Search

Background: Cannabis is the second most used recreational drug in the United States and one of the most used substances in patients with schizophrenia spectrum disorder (SSD). Unfortunately, the increased use is likely to continue as more states legalize recreational use of cannabis. Although the association between cannabis and schizophrenia has been studied extensively, the understanding of the relationship is still evolving. In this study, we sought to determine the prevalence and potential factors associated with cannabis use (CU) among inpatients with SSD at a community teaching hospital., Methods: We performed a retrospective review of the electronic medical charts of patients discharged from the psychiatric unit of our hospital from July 1, 2017 through October 31, 2017. Patients were included in this study if: 1) They were ≥ 18 years old; 2) They had discharge diagnosis of SSD; and 3) They had urine drug testing performed. Pertinent sociodemographic and clinical variables, including substance use status and hospital length of stay (LOS), were abstracted. Univariate frequencies and summary statistics were performed. Odds ratios (ORs) were determined by logistic regression analysis of bivariate and multivariate analyses., Results: Three hundred sixty-five (52.2%) patients had a discharge diagnosis of SSD, and only 322 had urine toxicology result for cannabinoids and were included in analysis. Of the 322 patients, 41.5% (n = 133) screened positive for cannabinoids. Of the 133 patients, 78% were African American, 15% were Hispanic and 5% were White; 77% were male and the median age was 36 years. Bivariate analyses showed tobacco use (OR: 2.8, 95% confidence interval (CI): 1.7 - 4.6), alcohol use (OR: 3.4, 95% CI: 2.9 - 7.0), younger age (OR: 2.8, 95% CI: 1.8 - 4.5), male gender (OR: 2.9, 95% CI: 2.2 - 3.2), unemployment (OR: 3.91, 95% CI: 3.49 - 7.35), homelessness (OR: 3.18, 95% CI: 2.76 - 3.84) and LOS (OR: 3.46, 95% CI: 2.93 - 4.31) were significantly associated with CU. Result of multivariate analysis was similar to that found in bivariate analysis., Conclusions: CU appears to be prevalent among patients with SSD. Clinicians and public health professionals are encouraged to understand the health implications of its use in patients with mental illness especially against the backdrop of current marijuana laws., Competing Interests: The authors declare no conflict of interest., (Copyright 2020, Olayinka et al.)

Prediction and wager on the outcome of games/matches are known as sports betting. Positive attitudes toward sports betting may, in the long run, predict sports betting behavior and gambling-related problems. This study, therefore, examined the influence of gender, age, sports betting knowledge and peer-based gambling on attitudes toward sports betting among young adults in Nigeria. The ex-post facto design was adopted in this cross-sectional survey. The participants were 749 students (42.9% females) of a large tertiary institution in southwest Nigeria. A standardized questionnaire comprising demographics and measures of attitudes toward sports betting, sports betting knowledge and perception of peer gambling behavior was utilized in the study. Results revealed that attitudes toward sports betting are positive for older males who are knowledgeable about sports betting and have friends who gamble. Sports betting knowledge and peer-based gambling stood out as significant predictors of attitudes toward sports betting. The social circles of young adults may be the starting points for initiatives to develop healthy attitudes toward sports betting and preventing gambling-related problems.

Dye-sensitized solar cells (DSSCs) are characterized by several special attributes such as low cost, ease of fabrication, all year availability of sunlight, and capacity to operate under diffuse lighting conditions. However, their universal adoption is still restricted by a low efficiency photovoltaic output. Thus, this research seeks to explore avenues of present photon mitigation which could be corrected in future DSSC technology in order to improve on existing efficiency records. A preliminary phytochemical screening of Prunus dulcis ( P. dulcis ) leaf extract revealed a variety of chromophores which renders high possibility for charge transport. UV/VIS spectroscopy showed P. dulcis with peak absorbance wavelength within the visible region of the electromagnetic spectrum of light. Fourier transform infrared spectroscopy specifically highlighted the fingerprint of the chromophores present in this organic extract. Photovoltaic parameters such as short circuit current (I sc ), open circuit voltage (V oc ), maximum power (P max ), fill factor (ff ) and efficiency (ƞ) were the factors taken into consideration for the determination of the photovoltaic outcome. In P. dulcis DSSCs, KBr electrolyte recorded the best ƞ of 10.18%. However, P. dulcis DSSC with electrolyte KI indicated the best I sc , V oc and P max of 0.135 mA, 280 mV and 34.2 mW respectively. The similarity of this photovoltaic result with previous DSSC results necessitated further analysis. Consequently, scanning electron micrograph (SEM) of P. dulcis was modelled first with Gwyddion software and this output was analyzed with Excel and Origin programs. The outcome is a scientific discovery of electron tunneling in the P. dulcis shells, effect of dopant ions boosting the electrolytic Fermi level and a high probability of influencing the future efficiency outcome in P. dulcis DSSCs. Using mathematical algorithms from the Origin and Excel software applications, a direct function of the impact of doping, relative speed of electrolyte molecules as they percolate P. dulcis framework was obtained. Thus, the significance of this work lies in the relationship of behavioral dynamics of dopants to photovoltaic performance of P. dulcis . This indicates that a vital optical tunable characteristic of DSSCs lies in electrodynamics of dopant ions, which presents a viable prospect for application in DSSC technology research., (© 2019 The Authors.)

In October of 2015, a large underground storage well at the Aliso Canyon natural gas storage facility experienced a massive methane leak (also referred to as "natural gas blowout"), which resulted in the largest ever anthropogenic release of methane from a single point source in the United States. Additional sampling conducted during the event revealed unique gas and particle concentrations in ambient air and a characteristic "fingerprint" of metals in the indoor dust samples similar to samples taken at the blowout site. We further investigated the association between the Aliso Canyon natural gas storage site and several measured air pollutants by: (a) conducting additional emission source studies using meteorological data and correlations between particulate matter, methane, and hazardous air pollutants (HAPs) collected during the natural gas blowout at distances ranging from 1.2 to 7.3 km due south of well SS25, (b) identifying the unique i/n-pentane ratio signature associated with emissions from the blowout event, and (c) identifying characteristics unique to the homes that tested positive for air pollutants using data collected from extensive indoor environmental assessment surveys. Results of air quality samples collected near Aliso Canyon during the final weeks of the event revealed that elevated levels of several HAP compounds were likely influenced by the active natural gas blowout. Furthermore, the final attempts to plug the well during the days preceding the well kill were associated with particle emissions likely from the well site. Together, this investigation suggests uncontrolled leaks or blowout events at natural gas storage facilities have the potential to release harmful pollutants with adverse health and environmental consequences into proximate communities. With this evidence, our recommendations include facility-specific meteorological and air quality data-collection equipment installed at natural gas storage facilities and support of environmental surveillance after severe off-normal operation events., (Copyright © 2019. Published by Elsevier Ltd.)

