvement route for EARL accredited protocols so that they may be developed in classes to take advantage of scanner possibilities. The application of optimized reconstruction protocol eliminates the need of partial volume corrections., This work was in part supported by the Spanish regional government of Andalucía (Junta de Andalucía) within the project with reference CTS 2482 and the European Community funding (FEDER). “Acuerdo de colaboración en formación especializada entre el Hospital Universitario Virgen del Rocío y el Centro Nacional de Aceleradores” Spain is acknowledged for providing institutional and financial support.

Probiotics are live microorganisms with confirmed beneficial effects on poultry health, growth performance, immune system and gut microbial population. A better perception of the mechanisms underlying the immunomodulatory effects of probiotic bacteria is usually needed to give a superior direction to the development and administration of probiotics. The oral administration of probiotic bacteria influence host cytokine levels and therefore, alters both innate and adaptive host immune responses. Selected probiotics, including some lactobacillus isolates and enterococcal strains, have been considered to prevent salmonella colonisation. Part of the effect of probiotic bacteria may be mediated through changes in the immune system related genes, including cytokine expression. Administration of probiotics in chickens could moderate salmonella mediated changes in genes, including encoding pro-inflammatory cytokines, T helper (Th) 1 cytokines, and Th2 cytokines. This review summarises the findings on the mechanisms of salmonella inhibition by using probiotic bacteria at the molecular level.

This article describes a 10-session group-based Mindfulness Program for people with mild to moderate dementia. It aims to equip people with dementia with skills to manage psychological distress, with support from carers. The Mindfulness Program was developed through reviews of existing literature, consultation with experts, and a focus group with people with dementia. In a randomized controlled feasibility and pilot trial with people with mild to moderate dementia in care homes, it was found to significantly increase quality of life. The manual presented here is designed to be administered flexibly to promote participants’ personhood. The protocol is designed for use by therapists with experience in practicing mindfulness meditation.

To improve patient care/outcome, an evaluation was conducted of nursing procedures and protocols for pro re nata (PRN) medications.A 14-day chart review was conducted for 27 patients with mood and thought disorders (MTD) and for 24 patients with organic disorders (OD) at a geriatric psychiatric hospital, and a questionnaire was completed by 20 nurses.377 PRNs were administered to patients in the MTD and OD units (240 and 137, respectively). The majority of PRNs were administered during the evening shifts on the MTD unit and during the day shifts on the OD unit. Chart notes indicated the behavior requiring PRN administration was not always specifically described and therapeutic interventions were not often attempted before PRN administration. Inconsistency between chart notes and medication record books was noted in the majority of cases. It was often not known whether the PRN was initiated by the staff, patient, or family. PRNs were reported to be not effective in the majority of cases.Documentation was suboptimal and effectiveness was poor.It would be worthwhile to train all staff in a patient-centered or ecopsychosocial (i.e., non-pharmacological) model of care, which would provide staff alternatives to PRNs. In that context, it would be important to implement standards of practice into geriatric psychiatry inpatient settings for PRN administration and documentation.

The e-prescribing system at the Great Western Hospital offers a note taking system that pharmacy uses to record a 24-hour drug history and allows users to add notes clarifying any changes. A QI project aimed to reduce near-misses caused by prescribing errors by increasing the utilisation of the 24-hour drug history and note system. This was done via education targeted at the primary users of the system using pre-existing channels in the trust. Three cycles of interventions were implemented: teaching the prescribers how to use the system during teaching sessions, increasing publicity via posters in clinical areas and trust mailing lists, and making a version of the guide available on the trust intranet. The primary measure was the number of near-misses identified from pharmacy phone calls to the medical team in a 24-hour period, which fell from 22 to 10 to 8 to 7. Secondary measures were the percentage drug histories being ‘read’, which improved from 12.77% to 23.26% initially but fell to 2.38% and 4.65%; and the percentages of drug charts with notes clarifying discrepancies which changed little despite intervention from 18.92% to 28.00% to 33.33% to 29.54%. The interventions show that it is possible to use existing trust education channels to produce a sustainable reduction in near-misses. The reduction in percentage drug histories being ‘read’, and the lack of change in the percentages of drug charts with notes clarifying discrepancies illustrate the challenges in using an e-prescribing system.

