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BackgroundOver a third of pregnant women (around 250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period.MethodsSystematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual.ResultsWe included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians.ConclusionDiscussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions.

BackgroundTaxation on sugar-sweetened beverages (SSBs) has been adopted in more than 40 countries but remained under discussion in Vietnam. This study aimed to estimate the health impacts of different SSBs tax plans currently under discussion to provide an evidence base to inform decision-making about a SSBs tax policy in Vietnam.Method & findingsFive tax scenarios were modelled, representing three levels of price increase: 5%, 11% and 19-20%. Scenarios of the highest price increase were assessed across three different tax designs: ad valorem, volume-based specific tax & sugar-based specific tax. We modelled SSBs consumption in each tax scenario; how this reduction in consumption translates to a reduction in total energy intake and how this relationship in turn translates to an average change in body weight and obesity status among adults by applying the calorie-to weight conversion factor. Changes in type 2 diabetes burden were then calculated based on the change in average BMI of the modelled cohort. A Monte Carlo simulation approach was applied on the conversion factor of weight change and diabetes risk reduction for the sensitivity analysis. We found that the taxation that involved a 5% price increase gave relatively small impacts while increasing SSBs' price up to 20% appeared to impact substantially on overweight and obesity rates (reduction of 12.7% and 12.4% respectively) saving 27 million USD for direct medical cost. The greatest reduction was observed for overweight and obesity class I. The decline in overweight and obesity rates was slightly higher for women than men.ConclusionThis study supports the SSB tax policy in pursuit of public health benefits, especially where the tax increase involves around a 20% price increase. The health benefit and revenue gains were evident across all three tax designs with the specific tax based on sugar density achieving greatest effects.

Probiotic microbiota plays a vital role in gastrointestinal health and possesses other beneficial attributes such as antimicrobial and antibiotic agents along with a significant role in the management of diabetes. The present study identifies the probiotic potential of Lactobacillus spp. isolated from three traditionally fermented foods namely, jalebi, medhu vada, and kallappam batters at biochemical, physiological, and molecular levels. By 16S rRNA gene amplification and sequencing, the isolates were identified. A similarity of >98% to Lacticaseibacillus rhamnosus RAMULAB13, Lactiplantibacillus plantarum RAMULAB14, Lactiplantibacillus pentosus RAMULAB15, Lacticaseibacillus paracasei RAMULAB16, Lacticaseibacillus casei RAMULAB17, Lacticaseibacillus casei RAMULAB20, and Lacticaseibacillus paracasei RAMULAB21 was suggested when searched for homology using NCBI database. Utilizing the cell-free supernatant (CS), intact cells (IC), and cell-free extract (CE) of the isolates, inhibitory potential activity against the carbohydrate hydrolyzing enzymes α-glucosidase and α-amylase was assessed. CS, CE, and IC of the isolates had a varying capability of inhibition against α-glucosidase (15.08 to 59.55%) and α-amylase (18.79 to 63.42%) enzymes. To assess the probiotic potential of seven isolates, various preliminary characteristics were examined. All the isolates exhibited substantial tolerance toward gastrointestinal conditions and also demonstrated the highest survival rate (> 99%), hydrophobicity (> 65%), aggregation (> 76%), adherence to HT-29 cells (> 84%), and chicken crop epithelial cells suggesting that the isolates had a high probiotic attribute. Additionally, the strains showed remarkable results in safety assessment assays (DNase and hemolytic), and antibacterial and antibiotic evaluations. The study concludes that the lactic acid bacteria (LAB) characterized possesses outstanding probiotic properties and has antidiabetic effects. In order to obtain various health advantages, LAB can be utilized as probiotic supplements.

