Search

The editorial "Medical Anthropology Past, Present, and Future: The State of the Art" reflects on the changes and challenges faced by medical anthropology over the last decade. It highlights the increasing recognition of planetary health and the blurring of disciplinary boundaries, as well as the need for decolonization and inclusivity in scholarship. The editorial also discusses the evolving role of medical anthropologists in addressing global health issues, technological advancements, and the shifting landscape of the discipline towards transdisciplinary collaborations and a more global perspective. [Extracted from the article]

Our intent was to explore if maternal anxiety, depression, reflective functioning and level of attachment significantly changed after the Building Bonds and Attachment Service (BABS) Intervention. We measured outcomes for 46 at risk mothers via HADS; MAAS; MPAS and P-PRFQ. Our findings, triangulated with 32 semi structured interviews identified that BABS intervention made a significant difference to participants who were admitted during the antenatal period (Pregnant group: depression 9.63[CI:7.63–11.63; p < 0.001]; anxiety 9.40[CI: 7.56–11.24]; p < 0.001]; reflective functioning 30.78[CI:24.84–36.72; p < 0.001] and maternal attachment 8.78[CI:4.08–13.48]; p 0.001). Suicidal contemplation was prevented for two women. Our conclusions explained the service made a significant difference to the lives of mothers between baseline and post intervention for pregnant mothers with anxiety and depression who struggled to bond with their baby. Appropriate referral may help to increase accessibility to those who may benefit most. Further research needs to test if this care model would be acceptable to culturally diverse populations. [ABSTRACT FROM AUTHOR]

Aghjayan et al. conduct a systematic review and meta-analysis of randomised controlled trials on the effect of aerobic exercise on episodic memory in late adulthood. The results demonstrate that exercise interventions improve episodic memory, with age being one moderator of this effect.

Abstract Background There is increasing evidence that the airway microbiome plays a key role in the establishment of respiratory health by interacting with the developing immune system early in life. While it has become clear that bacteria are involved in this process, there is a knowledge gap concerning the role of fungi. Moreover, the inter-kingdom interactions that influence immune development remain unknown. In this prospective exploratory human study, we aimed to determine early post-natal microbial and immunological features of the upper airways in 121 healthy newborns. Results We found that the oropharynx and nasal cavity represent distinct ecological niches for bacteria and fungi. Breastfeeding correlated with changes in microbiota composition of oropharyngeal samples with the greatest impact upon the relative abundance of Streptococcus species and Candida. Host transcriptome profiling revealed that genes with the highest expression variation were immunological in nature. Multi-omics factor analysis of host and microbial data revealed unique co-variation patterns. Conclusion These data provide evidence of a diverse multi-kingdom microbiota linked with local immunological characteristics in the first week of life that could represent distinct trajectories for future respiratory health. Trial registration NHS Health Research Authority, IRAS ID 199053. Registered 5 Oct 2016. https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/breathing-together/ Video abstract

BackgroundChronic lung allograft dysfunction (CLAD) is the leading cause of poor long-term survival after lung transplantation (LT). Systems prediction of Chronic Lung Allograft Dysfunction (SysCLAD) aimed to predict CLAD.MethodsTo predict CLAD, we investigated the clinicome of patients with LT; the exposome through assessment of airway microbiota in bronchoalveolar lavage cells and air pollution studies; the immunome with works on activation of dendritic cells, the role of T cells to promote the secretion of matrix metalloproteinase-9, and subpopulations of T and B cells; genome polymorphisms; blood transcriptome; plasma proteome studies and assessment of MSK1 expression.ResultsClinicome: the best multivariate logistic regression analysis model for early-onset CLAD in 422 LT eligible patients generated a ROC curve with an area under the curve of 0.77. Exposome: chronic exposure to air pollutants appears deleterious on lung function levels in LT recipients (LTRs), might be modified by macrolides, and increases mortality. Our findings established a link between the lung microbial ecosystem, human lung function, and clinical stability post-transplant. Immunome: a decreased expression of CLEC1A in human lung transplants is predictive of the development of chronic rejection and associated with a higher level of interleukin 17A; Immune cells support airway remodeling through the production of plasma MMP-9 levels, a potential predictive biomarker of CLAD. Blood CD9-expressing B cells appear to favor the maintenance of long-term stable graft function and are a potential new predictive biomarker of BOS-free survival. An early increase of blood CD4 + CD57 + ILT2+ T cells after LT may be associated with CLAD onset. Genome: Donor Club cell secretory protein G38A polymorphism is associated with a decreased risk of severe primary graft dysfunction after LT. Transcriptome: blood POU class 2 associating factor 1, T-cell leukemia/lymphoma domain, and B cell lymphocytes, were validated as predictive biomarkers of CLAD phenotypes more than 6 months before diagnosis. Proteome: blood A2MG is an independent predictor of CLAD, and MSK1 kinase overexpression is either a marker or a potential therapeutic target in CLAD.ConclusionSystems prediction of Chronic Lung Allograft Dysfunction generated multiple fingerprints that enabled the development of predictors of CLAD. These results open the way to the integration of these fingerprints into a predictive handprint.