Representative volume elements (RVEs) are commonly used to compute the effective elastic properties of solid media having repeating microstructure, such as fiber reinforced composites. However, for softening materials, an RVE could be problematic due to localization of deformation. Here, we address the effects of unit cell size and fiber packing on the transverse tensile response of fiber reinforced composites in the context of integrated computational materials engineering (ICME). Finite element computations for unit cells at the microscale are performed for different sizes of unit cells with random fiber packing that preserve a fixed fiber volume fraction&mdash, these unit cells are loaded in the transverse direction under tension. Salient features of the response are analyzed to understand the effects of fiber packing and unit cell size on the details of crack path, overall strength and also the shape of the stress-strain response before failure. Provision for damage accumulation/cracking in the matrix is made possible via the Bazant-Oh crack band model. The results suggest that the choice of unit cell size is more sensitive to strength and less sensitive to stiffness, when these properties are used as homogenized inputs to macro-scale models. Unit cells of smaller size exhibit higher strength and this strength converges to a plateau as the size of the unit cell increases. In this sense, since stiffness has also converged to a plateau with an increase in unit cell size, the converged unit cell size may be thought of as an RVE. Results in support of these insights are presented in this paper.

OBJECTIVE: Depression and anxiety are common in dementia. There is a need to develop effective psychosocial interventions. This study sought to develop a group-based adapted mindfulness programme for people with mild to moderate dementia in care homes and to determine its feasibility and potential benefits. METHODS: A manual for a 10-session intervention was developed. Participants were randomly allocated to the intervention plus treatment as usual (n = 20) or treatment as usual (n = 11). Measures of mood, anxiety, quality of life, cognitive function, stress and mindfulness were administered at baseline and 1 week post-intervention. RESULTS: There was a significant improvement in quality of life in the intervention group compared to controls (p = 0.05). There were no significant changes in other outcomes. CONCLUSIONS: The intervention was feasible in terms of recruitment, retention, attrition and acceptability and was associated with significant positive changes in quality of life. A fully powered randomised controlled trial is required. Copyright © 2017 John Wiley & Sons, Ltd.

This paper explains the effects of BSA/PBA-NHS/Graphene/SiO2 used as a sensing layer for E. coli bacteria sensor based on the electrical properties. In this research, graphene is used as a sensing layer due to its superior properties especially its biocompatibility. The biocompatibility of graphene was examined by topological properties by AFM. Moreover, it was also confirmed by Raman spectroscopy. The topological structure and Raman spectroscopy showed good results which is indicate the graphene layer suitable for biosensing applications. Additionally, it was also confirmed that the antibody was successfully immobilized on the modified SiO2/graphene/PBANHS. PBANHS is used as a linker due to its cost-effective and time-saving. The electrical properties of the sensing layer before and after the immobilized antibody shows a significant difference. When the number of E. coli bacteria increases, the current increase also became higher. The change in resistance gradually increases from 0.04 to 2.62 Ħ when the number of bacteria increases from 55 to 1200 CFU/ml.-+.

Stigma has been identified as being central to the experience of having a dementia, both for the person with dementia (PwD) and for their care partners. Despite this growing recognition, we still know very little about the area. Our objectives were to identify the types and degree of stigma experienced by care partners of PwD, identify PwD and care partner variables that may influence the effect of care partner stigma, and determine if there are styles of coping that are associated with dementia stigma. Results indicate that care partners (N=20) report experiencing three types of stigma (stigma by association, lay person’s stigma, and structural stigma). Trends in the data indicate that several types of coping styles are associated with these types of stigma. Only care partner’s education was positively associated with structural stigma. Helping care partners to develop better coping styles may reduce the powerful effect of stigma.