BackgroundIbrutinib compared with ofatumumab significantly improves progression-free and overall survival in patients with previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).Patients and methodsMeasures of well-being were assessed in RESONATE, where previously treated patients with CLL/SLL were randomized to receive ibrutinib 420 mg/day (n = 195) or ofatumumab (n = 196) for up to 24 weeks. Endpoints included hematologic function, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), disease-related symptoms, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 (EORTC QLQ-C30), and medical resource utilization.ResultsWith up to 24 months' follow-up (median, 16.4 months), 79% of cytopenic patients showed sustained hematologic improvement (82% with improved platelet count, 69% with improved hemoglobin) on ibrutinib versus 43% on ofatumumab (P < .0001). Higher rates of clinically meaningful improvement were demonstrated with ibrutinib versus ofatumumab for FACIT-F and EORTC global health. Greater improvement was observed in disease-related weight loss, fatigue, night sweats, and abdominal discomfort with ibrutinib versus ofatumumab. Hospitalizations in the first 30 days occurred less frequently with ibrutinib than ofatumumab (0.087 vs. 0.184 events/patient; P = .0198). New-onset diarrhea was infrequent with ibrutinib after the first 6 months (47% at ≤6 months vs. 5% at 12-18 months). With ibrutinib, grade ≥ 3 hypertension occurred in 6%, grade ≥ 3 atrial fibrillation in 4%, major hemorrhage in 2%, and tumor lysis syndrome in 1% of patients.ConclusionIbrutinib led to significant improvements in hematologic function and disease symptomatology versus ofatumumab, and can restore quality of life while prolonging survival in relapsed/refractory CLL/SLL.

Genistein is an isoflavonoid present in high quantities in soybeans. Possessing a wide range of bioactives, it is being studied extensively for its tumoricidal effects. Investigations into mechanisms of the anti-cancer activity have revealed many pathways including induction of cell proliferation, suppression of tyrosine kinases, regulation of Hedgehog-Gli1 signaling, modulation of epigenetic activities, seizing of cell cycle and Akt and MEK signaling pathways, among others via which the cancer cell proliferation can be controlled. Notwithstanding, the observed activities have been time- and dose-dependent. In addition, genistein has also shown varying results in women depending on the physiological parameters, such as the early or post-menopausal states.

Dilated cardiomyopathy (DCM) is a common heart muscle disorder that frequently leads to heart failure, arrhythmias, and death. While DCM is often heritable, disease-causing mutations are identified in only ~30% of cases. In a forward genetic mutagenesis screen, we identified a novel zebrafish mutant, heart and head (hahvcc43), characterized by early-onset cardiomyopathy and craniofacial defects. Linkage analysis and next-generation sequencing identified a nonsense variant in the highly conserved scfd1 gene, also known as sly1, that encodes sec1 family domain-containing 1. Sec1/Munc18 proteins, such as Scfd1, are involved in membrane fusion regulating endoplasmic reticulum (ER)/Golgi transport. CRISPR/Cas9-engineered scfd1vcc44 null mutants showed severe cardiac and craniofacial defects and embryonic lethality that recapitulated the phenotype of hahvcc43 mutants. Electron micrographs of scfd1-depleted cardiomyocytes showed reduced myofibril width and sarcomere density, as well as reticular network disorganization and fragmentation of Golgi stacks. Furthermore, quantitative PCR analysis showed upregulation of ER stress response and apoptosis markers. Both heterozygous hahvcc43 mutants and scfd1vcc44 mutants survived to adulthood, showing chamber dilation and reduced ventricular contraction. Collectively, our data implicate scfd1 loss-of-function as the genetic defect at the hahvcc43 locus and provide new insights into the role of scfd1 in cardiac development and function.