Purpose The purpose of the current study, The National Institute of Child Health and Human Development (NICHD) Study of Health in Early and Adult Life (SHINE), was to build on the landmark Study of Early Child Care and Youth Development (SECCYD), a longitudinal birth cohort initiated in 1991, by conducting a health-focused follow-up of the now adult participants. This effort has produced an invaluable resource for the pursuit of life course research examining links between early life risk and resilience factors and adulthood health and disease risk.Participants Of the 927 NICHD SECCYD participants available for recruitment in the current study, 705 (76.1%) participated in the study. Participants were between 26 and 31 years and living in diverse geographic locations throughout the USA.Findings to date In descriptive analyses, the sample exhibited risk on health status indicators, especially related to obesity, hypertension and diabetes. Of particular concern, the prevalence of hypertension (29.4%) and diabetes (25.8%) exceeded national estimates in similar-age individuals. Health behaviour indicators generally tracked with the parameters of poor health status, showing a pattern of poor diet, low activity and disrupted sleep. The juxtaposition of the sample’s relatively young age (mean=28.6 years) and high educational status (55.6% college educated or greater) with its poor health status is noteworthy, suggesting a dissociation between health and factors that are typically health protective. This is consistent with observed population health trends, which show a worsening of cardiometabolic health status in younger generations of Americans.Future plans The current study, SHINE, lays the groundwork for future analyses in which the uniquely robust measures collected as a part of the original NICHD SECCYD will be leveraged to pinpoint specific early life risk and resilience factors as well as the correlates and potential mechanisms accounting for variability in health and disease risk indicators in young adulthood.

BACKGROUND:Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. METHODS:Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging. RESULTS:Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state. CONCLUSIONS:Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.

We present a reverse-taper quantum cascade laser (QCL) emitting at 4.6 μm, a novel-geometry device that can scale the output power while maintaining good beam quality. Buried-ridge waveguides with tapered and straight regions were formed by ICP etching and HVPE regrowth – the tapered region scales the output power, while the emitting facet is located at the narrow-end taper section, which provides mode filtering by suppressing high-order spatial modes. Beam profiles were observed under quasi-continuous-wave (QCW)/CW operation and beam quality (M2) measurements along with beam-stability measurements were performed – a small degree of collimated-beam centroid movement (2 values close to 1 up to ∼1 W QCW power. Devices of shorter cavity lengths were also investigated, indicating that the output power scales with the core-region volume but results in a small increase in angular deviation.

The Australian Community Climate and Earth System Simulator (ACCESS) has contributed to the World Climate Research Programme’s Coupled Model Intercomparison Project Phase 6 (CMIP6) using two fully coupled model versions (ACCESS-CM2 and ACCESS-ESM1.5) and two ocean–sea-ice model versions (1° and 0.25° resolution versions of ACCESS-OM2). The fully coupled models differ primarily in the configuration and version of their atmosphere components (including the aerosol scheme), with smaller differences in their sea-ice and land model versions. Additionally, ACCESS-ESM1.5 includes biogeochemistry in the land and ocean components and can be run with an interactive carbon cycle. CMIP6 comprises core experiments and associated thematic Model Intercomparison Projects (MIPs). This paper provides an overview of the CMIP6 submission, including the methods used for the preparation of input forcing datasets and the post-processing of model output, along with a comprehensive list of experiments performed, detailing their initialisation, duration, ensemble number and computational cost. A small selection of model output is presented, focusing on idealised experiments and their variants at global scale. Differences in the climate simulation of the two coupled models are highlighted. ACCESS-CM2 produces a larger equilibrium climate sensitivity (4.7°C) than ACCESS-ESM1.5 (3.9°C), likely a result of updated atmospheric parameterisation in recent versions of the atmospheric component of ACCESS-CM2. The idealised experiments run with ACCESS-ESM1.5 show that land and ocean carbon fluxes respond to both changing atmospheric CO2 and to changing temperature. ACCESS data submitted to CMIP6 are available from the Earth System Grid Federation (https://doi.org/10.22033/ESGF/CMIP6.2281 and https://doi.org/10.22033/ESGF/CMIP6.2288). The information provided in this paper should facilitate easier use of these significant datasets by the broader climate community.