The past century has witnessed the rise and maturity of the flying machine, starting with the Wright brothers flyer to today’s modern passenger aircrafts and warfighters. At the start of this century, yet another achievement in flying vehicle technology was seen with the launch of the Boeing 787 aircraft, which has a significant portion by weight of polymer matrix fibre composites. This paper, therefore, addresses the effects of the manufacturing process of fibre reinforced polymer matrix composites on mechanical performance. Computations are carried out using the Finite Element (FE) method at the microscale where Representative Volume Elements (RVEs) are analysed with Periodic Boundary Conditions (PBCs). Straight fibre pre-preg-based composites and textile composites are considered. The commercial code ABAQUS is used as the solver for the FE equations, supplemented by user-written subroutines. The transition from a continuum to damage/failure is effected by using the Bažant-Oh crack band model, which preserves mesh objectivity. Results are presented for RVEs that are first subjected to curing and subsequently to mechanical loading. The effect of the fibre packing randomness on the microstructure is examined by considering multifibre RVEs where fibre volume fraction is held constant but with random packing of fibres. Plain weave textile composites are also cured first and then subjected to mechanical loads. The possibility of failure is accommodated throughout the analysis – failure can take place during the curing process even prior to the application of in-service mechanical loads. The analysis shows the differences in both the cured RVE strength and stiffness, when cure-induced damage has and has not been taken into account.

Traditionally, poultry farmers aimed to produce birds with high body weight and feed conversion ratio. However, in line with current developments, there are other traits that must be taken into account as well. These include producing poultry meat with lower body fat content and improving the nutritional quality of the poultry meat to appeal to consumer requirements. The interrelated importance of human diet and health status is an ancient subject. Human foods as a lifestyle factor is involved in the incidence of many types of diseases, such as cardiovascular diseases and cancer. Recent reports suggest that not only the quantity but also the composition of dietary fat is an important factor to prevent these metabolic diseases in human populations. It has been reported that some dietary fats are able to reduce lipid synthesis and increase fatty acid oxidation and diet-mediated thermogenesis. The outcome of this change is a superior animal product with lower fat content. There is evidence of dissimilar mechanisms of action of n-3 and n-6 fatty acids. Dietary fatty acids have various effects on cellular metabolism, and many of these effects are carried out through the alteration of gene expression. This review will focus on the control of body fat by gene expression in avians.

Conjugated linoleic acid (CLA) is a mixture of isomers of linoleic acid (C18:2 n-6), which is mostly found in the ruminant meat and dairy products. The CLA is known to have many potential health benefits, and considered a potent powerful fatty acid, which is linked to animal and human health. The present work aims to discuss the source and production, mechanism of action, and effects of CLA on humans, poultry, and ruminants by reviewing the recent studies carried out on CLA. Despite most of the recent studies indicating beneficial effects of CLA on improving body weight control parameters, its effects on reducing risk factors of cardiovascular diseases (CVD), inflammation, blood glucose, and insulin are still controversial, and need to be further studied in different hosts.

This study compared the early clinical outcomes and safety of the Norwich Enhanced Recovery Programme (NERP) and a non-enhanced recovery programme following Total Hip Replacement (THR) and Total Knee Replacement (TKR). The NERP programme is a multi-componented nursing and multidisciplinary pre- and peri-operative recovery programme which harnesses elements of managing patient expectation with education, pain control and early intensive rehabilitation. This new programme was compared with an age- and gender-matched cohort who followed the recovery pathway provided prior to the NERP regime. A total of 192 patients were reviewed. The results indicated that for THR and TKR hospital length of stay and requirement for in-patient rehabilitation was significantly lower following the NERP regime (p