Background: The relative contribution of bacterial infections to febrile disease is poorly understood in many African countries due to diagnostic limitations. This study screened pediatric and adult patients attending 4 healthcare facilities in Ibadan, Nigeria, for bacteremia and malaria parasitemia., Methods: Febrile patients underwent clinical diagnosis, malaria parasite testing, and blood culture. Bacteria from positive blood cultures were isolated and speciated using biochemical and serological methods, and Salmonella subtyping was performed by polymerase chain reaction. Antimicrobial susceptibility was tested by disk diffusion., Results: A total of 682 patients were recruited between 16 June and 16 October 2017; 467 (68.5%) were <18 years of age. Bacterial pathogens were cultured from the blood of 117 (17.2%) patients, with Staphylococcus aureus (69 [59.0%]) and Salmonella enterica (34 [29.1%]) being the most common species recovered. Twenty-seven (79.4%) of the Salmonella isolates were serovar Typhi and the other 7 belonged to nontyphoidal Salmonella serovarieties. Thirty-four individuals were found to be coinfected with Plasmodium falciparum and bacteria. Five (14.7%) of these coinfections were with Salmonella, all in children aged <5 years. Antimicrobial susceptibility testing revealed that most of the Salmonella and Staphylococcus isolates were multidrug resistant., Conclusions: The study demonstrates that bacteria were commonly recovered from febrile patients with or without malaria in this location. Focused and extended epidemiological studies are needed for the introduction of typhoid conjugate vaccines that have the potential to prevent a major cause of severe community-acquired febrile diseases in our locality., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)

Background: Invasive salmonellosis is a common community-acquired bacteremia in persons residing in sub-Saharan Africa. However, there is a paucity of data on severe typhoid fever and its associated acute and chronic host immune response and carriage. The Severe Typhoid Fever in Africa (SETA) program, a multicountry surveillance study, aimed to address these research gaps and contribute to the control and prevention of invasive salmonellosis., Methods: A prospective healthcare facility-based surveillance with active screening of enteric fever and clinically suspected severe typhoid fever with complications was performed using a standardized protocol across the study sites in Burkina Faso, the Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Defined inclusion criteria were used for screening of eligible patients for enrollment into the study. Enrolled patients with confirmed invasive salmonellosis by blood culture or patients with clinically suspected severe typhoid fever with perforation were eligible for clinical follow-up. Asymptomatic neighborhood controls and immediate household contacts of each case were enrolled as a comparison group to assess the level of Salmonella-specific antibodies and shedding patterns. Healthcare utilization surveys were performed to permit adjustment of incidence estimations. Postmortem questionnaires were conducted in medically underserved areas to assess death attributed to invasive Salmonella infections in selected sites., Results: Research data generated through SETA aimed to address scientific knowledge gaps concerning the severe typhoid fever and mortality, long-term host immune responses, and bacterial shedding and carriage associated with natural infection by invasive salmonellae., Conclusions: SETA supports public health policy on typhoid immunization strategy in Africa., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)

The Mediator is an evolutionarily conserved, multi-subunit complex that regulates multiple steps of transcription. Mediator activity is regulated by the reversible association of a four-subunit module comprising CDK8 or CDK19 kinases, together with cyclin C, MED12 or MED12L, and MED13 or MED13L. Mutations in MED12, MED13, and MED13L were previously identified in syndromic developmental disorders with overlapping phenotypes. Here, we report CDK8 mutations (located at 13q12.13) that cause a phenotypically related disorder. Using whole-exome or whole-genome sequencing, and by international collaboration, we identified eight different heterozygous missense CDK8 substitutions, including 10 shown to have arisen de novo, in 12 unrelated subjects; a recurrent mutation, c.185C>T (p.Ser62Leu), was present in five individuals. All predicted substitutions localize to the ATP-binding pocket of the kinase domain. Affected individuals have overlapping phenotypes characterized by hypotonia, mild to moderate intellectual disability, behavioral disorders, and variable facial dysmorphism. Congenital heart disease occurred in six subjects; additional features present in multiple individuals included agenesis of the corpus callosum, ano-rectal malformations, seizures, and hearing or visual impairments. To evaluate the functional impact of the mutations, we measured phosphorylation at STAT1-Ser727, a known CDK8 substrate, in a CDK8 and CDK19 CRISPR double-knockout cell line transfected with wild-type (WT) or mutant CDK8 constructs. These experiments demonstrated a reduction in STAT1 phosphorylation by all mutants, in most cases to a similar extent as in a kinase-dead control. We conclude that missense mutations in CDK8 cause a developmental disorder that has phenotypic similarity to syndromes associated with mutations in other subunits of the Mediator kinase module, indicating probable overlap in pathogenic mechanisms., (Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background:  Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies., Aim:  The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA., Setting:  FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA., Methods:  A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants' CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed., Results:  Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates., Conclusion:  Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study.