We analyse and document the historical simulations performed by two versions of the Australian Community Climate and Earth System Simulator (ACCESS-CM2 and ACCESS-ESM1.5) for the Coupled Model Intercomparison Project Phase 6 (CMIP6). Three ensemble members from each model are used to compare the simulated seasonal-mean climate, climate variability and climate change with observations over the historical period. Where appropriate, we also compare the ACCESS model results with the results from 36 other CMIP6 models. We find that the simulations of the winter and summer mean climates (over the global domain) by the two ACCESS models are similar to or better than most of the other CMIP6 models for surface temperature, precipitation and surface specific humidity. For sea-level pressure, both ACCESS models perform worse than most other models. The spatial structures of the prominent climate variability modes (ENSO, IOD, IPO and AMO) also compare favourably with the corresponding observed structures. However, the results for the simulation of the models’ temporal variability are mixed. In particular, whereas ACCESS-ESM1.5 simulates ENSO events with ~3-year periods (that are closer to the observed periods of 3–7years), the ACCESS-CM2 simulates ENSO events having quasi-biennial periods. However, ACCESS-CM2 has a much smaller bias (−0.1Wm−2) in present-day top-of-the-atmosphere energy balance than ACCESS-ESM1.5 (−0.6Wm−2). The ACCESS models simulate the anthropogenic climate change signal in historical global-mean surface temperature reasonably well, although the simulated signal variances are ~10% weaker than the observed signal variance (a common bias in most CMIP6 models). Both models also well simulate the major features of observed surface temperature changes, as isolated using a multiple regression model. Despite some identified biases, the two ACCESS models provide high-quality climate simulations that may be used in further analyses of climate variability and change.

Introduction Multimorbidity, the coexistence of two or more chronic conditions, has been extensively studied in certain disease states. Bronchiectasis aetiology is complex and multimorbidity is insufficiently understood. We performed a scoping review, summarising the existing literature and identifying deficits. Method A literature search of the electronic databases PubMed, CINAHL and EMBASE was conducted following PRISMA guidelines. Observational, interventional, qualitative, randomised control trials and systematic reviews were included. The main objective was to identify prevalence, prognosis, symptoms, quality of life and management in bronchiectasis multimorbidity. Key findings were analysed descriptively. Results 40 studies (200 567 patients) met the inclusion criteria, the majority (68%) being cohort studies. Study size ranged from 25 to 57 576 patients, with mean age 30–69 years. 70% of studies investigated the prognosis of comorbidities and 68% prevalence; 70% analysed multiple comorbidities in bronchiectasis. The most frequent comorbid diseases evaluated were COPD (58%), cardiovascular disease (53%) and asthma (40%). COPD and hypertension were the most prevalent conditions (pooled mean 35% and 34% respectively). Multimorbidity was associated with increased mortality, exacerbations and hospitalisation rates. It had a negative impact on lung function. Mortality increased in the following comorbidities: COPD, gastro-oesophageal reflux disease and rheumatoid arthritis. Conclusion Bronchiectasis multimorbidity is common. Research focuses on a few key aspects and favoured comorbidities (e.g. COPD). There is a deficit of research into symptoms, quality of life, interactions and management. High-resolution computed tomography diagnosis is not consistent, and there is no agreed multimorbidity screening questionnaire. Bronchiectasis multimorbidity is of importance; it is associated with morbidity and mortality.

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries range from sprains to fracture-dislocations of the tarsometatarsal joints which include injury to the Lisfranc ligament complex. Most require surgical intervention. However, apparently stable injuries can be managed nonoperatively. The aims of the current study were to perform a systematic review of outcomes following nonoperative treatment of Lisfranc injuries. Methods: Following PRISMA guidelines and PROSPERO registered, a review was performed of the literature (2000 - 2021) reporting Lisfranc injuries considered to be stable and initially managed nonoperatively. Following exclusions, 8 papers were identified; 1 prospective and 7 retrospective studies. A total of 220 patients were studied with a mean age of 39.8 years and mean follow up of 4.3 years. Outcomes included function, displacement, rates of surgery and secondary osteoarthritis. Results: Four papers reported good outcomes, with adjusted functional scores ranging from of 82.6 to 100 (out of 100). However, poor outcomes were frequently reported. One paper reported that late displacement occurred in 54% of patients. Surgical intervention was required in 12.2 to 55.6% of patients. Rates of secondary osteoarthritis were 4.9 to 37.5%. Two papers directly compared operative to non-operative treatment. In an injury matched cohort, superior outcomes were reported in the surgical arm. Numerous limitations were identified, including a lack of consensus on what constitutes a stable injury. Furthermore, wide heterogeneity was identified due to use of different classification systems, PROMS, investigation modalities and treatment protocols. Conclusion: Reported outcomes following nonoperative treatment of Lisfranc injuries vary widely, including high rates of conversion to surgery. There is no agreed definition of what a stable Lisfranc injury is, and no agreed treatment protocol. With the advantage of modern imaging techniques, prospective research is needed to determine which Lisfranc injuries can be safely treated nonoperatively.