Context Electives commonly represent a valued, enjoyed and formative part of medical training. However, there is little empirical evidence about students' preparedness, practices and perceptions of medical electives in resource-poor settings. Exploring what students do, why and under what circumstances is therefore worthwhile. Objectives This study aimed to evaluate students' views on the processes, outcomes and impacts of medical electives in three low-income countries. Methods A qualitative study using purposeful sampling and semi-structured interviews was conducted. Participants were 29 Western students on medical electives at seven host sites in sub-Saharan Africa. A framework approach was used to analyse 872 minutes of audio-recorded data. Results Students were highly positive about their experiences and seemed aware of their clinical limitations. Pre-departure training offered by some institutions was beneficial, but the content was perceived to be of little clinical relevance. Language barriers were the main challenges faced by students, even in places where English was the second language. Students who stayed longer, were nearer qualification or were based in rural units (rather than teaching centres) contributed more to patient care. Supervision was considered adequate but this appeared to be judged in a local context. Deliberate inappropriate practice was not encountered, but on occasion misunderstanding arose over the student's status. Conclusions Students who undertake electives in resource-poor countries appear to have clearly thought out and positive intentions, but current systems cause concern with reference to student activities and staff time, and require improvement. Instead of focusing on education benefits alone, students (and their sending institutions) need to consider other approaches through which host communities can more clearly benefit. Effective pre-departure preparation should become a requirement.

A randomized complete block design trial was conducted with 3,444 beef heifers housed in 10 pens per treatment and fed barley-based diets to evaluate the effects of ractopamine (Optaflexx, Elanco Animal Health, Greenfield, IN) and zilpaterol (Zilmax, Intervet/Schering-Plough Animal Health, De soto, KS) on health, performance, carcass traits, and longissimus muscle tenderness in a commercial feedlot in western Canada. Treatments consisted of feeding Optaflexx at 20 mg/kg (100% DM basis) for 29 d at the end of the feeding period or Zilmax at 8.3 mg/kg (100% DM basis) for 20 d at the end of the feeding period, followed by a 4-d withdrawal period before slaughter. No differences (P > 0.05) were detected in morbidity, mortality, number of salvaged animals, ADG, feed efficiency, or final BW between heifers fed Zilmax or Optaflexx. Dry matter intake was reduced (P

Most studies investigating anuran jumping behaviour have examined the relationship between body size and parameters such as jump distance, velocity, and force; however, few have investigated jump trajectory. We constructed an arena to determine escape trajectories in relation to the direction of an artificial stimulus in the aromobatid Mannophryne trinitatis (Garman, 1888) and two treefrogs, Trachycephalus venulosus (Laurenti, 1768) and Hypsiboas geographicus (Spix, 1824). Three categories of M. trinitatis (i.e., tadpole-transporting males, nontransporting males, and females) and three ontogenetic stages of the treefrogs were compared. Mannophryne trinitatis escaped in a broadly predictable trajectory away from the stimulus, although jump trajectories were highly variable, suggesting a degree of unpredictability. No systematic differences were found between categories of M. trinitatis, adding to the findings of previous studies that larval transport incurs no measurable locomotor costs on antipredatory jumping behaviour with regards to jump angle and distance. The treefrogs showed similar patterns of escape trajectory and unpredictability. There were no consistent differences between life-history stages and no relationship between distance jumped and angular deviation. In M. trinitatis and H. geographicus, there was some evidence of bimodality in escape trajectory. The results are discussed in the context of other work on escape trajectories and the concept of “protean” defence strategies.