Introduction: The objective of the Health Population Africa (HPAfrica) study is to determine health behaviour and population-based factors, including socioeconomic, ethnographic, hygiene and sanitation factors, at sites of the Severe Typhoid Fever in Africa (SETA) programme. SETA aims to investigate healthcare facility-based fever surveillance in Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar and Nigeria. Meaningful disease burden estimates require adjustment for health behaviour patterns, which are assumed to vary among a study population., Methods and Analysis: For the minimum sample size of household interviews required, the assumptions of an infinite population, a design effect and age-stratification and sex-stratification are considered. In the absence of a population sampling frame or household list, a spatial approach will be used to generate geographic random points with an Aeronautical Reconnaissance Coverage Geographic Information System tool. Printouts of Google Earth Pro satellite imagery visualise these points. Data of interest will be assessed in different seasons by applying population-weighted stratified sampling. An Android-based application and a web service will be developed for electronic data capturing and synchronisation with the database server in real time. Sampling weights will be computed to adjust for possible differences in selection probabilities. Descriptive data analyses will be performed in order to assess baseline information of each study population and age-stratified and sex-stratified health behaviour. This will allow adjusting disease burden estimates. In addition, multivariate analyses will be applied to look into associations between health behaviour, population-based factors and the disease burden as determined in the SETA study., Ethics and Dissemination: Ethic approvals for this protocol were obtained by the Institutional Review Board of the International Vaccine Institute (No. 2016-0003) and by all collaborating institutions of participating countries. It is anticipated to disseminate findings from this study through publication on a peer-reviewed journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Oral health problems arising from tobacco use have been reported and some of these conditions can be prevented through Tobacco Cessation (TC). Dentists are well positioned to provide tobacco cessation services to patients. In Nigeria, little is documented on the provision of cessation services among dentists and the challenges. This study was conducted to assess the cessation practices of dentists and their related challenges in Southwest Nigeria., Methods: A cross sectional study was carried out in all the tertiary healthcare facilities within the six states of the Southwest geopolitical zone. A total population survey involving dentists below the cadre of Consultant/Chief Dental Officers undergoing postgraduate training and/or providing services in the tertiary hospitals was conducted using a pretested semi structured self-administered questionnaire. This included questions on challenges experienced in the provision of TC services in their respective facilities., Results: A total of 224 eligible dentists were approached to participate in this study with a response rate of 91.5%. Mean age and completed years of working experience were 33.8±5.2 and 6.1±4.4 respectively. In reporting challenges to implementing tobacco cessation services, 60% of respondents reported 'lack of perceived efficacy and training' as the major barriers., Conclusion: From this study, incorporation of tobacco cessation into the dental curriculum will increase the knowledge and competence of dentists. Provision of systems support to dentists willing to help patients quit smoking may be important in ensuring the health system is responsive to the tobacco control needs of patients in Southwest Nigeria.

Objective: Inflammation in adipose tissues in obesity promotes insulin resistance and metabolic disease. The Duffy antigen receptor for chemokines (DARC) is a promiscuous non-signaling receptor expressed on erythrocytes and other cell types that modulates tissue inflammation by binding chemokines such as monocyte chemoattractant protein-1 (MCP-1) and by acting as a chemokine reservoir. DARC allelic variants are common in humans, but the role of DARC in modulating obesity-related metabolic disease is unknown., Methods: We examined body weight gain, tissue adiposity, metabolic parameters and inflammatory marker expression in wild-type and DARC knockout mice fed a chow diet (CD) and high fat diet (HFD)., Results: Compared to wild-type mice, HFD-fed DARC knockout mice developed glucose intolerance and insulin resistance independent of increases in body weight or adiposity. Interestingly, insulin sensitivity was also diminished in lean male DARC knockout mice fed a chow diet. Insulin production was not reduced by DARC gene deletion, and plasma leptin levels were similar in HFD fed wild-type and DARC knockout mice. MCP-1 levels in plasma rose significantly in the HFD fed wild-type mice, but not in the DARC knockout mice. Conversely, adipose tissue MCP-1 levels were higher, and more macrophage crown-like structures were detected, in the HFD fed DARC knockout mice as compared with the wild-type mice, consistent with augmented adipose tissue inflammation that is not accurately reflected by plasma levels of DARC-bound MCP-1 in these mice., Conclusions: These findings suggest that DARC regulates metabolic function and adipose tissue inflammation, which may impact obesity-related disease in ethnic populations with high frequencies of DARC allelic variants., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity., Methods: Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical center-specific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics., Results: The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required., Conclusion: The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.

Purpose: Cancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA., Methods: We established the Men of African Descent and Carcinoma of the Prostate Network, which includes seven SSA centers partnering with five US centers to study the genetics and epidemiology of CaP in SSA. We developed common data elements and instruments, regulatory infrastructure, and biosample collection, processing, and shipping protocols. We tested this infrastructure by collecting epidemiologic, medical record, and genomic data from a total of 311 patients with CaP and 218 matched controls recruited at the seven SSA centers. We extracted genomic DNA from whole blood, buffy coat, or buccal swabs from 265 participants and shipped it to the Center for Inherited Disease Research (Baltimore, MD) and the Centre for Proteomics and Genomics Research (Cape Town, South Africa), where genotypes were generated using the UK Biobank Axiom Array., Results: We used common instruments for data collection and entered data into the shared database. Double-entered data from pilot participants showed a 95% to 98% concordance rate, suggesting that data can be collected, entered, and stored with a high degree of accuracy. Genotypes were obtained from 95% of tested DNA samples (100% from blood-derived DNA samples) with high concordance across laboratories., Conclusion: We provide approaches that can produce high-quality epidemiologic and genomic data in multicenter studies of cancer in SSA.

The peak particle velocity datasets recorded during quarry blasts in the neighborhood villages and towns in Ibadan and Abeokuta were processed and analyzed in order to recommend a safe blast design for each of the quarries. The minimum peak particle velocity of 48.27 mm/s was recorded near the foundation of the nearest residence at the shot to monitored distance of 500 m. The tendency of ground vibration emanating from the quarry sites to cause damage to the structures in the nearby dwelling areas is very high. The peak particle velocity datasets recorded were not within the safe limit. Therefore the peak particle velocity that will not exceed 35 mm/s is recommended for a safe blast design.