Alcohol use during adolescence is a serious public health problem, with binge drinking and high-intensity drinking being particularly harmful to the developing adolescent brain. To investigate the adverse consequences of binge drinking and high-intensity adolescent drinking, adolescent rodents were intermittently exposed to ethanol through intragastric gavage, intraperitoneal injection, or vapor inhalation. These models revealed the long-lasting behavioral and neural consequences of adolescent intermittent ethanol (AIE) exposure. The present study was designed to characterize a different AIE model, namely, intermittent exposure to a single bottle of 10% ethanol as the only source of fluids on a 2 days on/2 days off (water days) schedule, and to determine whether this AIE exposure model would produce changes in hormonal and neuroimmune responsiveness to challenges of differing modalities. Assessments of ethanol intake as well as blood and brain ethanol concentrations (BECs and BrECs, respectively) in adult male and female rats (Experiment 1) revealed that BECs and BrECs peaked following access to ethanol for a 2 h period when assessed 1 h into the dark cycle. Experiment 2 revealed age differences in ethanol intake, BECs, and BrECs following a 2 h access to ethanol (1 h into the dark cycle), with adolescents ingesting more ethanol and reaching higher BECs as well as BrECs than adults. In Experiment 3, intermittent exposure to a single bottle of 10% ethanol for 10 cycles of 2 days on/2 days off was initiated either in early or late adolescence, followed by an acute systemic immune challenge with lipopolysaccharide (LPS) in adulthood. LPS increased corticosterone and progesterone levels regardless of sex and prior ethanol history, whereas an LPS-induced increase in cytokine gene expression in the hippocampus was evident only in ethanol-exposed males and females, with females who underwent early exposure to ethanol being more affected than their later-exposed counterparts. In Experiment 4, intermittent ethanol exposure in females was initiated either in adolescence or adulthood and lasted for 12 ethanol exposure cycles. Then, behavioral (freezing behavior), hormonal (corticosterone and progesterone levels), and neuroimmune (cytokine gene expression in the PVN, amygdala, and hippocampus) responses to novel environments (mild stressors) and shock (intense stressors) were assessed. More pronounced behavioral and hormonal changes, as well as changes in cytokine gene expression, were evident in the shock condition than following placement in the novel environment, with prior history of ethanol exposure not playing a substantial role. Interleukin (IL)-1β gene expression was enhanced by shock in the PVN, whereas shock-induced increases in IL-6 gene expression were evident in the hippocampus. Together, these findings demonstrate that our intermittent adolescent exposure model enhances responsiveness to immune but not stress challenges, with females being more vulnerable to this AIE effect than males.

Background: Following Lisfranc injury fixation, no consensus exists on whether to routinely remove metalwork. The aim of this study was to evaluate functional outcomes and complications in patients following routine removal of metalwork and in those with retained metalwork. Methods: A systematic review of literature (1999-2020) reporting results of metalwork removal vs retention following Lisfranc injury fixation, was undertaken. The primary outcome was functional outcomes at 1 year following index surgery. Secondary outcomes were rates of complications including unplanned removal of metalwork. Results: No studies directly comparing routine metalwork removal vs retention were found. A total of 28 studies reporting on 1069 patients were included. Of these, 10 studies (317 patients) reported on retention and 18 (752 patients) on routine removal of metalwork. The difference in the American Orthopaedic Foot & Ankle Society (AOFAS) score between removal and retention groups was 3.38 (95% CI 6.3-0.48), P = .02 (removal 79.97 [±16.09; 71-96]; retention 76.59 [±20.36; 65.4-94]). No difference in reported rates of infection was found between the 2 groups (0%-12% for both groups). Of the 317 patients in the retention group, metalwork was removed in 198 cases, resulting in a 62.5% unplanned removal rate. Conclusion: In conclusion, this systematic review found limited evidence comparing different strategies of metalwork management after Lisfranc injury fixation. A randomized controlled trial is necessary to elucidate if routine removal of metalwork confers any true benefit. Level of Evidence: Level IV, systematic review including case series.