Shiga toxin (Stx) is implicated in the development of hemorrhagic colitis and hemolytic-uremic syndrome, but early symptoms of enterohemorrhagic Escherichia coli (EHEC) infection such as nonbloody diarrhea may be Stx independent. In this study, we defined the effects of EHEC, in the absence of Stx, on the intestinal epithelium using a murine model. EHEC colonization of intestines from two groups of antibiotic-free and streptomycin-treated C57Bl/6J mice were characterized and compared. EHEC colonized the cecum and colon more efficiently than the ileum in both groups; however, greater amounts of tissue-associated EHEC were detected in streptomycin-pretreated mice. Imaging of intestinal tissues of mice infected with bioluminescent EHEC further confirmed tight association of the bacteria with the cecum and colon. Greater numbers of EHEC were also cultured from stool samples obtained from streptomycin-pretreated mice, as compared with those that received no antibiotics. Transmission electron microscopy shows that EHEC infection leads to microvillous effacement of mouse colonocytes. Hematoxylin and eosin staining of the colonic tissues of infected mice revealed a slight increase in the number of lamina propria polymorphonuclear leukocytes. Transmucosal electrical resistance, a measure of epithelial barrier function, was reduced in the colonic tissues of infected animals. Increased mucosal permeability to 4- kDa FITC-dextran was also observed in the colonic tissues of infected mice. Immunofluorescence microscopy showed that EHEC infection resulted in redistribution of the tight junction (TJ) proteins occludin and claudin-3 and increased the expression of claudin-2, whereas ZO-1 localization remained unaltered. Quantitative real-time PCR showed that EHEC altered mRNA transcription of OCLN, CLDN2, and CLDN3. Most notably, claudin-2 expression was significantly increased and correlated with increased intestinal permeability. Our data indicate that C57Bl/6J mice serve as an in vivo model to study the physiological effects of EHEC infection on the intestinal epithelium and suggest that altered transcription of TJ proteins has a role in the increase in intestinal permeability.

Epithelial cells lining the colon do not normally express galanin type 1 receptors (Gal1Rs). However, subsequent to infection with enteric pathogens such as Salmonella typhimurium, the Gal1R is rapidly upregulated in colonocytes where it contributes to the excess fluid production associated with diarrhoea. Humans infected with non-typhoid Salmonella respond differently according to age: infants develop diarrhoea but not bacteraemia and survive, while the elderly become bacteraemic and die. Thus the aim of this study was to determine if age-related differences exist in response to S typhimurium infection in mice, and whether these differences are due to altered Gal1R expression. Wild-type C57BL/6J mice that were 2 and 15 months old, as well as 2-month-old Gal1R knockout mice, were infected by gavage. Young wild-type mice expressed Gal1R in response to infection, had increased colonic fluid secretion, low rates of bacteraemia and survived. In contrast, 15-month-old wild-type mice expressed fewer Gal1Rs in response to infection, had attenuated increases in colonic fluid secretion, high rates of bacteraemia and died. A similar profile was noted in 2-month-old Gal1R knockout mice. Addition of polyethylene glycol to the drinking water of 15-month-old wild-type mice increased colonic fluid secretion and reduced rates of bacteraemia to those observed in 2-month-old wild-type mice and eliminated fatalities. The difference in response to S typhimurium infection with age may be due, at least in part, to decreased Gal1R expression and decreased amounts of colonic fluid secretion.

Eleven monoclonal antibodies (MAbs) that were reactive against the hemagglutinating encephalomyelitis virus (HEV), as seen in the enzyme-linked immunosorbent assay, were obtained. All of these MAbs showed neutralizing activity (1:20,000 to 1:800,000) against the 67N strain of HEV. They also showed hemagglutination inhibition activity (1:400 to 1:409,600). Western blotting tests revealed that all of these 11 MAbs were specific for the S protein of HEV. All MAbs with neutralizing activity showed the same fluorescent staining pattern. Ten-day-old mice pups were immunized with MAb, inoculated with the 10(5) tissue culture-infective dose of HEV at 3 days after immunization, and then examined to determine the viral inhibition. The 1:800-diluted MAb120 inhibited the viral infection in mice pups, though the 1:1,000-diluted MAb120 failed to inhibit the viral infectivity. These MAbs would be a useful tool for rapid and specific diagnosis of HEV and also for antibody-based treatment of the disease.