Low cost, personal air pollution sensors may reduce exposure measurement errors in epidemiological investigations and contribute to citizen science initiatives. Here we assess the validity of a low cost personal air pollution sensor. Study participants were drawn from two ongoing epidemiological projects in Barcelona, Spain. Participants repeatedly wore the pollution sensor - which measured carbon monoxide (CO), nitric oxide (NO), and nitrogen dioxide (NO 2 ). We also compared personal sensor measurements to those from more expensive instruments. Our personal sensors had moderate to high correlations with government monitors with averaging times of 1-h and 30-min epochs (r ~ 0.38-0.8) for NO and CO, but had low to moderate correlations with NO 2 (~0.04-0.67). Correlations between the personal sensors and more expensive research instruments were higher than with the government monitors. The sensors were able to detect high and low air pollution levels in agreement with expectations (e.g., high levels on or near busy roadways and lower levels in background residential areas and parks). Our findings suggest that the low cost, personal sensors have potential to reduce exposure measurement error in epidemiological studies and provide valid data for citizen science studies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system., Methods: We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk-perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis., Results: Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts., Conclusion: Developing and implementing comprehensive context-relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Objectives/hypothesis: Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate nascent subglottic mucosal injury and characterize mucosal thickness and structural changes using texture analysis in a simulated intubation rabbit model., Study Design: Prospective animal study in rabbits., Methods: Three-centimeter-long sections of endotracheal tubes (ETT) were endoscopically placed in the subglottis and proximal trachea of New Zealand White rabbits (n = 10) and secured via suture. OCT imaging and conventional endoscopic video was performed just prior to ETT segment placement (day 0), immediately after tube removal (day 7), and 1 week later (day 14). OCT images were analyzed for airway wall thickness and textural properties., Results: Endoscopy and histology of intubated rabbits showed a range of normal to edematous tissue, which correlated with OCT images. The mean airway mucosal wall thickness measured using OCT was 336.4 μm (day 0), 391.3 μm (day 7), and 420.4 μm (day 14), with significant differences between day 0 and day 14 (P = .002). Significance was found for correlation and homogeneity texture features across all time points (P < .05)., Conclusions: OCT is a minimally invasive endoscopic imaging modality capable of monitoring progression of subglottic mucosal injury. This study is the first to evaluate mucosal injury during simulated intubation using serial OCT imaging and texture analysis. OCT and texture analysis have the potential for early detection of subglottic mucosal injury, which could lead to better management of the neonatal airway and limit the progression to stenosis., Level of Evidence: NA Laryngoscope, 127:64-69, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Recent developments in sensory and communication technologies have made the development of portable air-quality (AQ) micro-sensing units (MSUs) feasible. These MSUs allow AQ measurements in many new applications, such as ambulatory exposure analyses and citizen science. Typically, the performance of these devices is assessed using the mean error or correlation coefficients with respect to a laboratory equipment. However, these criteria do not represent how such sensors perform outside of laboratory conditions in large-scale field applications, and do not cover all aspects of possible differences in performance between the sensor-based and standardized equipment, or changes in performance over time. This paper presents a comprehensive Sensor Evaluation Toolbox (SET) for evaluating AQ MSUs by a range of criteria, to better assess their performance in varied applications and environments. Within the SET are included four new schemes for evaluating sensors' capability to: locate pollution sources; represent the pollution level on a coarse scale; capture the high temporal variability of the observed pollutant and their reliability. Each of the evaluation criteria allows for assessing sensors' performance in a different way, together constituting a holistic evaluation of the suitability and usability of the sensors in a wide range of applications. Application of the SET on measurements acquired by 25 MSUs deployed in eight cities across Europe showed that the suggested schemes facilitates a comprehensive cross platform analysis that can be used to determine and compare the sensors' performance. The SET was implemented in R and the code is available on the first author's website., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Mediator-associated kinases CDK8/19 are context-dependent drivers or suppressors of tumorigenesis. Their inhibition is predicted to have pleiotropic effects, but it is unclear whether this will impact on the clinical utility of CDK8/19 inhibitors. We discovered two series of potent chemical probes with high selectivity for CDK8/19. Despite pharmacodynamic evidence for robust on-target activity, the compounds exhibited modest, though significant, efficacy against human tumor lines and patient-derived xenografts. Altered gene expression was consistent with CDK8/19 inhibition, including profiles associated with super-enhancers, immune and inflammatory responses and stem cell function. In a mouse model expressing oncogenic beta-catenin, treatment shifted cells within hyperplastic intestinal crypts from a stem cell to a transit amplifying phenotype. In two species, neither probe was tolerated at therapeutically-relevant exposures. The complex nature of the toxicity observed with two structurally-differentiated chemical series is consistent with on-target effects posing significant challenges to the clinical development of CDK8/19 inhibitors., Competing Interests: PAC: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. M-JO-R: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. RT: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. OA-P: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. GB: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. WC: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. SC: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. SEB: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. CE: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. SG: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. ADHB: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. PH: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. SMH: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. WK: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. AM: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. FRa: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. TR: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. FRo: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. KS: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. SS: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. RS: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. MV: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. SW: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. JB: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. AB: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. SAE: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. SH: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. KU: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. PW: Current or former employee of The Institute of Cancer Research, which has a commercial interest in the development of WNT pathway inhibitors. DW: Current or former employee of Merck KGaA (Darmstadt, Germany), which has a commercial interest in the development of WNT pathway inhibitors. The other authors declare that no competing interests exist.

Background: Doctors respond differently to their complex work environment, some find it stimulating while others find it stressful. This study aimed to assess the prevalence and correlates of stress among junior doctors in a teaching hospital in Southwest Nigeria., Method: A descriptive cross sectional survey of all junior doctors employed at the University College Hospital, Ibadan was carried out. Information was collected with a structured pretested questionnaire from 253 doctors. Descriptive statistics were generated. T-test, chi square and logistic regression analyses were conducted using SPSS version 16. Statistical significance was set at 5%., Results: Mean age of respondents was 29.9 (±4.1) years, 61.3% were males, 59% had spent less than 5 years in medical practice, and 34.8% were married. Majority (79.4%) were resident doctors. Prevalence of stress, job dissatisfaction and poor mental health were 31.6%, 15.4% and 9.9% respectively. Age, gender, years of medical practice, religion, ethnicity and marital status were not significantly associated with job stress (p>0.05). Doctors who were stressed were more likely to be dissatisfied with their jobs (OR=2.33; CI=1.08-4.04) and to have poor mental health (OR=3.82; CI=1.47-9.95) than those who were not stressed., Conclusion: The prevalence of stress in this study is high, and job dissatisfaction and poor mental health have been implicated as determinants of stress. As such, there should be an improvement in doctors' welfare, health care facilities and delivery.