A total of 90 pigs, approximately one day of age, were used in a 42-day study to evaluate whether Endovac-Porci, a core antigen vaccine with an immunostimulant, provides piglets with broad-spectrum protection against the enteric and respiratory effects of Gram-negative bacteria. This study was a single-site, randomized, prospective, blinded, comparative placebo-controlled design. Individual pigs were randomly allocated to 1 of 2 treatments in a randomized design. An individual pig was considered the experimental unit for the farrowing phase (Study day 0 to 21), and the pen was considered the experimental unit for the nursery phase (Study day 21 to 42). Thus, there were 45 replications per treatment during the farrowing phase and 15 replications per treatment during the nursery phase. Treatments included a control product (saline; CP) and an investigational product (Endovac-Porci; IVP). On Study day 23, all pigs were challenged with enterotoxigenic Escherichia coli strain expressing K88 (F4) fimbriae and Pasteurella multocida. Individual pigs were weighed and feed consumption was measured to determine body weight gain, average daily gain, and feed-to-gain ratio. Clinical and fecal scores and overall health were recorded daily. Overall, administering the IVP to pigs led to an increase (p < 0.01) in body weight gain and average daily gain compared to pigs administered the CP. Pigs administered the IVP had reduced (p < 0.01) mortality compared to pigs administered the CP. There was a Study day × treatment interaction on clinical and fecal scores (p < 0.01). There was also a main effect of Study day where clinical and fecal scores increased (p < 0.01) as the Study day increased. Treatment also had an effect on clinical and fecal scores, where pigs administered the IVP had lower (p < 0.01) clinical and fecal scores compared to pigs administered the CP. In conclusion, administering pigs with the Endovac-Porci vaccination significantly improved the performance (i.e., body weight, body weight gain, and average daily gain) and health (i.e., clinical and fecal scores), while reducing the overall mortality in pigs challenged with E. coli K88 orally and Pasteurella multocida intranasally post-weaning. Results from this study suggest that Endovac-Porci could provide broad-spectrum protection against enteric and respiratory effects of Gram-negative bacteria in piglets.

ObjectiveThe Kidney Disease Outcome Quality Initiative and Fistula First Breakthrough Initiative call for the indiscriminate creation of arteriovenous fistulas (AVFs) over arteriovenous grafts (AVGs) without providing patient-specific criteria for vascular access selection. Although the U.S. AVF rate has increased dramatically, several reports have found that this singular focus on increasing AVFs has resulted in increased AVF nonmaturation/early failure and a high prevalence of catheter dependence. The objective of this study was to determine the appropriateness of vascular access procedures in clinical scenarios constructed with combinations of relevant factors potentially influencing outcomes.MethodsThe RAND/UCLA Appropriateness Method was used. Accordingly, a comprehensive literature search was performed and a synthesis of results compiled. The RAND/UCLA Appropriateness Method was applied to 2088 AVF and 1728 AVG clinical scenarios with varying patient characteristics. Eleven international vascular access experts rated the appropriateness of each scenario in two rounds. On the basis of the distribution of the panelists' scores, each scenario was determined to be appropriate, inappropriate, or indeterminate.ResultsPanelists achieved agreement in 2964 (77.7%) scenarios; 860 (41%) AVF and 588 (34%) AVG scenarios were scored appropriate, 686 (33%) AVF and 480 (28%) AVG scenarios were scored inappropriate, and 542 (26%) AVF and 660 (38%) AVG scenarios were indeterminate. Younger age, larger outflow vein diameter, normal or obese body mass index (vs morbidly obese), larger inflow artery diameter, and higher patient functional status were associated with appropriateness of AVF creation. Older age, dialysis dependence, and smaller vein size were associated with appropriateness of AVG creation. Gender, diabetes, and coronary artery disease were not associated with AVF or AVG appropriateness. Dialysis status was not associated with AVF appropriateness. Body mass index and functional status were not associated with AVG appropriateness. To simulate the surgeon's decision-making, scenarios were combined to create situations with the same patient characteristics and both AVF and AVG options for access. Of these 864 clinical situations, 311 (36%) were rated appropriate for AVG but inappropriate or indeterminate for AVF.ConclusionsThe results of this study indicate that patient-specific situations exist wherein AVG is as appropriate as or more appropriate than AVF. These results provide patient-specific recommendations for clinicians to optimize vascular access selection criteria, to standardize care, and to inform payers and policy. Indeterminate scenarios will guide future research.