OBJECTIVE: To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic therapy. DESIGN: Prospective cohort study using historical controls. SETTING: Hunter Region of New South Wales, September 2005 to March 2006 (pre-intervention) and September 2006 to March 2007 (post-intervention). PARTICIPANTS: Consecutive patients presenting with acute stroke to a regional, tertiary referral hospital. INTERVENTION: PAST protocol, comprising a pre-hospital stroke assessment tool for ambulance officers, an ambulance protocol for hospital bypass for potentially thrombolysis-eligible patients, and pre-hospital notification of the acute stroke team. MAIN OUTCOME MEASURES: Proportion of patients who received intravenous tissue plasminogen activator (tPA), process of care time points (symptom onset to ED arrival, ED arrival to tPA treatment, and ED transit time), and clinical outcomes of patients treated with tPA. RESULTS: The proportion of ischaemic stroke patients treated with tPA increased from 4.7% (pre-intervention) to 21.4% (post-intervention) (P < 0.001). Time point outcomes also improved, with a reduction in median times from symptom onset to ED arrival from 150 to 90.5 min (P = 0.004) and from ED arrival to stroke unit admission from 361 to 232.5 minutes (P < 0.001). Of those treated with tPA, 43% had minimal or no disability at 3 months. CONCLUSIONS: Organised pre-hospital and ED acute stroke care increases patient access to tPA treatment, which is proven to reduce stroke-related disability.

Background: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. Methods: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. Results: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. Conclusions: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low. Language: en

There is a trend to separate Thoracic surgery from the Cardiothoracic surgical divisions. One of the main persuasive argument is the evidence in support of increased resection rate and effective delivery of thoracic surgical services. In such context we reviewed the outcome of thoracic surgical practice in our region where a cardiothoracic surgeon's service was standard.

Quality of life (QoL) is now seen as a key outcome in many aspects of dementia care. In a recent randomized controlled trial of Cognitive Stimulation Therapy (CST) groups, significant improvements in self-reported QoL were identified as well as changes in cognitive function. This further analysis of results from the trial examines whether the changes in these two domains occurred independently, perhaps for different reasons, or whether the effect of treatment on QoL was mediated by the changes in cognition. In all, 201 people with dementia living in residential homes or attending day centres were assessed using the Quality of Life-Alzheimer's Disease (QOL-AD) scale and a range of measures of cognition, dementia level, mood, dependency and communication. Participants were randomized to receive an intervention programme of CST or to receive treatment as usual. The QoL-AD and other measures were repeated eight weeks later. At baseline, higher QoL in dementia was significantly correlated with lower levels of ...

This study was conducted to evaluate the effect of garlic (Allium sativum) meal on the intestinal mucosal morphology of broiler chickens between 21 and 42 days of age. A total of 1800, 21 days old Ross 308 broiler chicks were weighed and randomly allotted into 0, 0.125, 0.25, 0.5, 1 and 2% dietary garlic meal groups of each 100 birds. Experimental diets were formulated by addition of each level of garlic meal to commercial finisher mash diet (CP : 20.45%, ME : 3,130kcal/kg), and fed ad libitum for 21d. At day 42, 15 chicks from each treatment were randomly killed to obtain intestinal samples.Villus height, epithelial thickness, goblet cell numbers, crypt depth and the ratio of crypt depth to villus height in each intestinal segment were compared using a light microscope. Garlic meal as a feed additive significantly enhanced villus height and crypt depth and decreased epithelial thickness and goblet cell numbers in duodenum, jejunum and ileum of birds. Fundamentally, jejunum and ileum revealed an almost similar morphological alteration to that in the duodenum except that dietary garlic meal supplement resulted in an increase in the ratio of crypt depth to villus height in duodenum but a decrease in jejunum and ileum. In present study, small intestinal morphological changes in chickens due to dietary garlic meal supplement demonstrate that absorptive process could be activated by garlic meal as an antibiotics alternative growth promoter.