Objective: To describe a novel approach for excision of exostoses and evaluate the outcomes of transcanal excision of exostoses using ultrasonic serrated knife-assistance versus microosteotomes only., Study Design: Retrospective analysis., Setting: Academic Tertiary Care Center., Patients/interventions: Patients receiving a transcanal excision of exostoses between 2007 and 2016., Main Outcome Measures: The outcomes and postoperative complications of 138 patients who received transcanal microosteotome only technique were compared to 10 patients who received transcanal excision of exostoses using ultrasonic serrated knife-assistance (Stryker Corporation, Kalamazoo, MI)., Results: A total of 175 ears in 128 patients underwent a transcanal microosteotome only technique. Of these, 11 (6.3%) developed an intraoperative tympanic membrane perforation. One developed anterior canal mobilization requiring prolonged (3 wk) packing. One hundred thirty-five ears (77%) were well healed by the 3-week postoperative visit. All but one ear was well healed by the 6-week visit. In comparison, 11 ears in 10 patients were treated for exostoses using a transcanal approach with the use of ultrasonic serrated knife and microosteotomes. One ear canal (the first in the series) was not well healed by the 3-week postoperative visit due to suspected thermal injury. All patients had well-healed ear canals by 6 weeks, and there were no complications., Conclusion: This is the first series to report the use of an ultrasonic serrated knife in the transcanal excision of exostoses. When compared with a transcanal microosteotome only excision of exostoses, the addition of the Sonopet seems to result in a similarly low complication rate. Sonopet can allow for more controlled transcanal excision of broad-based exostoses in patients with severe obstruction.

Background: A competency-based approach to family medicine (FM) post graduate (PG) training falls short of a holistic process if it focuses only on patients' needs without eliciting those of trainees., Aim: To identify perceived competency deficits of trainees and challenges hindering achievement of learning outcomes., Setting: PG FM programmes in sub-Saharan Africa., Methods: We conducted a cross-sectional survey using a web-based questionnaire with a list of competency items and challenges. Common Factor Analysis was used to ascertain which competency items and challenges accounted for the highest shared variability. A perceived competency deficit was assumed for any item with a component loading of <0.5. For challenges, higher component loadings denoted higher levels of agreement with the annotated item. Data were analysed using SPSS (version 16)., Results: A total of 150 trainees took the survey. Appraising and utilising scientific knowledge was the item with a perceived competency deficit, while poor mentor-mentee relationship was considered the foremost challenge that hindered learning outcomes., Conclusion: Critical appraisal and utilisation of scientific knowledge should be part of every stage of the African FM trainee's learning experience. To achieve this and other learning outcomes, improving mentor-mentee relationships are essential.

Introduction: Postoperative hemorrhage is one of the serious complications of adenotonsillar surgery. This study seeks to investigate the relationship between post-tonsillectomy/adenotonsillectomy hemorrhage in the pediatric population and obesity, obstructive sleep apnea (OSA), adenotonsillar hypertrophy (ATH), chronic tonsillitis (CT), and peritonsillar abscess (PTA) in the immediate post-operative setting., Methods: The California Ambulatory Surgery Data for the years 2005-2011 were reviewed. The records of patients aged less than 18 years undergoing tonsillectomy (T) or adenotonsillectomy (AT) were extracted using relevant ICD-9 diagnosis codes. The association between hemorrhage and obesity, OSA, AH, CT, PTA, and patients' demographics among surgeries performed in the outpatient setting was evaluated., Results: A total of 138,998 procedures, 22,478 Ts and 116,520 ATs, were performed during 2005-2011, of which 3.0% were performed on obese children. Hemorrhage occurred in 156 cases (0.1%), and was associated with an age from 9 to 18 years (p=0.01), and obesity (p=0.02). There was no association between hemorrhage and gender (p=0.8), OSA (p=0.6), ATH (p=0.5), CT (p=0.35), PTA (p=0.47), or T versus AT (p=0.3). Multivariate analysis revealed that hemorrhage was about 2.3 times more likely to occur in obese children (odds ratio [OR]=2.3; 95% Confidence Interval: 1.1-5.1; p=0.03)., Conclusions: Obesity and older age are associated with an increased risk of immediate post-operative hemorrhage following tonsillectomy with or without adenoidectomy in the outpatient setting. Gender, OSA, ATH, CT, PTA, and T versus AT did not alter the risk of post-operative hemorrhage., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Substance abuse and dependence is estimated to cost roughly $700 billion annually including direct and indirect care in the United States. Drug dreams (DD), or using dreams, are a reportedly common phenomenon among patients with substance abuse, and have been postulated as triggers for relapse. Prazosin is an alpha-1 receptor antagonist originally approved by the United States Food and Drug Administration for the treatment of hypertension. Prazosin passes the blood brain barrier easily, contributing to central and cognitive effects. Prazosin's efficacy has been demonstrated in the management of posttraumatic stress disorder (PTSD), and associated nightmares. We present the cases of two patients with substance use disorder experiencing DD which resolved after the addition of prazosin during an acute psychiatric hospitalization. To our knowledge, this is the first time treatment of DD with prazosin has been reported in the literature. Both patients reported an alleviation of their DD after the medication was initiated. The effect was immediate and results were seen on the same night of the initial dose. The precise mechanism of this effect is unclear, but we hypothesize it is related to the decrease in noradrenaline effects at α-1 adrenoreceptors in the brain, similar to the effect on nightmares in PTSD. The key limitation is the low number of patients and lack of follow up presented in this report. No causal relationship can be established between the use of prazosin and resolution of DD in our patients.