Este artigo introduz a filosofiaperformance, não obstante o risco de contradição performativa que tal ato envolve. Primeiramente, considera a filosofia-performance como um campo que questiona como a performance pensa e como o pensamento é performado (inclusive, especificamente como filosofia). A partir da não-filosofia de Laurelle, dirige-se à filosofia-performance como método, recortando-a como um paradigma alternativo, performativo, alternativo para a abordagem da filosofia da(s) arte(s) que, historicamente, dominou abordagens para a estética. Este conclui por afirmar a chamada para o campo para a abordar a ética-política nas dimensões da produção de conhecimento não apenas em termos disciplinares, mas também geopolíticos.

This article introduces performance philosophy, despite the risk of performative contradiction such an act involves. First, it considers performance philosophy as a field that questions how performance thinks and thought is performed (including, specifically as philosophy). Drawing from Laruelle’s non-philosophy, it then addresses performance philosophy as method, framing it as an alternative, performative paradigm to the philosophy of the arts approach that has historically dominated approaches to aesthetics. It concludes by affirming the call to the field to address the ethico-political dimensions of knowledgeproduction in not only disciplinary, but also geopolitical terms.

Brucellosis is a highly contagious bacterial disease that mainly affects ruminants, but it may affect equines, canines, and felines. The disease is of utmost significance from an economic standpoint in countries where there is no national brucellosis prevention and eradication policy in operation. A systematic review was done to estimate disease burden, incidences, prevalence, and geographical distribution critical in planning appropriate intervention strategies for the control and prevention of Brucellosis. Research articles that were published during the period 2000–2020 were considered for this study after reinforced scrutiny by two independent authors. Meta-regression was used to examine heterogeneity, and subgroup and sensitivity analyses were used to calculate residual heterogeneity and the pooled prevalence of Brucellosis in livestock. Confounders such as geography, a diagnostic test, and species had the greatest R2 values of 17.8, 8.8, and 2.3%, respectively, indicating the presence of heterogeneity and necessitating more research into sensitivity and subgroup analysis. The combined pooled prevalence of brucellosis in both Asia and African countries was 8% when compared to 12% in the Indian livestock population. The findings of our systematic review and meta-analysis indicate that brucellosis continues to be an important animal and public health concern in developing countries of Asia and Africa, as evidenced by the prevalence rate of brucellosis in these regions. Our findings suggested that well-planned epidemiological surveillance studies in different geographic settings are needed to generate reliable data on disease burden including the economic loss in Asian and African countries.

Children with disabilities experience elevated rates of maltreatment, but little is known about the interaction of children with autism spectrum disorder with child protection systems. A population-based dataset of 24,306 children born in 2008 in Tennessee, which included 387 children with autism spectrum disorder identified through the Autism and Developmental Disabilities Monitoring network, was linked with state child protection records. Rates of maltreatment referrals, screening for further action, and substantiated maltreatment were examined for children with versus without autism spectrum disorder. Significantly more children with autism spectrum disorder (17.3%) than without (7.4%) were referred to the Child Abuse Hotline. Children with autism spectrum disorder were less likely than children without autism spectrum disorder to have referrals screened in for further action (62% vs 91.6%, respectively), but substantiated maltreatment rates were similar across groups (3.9% vs 3.4%, respectively). Girls versus boys with autism spectrum disorder were more likely to have substantiated maltreatment (13.6% vs 1.9%, respectively). The high percentage of children with autism spectrum disorder referred for allegations of maltreatment, the differential pattern of screening referrals in for further action, and the high levels of substantiated maltreatment of girls with autism spectrum disorder highlights the need for enhanced training and knowledge of the complex issues faced by children with autism spectrum disorder, their families, and state welfare agencies.