The Mediator complex-associated cyclin-dependent kinase CDK8 has been implicated in human disease, particularly in colorectal cancer where it has been reported as a putative oncogene. Here we report the discovery of 109 (CCT251921), a potent, selective, and orally bioavailable inhibitor of CDK8 with equipotent affinity for CDK19. We describe a structure-based design approach leading to the discovery of a 3,4,5-trisubstituted-2-aminopyridine series and present the application of physicochemical property analyses to successfully reduce in vivo metabolic clearance, minimize transporter-mediated biliary elimination while maintaining acceptable aqueous solubility. Compound 109 affords the optimal compromise of in vitro biochemical, pharmacokinetic, and physicochemical properties and is suitable for progression to animal models of cancer.

There is unmet need for chemical tools to explore the role of the Mediator complex in human pathologies ranging from cancer to cardiovascular disease. Here we determine that CCT251545, a small-molecule inhibitor of the WNT pathway discovered through cell-based screening, is a potent and selective chemical probe for the human Mediator complex-associated protein kinases CDK8 and CDK19 with >100-fold selectivity over 291 other kinases. X-ray crystallography demonstrates a type 1 binding mode involving insertion of the CDK8 C terminus into the ligand binding site. In contrast to type II inhibitors of CDK8 and CDK19, CCT251545 displays potent cell-based activity. We show that CCT251545 and close analogs alter WNT pathway-regulated gene expression and other on-target effects of modulating CDK8 and CDK19, including expression of genes regulated by STAT1. Consistent with this, we find that phosphorylation of STAT1(SER727) is a biomarker of CDK8 kinase activity in vitro and in vivo. Finally, we demonstrate in vivo activity of CCT251545 in WNT-dependent tumors.

Objectives: To examine Texas health educators' practice of providing family health history (FHH)-based services, alongside factors shaping their practice., Methods: A theoretical model of factors influencing health educators' FHH-based practice was developed and tested through structural equation modeling. (Master) Certified Health Education Specialists (N = 228; 40.93%) in Texas completed a baseline survey immediately before online or workshop FHH training., Results: Participants incorporated FHH into their practice at low rates (on average=37.10%). Our model fit the data adequately based on the overall model chi-square test and model-fit-indices (ie, χ(2) [df = 21]=27.20; p = .16; RMSEA=0.04; SRMR=0.05; CFI=0.97). Intention, self-efficacy, attitudes, and knowledge were associated with practice., Conclusions: Training health educators to incorporate FHH into their practice is needed. Our theoretical model suggests intervention points for future training.

Background: Men of African descent have the highest incidence and mortality rates of prostate cancer (PrCa) worldwide. Notably, PrCa is increasing in Africa with Nigerian men being mostly affected. Thus, it is important to understand risk factors for PrCa in Nigeria and build capacity for cancer research. The goals of this study were to determine the feasibility of conducting an epidemiological study of PrCa and to obtain preliminary data on risk factors for PrCa in Nigeria., Methods: A case-control study (50 cases/50 controls) was conducted at the University College Hospital (UCH) in Ibadan, Nigeria, between October 2011 and December 2012. Men aged 40 to 80 years were approached for the study and asked to provide informed consent and complete the research protocol. Logistic regression models were used to examine associations between demographic, social and lifestyle characteristics and risk of PrCa., Results: The participation rate among cases and controls was 98% and 93%, respectively. All participants completed a questionnaire and 99% (50 cases/49 controls) provided blood samples. Cases had a median serum diagnostic PSA of 73 ng/ml, and 38% had a Gleason score 8-10 tumor. Family history of PrCa was associated with a 4.9-fold increased risk of PrCa (95% CI 1.0 - 24.8). There were statistically significant inverse associations between PrCa and height, weight and waist circumference, but there was no association with body mass index (kg/m(2)). There were no associations between other socio-demographic and lifestyle characteristics and PrCa risk., Conclusion: This feasibility study demonstrated the ability to ascertain and recruit participants at UCH and collect epidemiological, clinical and biospecimen data. Our results highlighted the advanced clinical characteristics of PrCa in Nigerian men, and that family history of PrCa and some anthropometric factors were associated with PrCa risk in this population. However, larger studies are needed to better understand the epidemiological risk factors of PrCa in Nigeria.

WNT signaling is frequently deregulated in malignancy, particularly in colon cancer, and plays a key role in the generation and maintenance of cancer stem cells. We report the discovery and optimization of a 3,4,5-trisubstituted pyridine 9 using a high-throughput cell-based reporter assay of WNT pathway activity. We demonstrate a twisted conformation about the pyridine-piperidine bond of 9 by small-molecule X-ray crystallography. Medicinal chemistry optimization to maintain this twisted conformation, cognisant of physicochemical properties likely to maintain good cell permeability, led to 74 (CCT251545), a potent small-molecule inhibitor of WNT signaling with good oral pharmacokinetics. We demonstrate inhibition of WNT pathway activity in a solid human tumor xenograft model with evidence for tumor growth inhibition following oral dosing. This work provides a successful example of hypothesis-driven medicinal chemistry optimization from a singleton hit against a cell-based pathway assay without knowledge of the biochemical target.

Aim: Newborns admitted to neonatal units (NNUs) in resource-limited settings face a high risk of mortality, but the epidemiology of these deaths is poorly understood. We describe risk factors for NNU mortality in an area with high prevalence of human immunodeficiency virus (HIV)., Methods: We performed a prospective cohort study of infants admitted to the NNU at a public referral hospital in Gaborone, Botswana. The primary outcome was neonatal death, defined as death within 28 days of a live delivery. Cox proportional hazard models were used to evaluate risk factors for mortality., Results: From October 2008 to April 2009, 449 neonates were admitted to the NNU. Cumulative mortality was 24.5% (110/449). Factors associated with increased risk of death included lack of enteral feeding (hazard ratio (HR) 18.8, 95% confidence interval (CI) 10.3, 34.2), gestational age <28 weeks (HR 2.0, 95% CI 1.1, 3.8) and Apgar score <7 at 10 min (HR 2.5, 95% CI 1.5, 4.2). Among 348 (78%) infants who were fed, there was no difference in mortality between infants who were breastfed compared with those who were formula fed or had mixed feeding (P = 0.76). There was no significant mortality difference by HIV exposure status; 35 (28%) of 128 HIV-exposed infants died compared with 55 (21%) of 272 HIV-unexposed infants (P = 0.19)., Conclusions: This study identified low Apgar scores, extreme prematurity and lack of enteral feeding as the most important risk factors for mortality in this NNU setting. HIV exposure and formula feeding were not significantly associated with death in neonates who were very ill., (© 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Unlabelled: Summary, Aims and Objectives: To evaluate the Pattern of Paediatric solid cancers seen over 5 years in the Radiotherapy and Oncology Department of Ahmadu Bello University Teaching Hospital, Zaria-Nigeria., Materials and Methods: The study involved patients aged 16 years and below diagnosed with solid cancers referred to the Radiotherapy and Oncology Centre for further management. Between January 2006 and December 2010, a total of 136 new patients with paediatric solid cancers were seen and evaluated. Only patients with histological confirmation were included in the study (136 out of 141 patients) irrespective of cancer type, sex, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patients folder included age, sex, histological type, stage and types of treatments received. Results were presented in tables., Results: A total of 136 patients were evaluated with a mean age of 6.9 years (median of 5 years, age range 1.5 - 16 years). 74 patients (54.4%) were 5 years and below and 98 patients (72%) were 10 years and below. The sex ratio M:F was 1.3:1. At presentation at the Radiotherapy and Oncology centre, only 4 (3%) patients had early stage disease, 100 (73.5%) with locally advanced disease and 32 (23.5%) with metastatic disease. Retinoblastoma 48 (35.3%) was the commonest cancer seen followed by soft tissue sarcoma 20 (14.7%, all rhabdomyosarcoma), lymphomas 15 (11%) (9 Burkitt's and 6 Hodgkin's lymphoma), nephroblastoma 13 (9.6%), bone sarcoma 12 (8.8%) (8 Osteosarcoma and 4 Ewing's sarcoma), nasopharyngeal cancers 8 (5.9%), brain cancer 6 (4.4%), sacrococcygeal tumours 6 (4.4%) and other cancers accounted for 8 (5.9%). 116 (85.3%) patients received chemotherapy, 86 (63.2%) patients were scheduled for radiotherapy but only 21 (15.4%) received local field irradiation due to financial constraints and 43 (31.6%) had definitive surgery. Palliative care with medications was done in 22 (16.2%) patients. Of 48 patients with retinoblastoma, 30 affected left eye, 16 affected right eye and 2 patients were with bilateral retinoblastoma. The mean age for retinoblastoma was 3.8 years (median age of 3 years and mode is 3 years). The mean age for rhabdomyosarcoma was 8.7 yr (median age of 6.5 years)., Conclusion: Paediatric solid cancers were found to be more common in males than females with more than half being diagnosed in children aged 5 years and below. Retinoblastoma and rhabdomyosarcoma were the most common neoplasms. Most patients presented with locally advanced and metastatic cancers. Geographic variation exists with histological types.

Metformin hydrochloride (MET) and glibenclamide (GB) are used in the management of Type 2 Diabetes (T2D). This study was designed to investigate the toxic effect of MET and GB in the Liver, kidney and testis of rats. Twenty one rats were divided into three groups of seven rats each; group 1 served as control, groups 2 and 3 received GB and MET at doses of 5 and 30 mg/kg, respectively, for 21 days by oral gavage. Results indicate that MET and GB treatment did not affect body weight-gain in the rats. Also, there were no treatment-related changes in the absolute and relative weights of liver, kidney, and testis in MET and GB-treated rats relative to controls. However, significant increase (p&lt;0.05) in testicular lipid peroxidation levels were accompanied by reduction in epididymal sperm count and motility in MET and GB-treated rats, whereas sperm live/dead ratio was unaffected. Specifically, MET and GB decreased sperm count and motility by 34%, 31% and 25%, 28%, respectively. Activities of hepatic and renal superoxide dismutase (SOD) and catalase (CAT), serum alkaline phosphatase, lactate dehydrogenase and alanine aminotransferase were not significantly (p&gt;0.05) affected in MET and GB-treated rats, whereas testicular SOD, CAT, glutathione, serum aspartate aminotransferase and conjugated bilirubin were markedly affected by MET treatment. Histopathological results showed marked necrosis, degeneration of seminiferous tubules and defoliation of spermatocytes in testis of MET-treated rats. Taken together, MET and GB induced lipid peroxidation, affected seminal qualities and decreased antioxidant status. These drugs may interfere with normal biochemical processes in testis and liver of the rats.

Background: Quality of life (QoL) is an important measure in the assessment of population well being and health status. However despite locally validated measuring tools, little is known about the quality of life and associated factors in Nigerian adults., Objective: This study therefore aimed to assess QoL and contributory factors among adults residing in a sub urban Nigerian community., Methods: A descriptive cross-sectional study of 527 adults, in Oru community was conducted. An interviewer-administered questionnaire adapted from the WHO quality of life (WHOQOL-BREF) questionnaire was used to obtain information from respondents. Associations were explored with the chi square test; multivariate analysis was done with logistic regression at 5% level of significance., Results: Respondents mean age was 33.3 ±8.1 years. In all, 46.5 % were currently married or cohabiting. Christianity was the dominant religion, 72.7%. In all, 81.6% had good QoL. Predictors of good QoL were respondents less than 25 years [OR: 3.5 (1.264-9.508)], having educational level that is secondary and above [OR: 4.2 (1.810-9.762)]. Being Unemployed [OR: 1.9 (1.099- 3.351)], living in flats and other bigger apartments [OR: 1.8 (1.121- 3.04)], currently ill [OR: 3.7 (2.096- 6.509)], and lack of involvement in religious activities [OR: 3.1 (1.166- 8.045)] were also shown to be predictors of good QoL., Conclusion: The majority of those evaluated had good QoL. Further surveys involving larger samples sizes are required to explore the QoL in distinct sub-populations and in currently ill patients to strengthen the results of this study.

Nasal gliomas are congenital, nonmalignant rests of neuroglial tissue that typically present as a craniofacial mass. The differential diagnosis of such masses includes lesions that often require the involvement of various surgical subspecialties, including otolaryngology, neurosurgery, plastic surgery, and ophthalmology. Early surgical excision of these masses is advised to minimize nasal and craniofacial distortion. Accordingly, early diagnosis and management planning are paramount, and advances in prenatal imaging are creating a new role for obstetricians and radiologists in the initiation of diagnostic and therapeutic interventions. We describe the case history of a young patient found to have a craniofacial mass on routine prenatal ultrasound and subsequently managed with a multidisciplinary team approach.

This paper presents experimental evidence that thin (< approximately 200 nm) boron coatings, deposited with a (vacuum) cathodic arc technique on pre-polished Co-Cr-Mo surfaces, could potentially extend the life of metal-on-polymer orthopedic devices using cast Co-Cr-Mo alloy for the metal component. The primary tribological test used a linear, reciprocating pin-on-disc arrangement, with pins made of ultra-high molecular weight polyethylene. The disks were cast Co-Cr-Mo samples that were metallographically polished and then coated with boron at a substrate bias of 500 V and at about 100 degrees C. The wear tests were carried out in a saline solution to simulate the biological environment. The improvements were manifested by the absence of a detectable wear track scar on the coated metal component, while significant polymer transfer film was detected on the uncoated (control) samples tested under the same conditions. The polymer transfer track was characterized with both profilometry and Rutherford Backscattering Spectroscopy. Mechanical characterization of the thin films included nano-indentation, as well as additional pin-on-disk tests with a steel ball to demonstrate adhesion, using ultra-high frequency acoustic microscopy to probe for any void occurrence at the coating-substrate interface.

CpG oligodeoxynucleotides are potent immunostimulants. For parenterally delivered alum-based vaccines, the immunostimulatory effect of CpG depends on the association of the CpG and antigen to the alum. We describe effects of buffer components on the binding of CPG 7909 to aluminum hydroxide (Alhydrogel), assays for measuring binding of CPG 7909 to alum and CPG 7909 induced dissociation of antigen from the alum. Free CPG 7909 is a potent inducer of IP-10 in mice. However the lack of IP-10 production from formulations containing bound CPG 7909 suggested that CPG 7909 does not rapidly dissociate from the alum after injection. It also suggests that IP-10 assays are not a good basis for potency assays for alum-based vaccines containing CPG 7909.

Apical membrane antigen 1 (AMA1) has been shown to be a promising malaria vaccine candidate. The multiallelic AMA1-C1 vaccine currently in Phase 1 trials in the US and Mali contains an equal mixture of the ectodomain portion of recombinant AMA1 from the FVO and 3D7 clones of Plasmodium falciparum, formulated on Alhydrogel. It is hoped that inclusion of a human-optimized CpG oligodeoxynucleotide (ODN) (CPG 7909) with our existing AMA1-C1/Alhydrogel vaccine will lead to a higher concentration of functional AMA1-C1 antibodies. Preclinical studies were performed in mice, rats and guinea pigs to assess the safety, immunogenicity and functionality of the immune response to AMA1-C1 with Alhydrogel + CPG 7909 compared to antigen with Alhydrogel alone. Day 42 mean anti-AMA1 ELISA titer values derived from individual animals were compared between Alhydrogel and Alhydrogel + CPG 7909 groups at each antigen dose for each species. Sera from Alhydrogel + CPG 7909 groups displayed significantly higher antibody titers (P < 0.025) than their comparable Alhydrogel alone group. Mouse IgG isotype analysis showed that AMA1-C1/Alhydrogel induced a predominately Th2 type response while AMA1-C1/Alhydrogel + CPG 7909 gave a mixed Th1/Th2 type response. When tested for functional activity by in vitro inhibition of parasite invasion, IgG isolated from serum pools of AMA1-C1/Alhydrogel + CPG 7909 animals was more effective against both FVO and 3D7 parasites than an equal concentration of IgG from animals receiving vaccines adjuvanted with Alhydrogel alone. These promising preclinical results have recently led to the start of a Phase 1 trial in the US.

Background: Non-selective, non-steroidal anti-inflammatory drugs (NSAIDs) are effective in terms of pain relief and improving function in osteoarthritis. The advent of cyclooxygenase-2 (Cox-2) specific inhibitor, celecoxib, in the treatment of osteoarthritis has shown similar efficacy in relieving pain in osteoarthritis with low incidence of GI (Gastrointestinal) symptoms., Objective: To determine the efficacy and toleration of celecoxib in treatment of osteoarthritis in Nigerian population., Methods: Eighty patients were recruited from six tertiary health institutions scattered over Nigeria. A fixed dose of 200 mg celecoxib was administered daily with patient seen on the second and six weeks after commencement of study. Efficacy of the drug and safety were assessed during the study., Results: The patients had a mean age of 57.8 years with a standard deviation of 13.3 year. The mean weight was 74.7 +/- 14.9kg while the female sex constituted the majority (73.8%) of the patients. Using the physician global assessment of osteoarthritis instrument, 36.3% of the patients were rated as having poor arthritis score at baseline. This value reduced to 2.6% at second visit and 0.00% at end of the study respectively. There was no significant difference between the vital signs, haematological indices, renal and hepatic function at baseline and the final visit. There was no case of serious adverse effect., Conclusion: The study showed statistically significant improvements in the symptoms of osteoarthristis following the administration of Celecoxib 200mg daily for six weeks.

Streptococcus pneumoniae is an important aetiological agent of infections in children worldwide. The isolation rate of the bacteria has been strikingly low in the recent past in Nigeria. In a study of 1000 blood samples from patients, out of which 642 were from children in Ibadan between May 1999 and December 2000, 14 isolates of Streptococcus pneumoniae were obtained (a prevalence rate of 1.4%). All the isolates were from children and clustered between 13th September and 22nd October 1999, period of 40 days and thereafter no more organisms were isolated. Antibiotic sensitivity testing of all isolates by disc diffusion method showed resistance to cotrimoxazole, tetracycline and penicillin to be 14%, 21% and 36% respectively. All the isolates were sensitive to chloramphenicol and erythromycin. No fatalities were recorded among the children. This may have indicated an outbreak and underscores the urgency for an epidemiological database in Nigeria to ascertain the exact clinical burden of S. pnemoniae infections so as to determine the appropriate vaccine strategies required for Nigerian children.