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Abstract Background Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a “cannot intubate, cannot ventilate” situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool. Methods We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps. Results The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p

Background: Alcohol consumption and stimulant use are major public health problems and contribute to morbidity and mortality in the United States. To inform interventions for substance use, there is a need to identify the day-level correlates of substance use by collecting repeated measures data in one's natural environment. There is also a need to use crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to efficiently engage larger populations of people who use alcohol and stimulants in research., Objective: We aimed to (1) utilize daily diaries to examine the temporal relationship between day-level cravings for alcohol and stimulant/substance use (ie, heavy drinking or any drug use) in a given day over 14 days and (2) assess whether depression, negative affect, and self-esteem measured at baseline predict substance use in a given day over 14 days among people who use alcohol and/or stimulants in the United States., Methods: Individuals aged ≥18 years in the United States, who reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use in the past year, were recruited using MTurk between March 26 and April 13, 2018. Eligible participants completed a baseline survey and 14 daily surveys online. The baseline survey assessed sociodemographics and psychosocial (ie, depression, affect, self-esteem, and stress) factors. Daily surveys assessed substance use and cravings for alcohol and stimulants. Four multivariable random-intercept logistic regression models were built to examine psychosocial constructs separately along with other significant predictors from bivariate analyses while controlling for age and education., Results: Among a total of 272 participants, 220 were White, 201 were male, and 134 were men who have sex with men (MSM). The mean age was 36.1 years (SD 10.5). At baseline, 173 participants engaged in any current or past hazardous alcohol consumption, 31 reported using cocaine, 19 reported using methamphetamine, 8 reported using crack cocaine, and 104 reported any noninjection or injection drug use in the past 6 months. Factors independently associated with substance use were depression (adjusted odds ratio [aOR] 1.11, 95% CI 1.02-1.21; P=.01), negative affect (aOR 1.08, 95% CI 1.01-1.16; P=.01), lower levels of self-esteem (aOR 0.90, 95% CI 0.82-0.98; P=.02), and cravings for alcohol (aOR 1.02, 95% CI 1.01-1.03; P<.001) and stimulants (aOR 1.03, 95% CI 1.01-1.04; P=.01). MSM had higher odds of engaging in substance use in all models (model 1: aOR 4.90, 95% CI 1.28-18.70; P=.02; model 2: aOR 5.47, 95% CI 1.43-20.87; P=.01; model 3: aOR 5.99, 95% CI 1.55-23.13; P=.009; and model 4: aOR 4.94, 95% CI 1.29-18.84; P=.01)., Conclusions: Interventions for substance use should utilize evidenced-based approaches to reduce depression, negative affect, and cravings; increase self-esteem; and engage MSM. Interventions may also consider leveraging technology-based approaches to reduce substance use among populations who use crowdsourcing platforms., (©Jennifer Payaal Jain, Claudine Offer, Christopher Rowe, Caitlin Turner, Carol Dawson-Rose, Thomas Hoffmann, Glenn-Milo Santos. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 27.04.2021.)

Introduction: Necrotizing enterocolitis (NEC) is a very aggressive, destructive and sometimes lethal disease, which mainly affects infants born with severe prematurity. These patients need a complex multidisciplinary approach. The clinical course is often long and complicated, and nutritional approach should ensure a balance between the need for nutrients and the risk of complications., Clinical Case: We describe the case of a preterm female infant born at 24 weeks and 5 days of gestational age transferred to our intensive care unit for NEC complicated with intestinal perforation. Subsequently, she developed short bowel syndrome. In terms of nutrition, the baby was treated with the use of standard parenteral nutrition (PN) solutions for preterm infants, which were prescribed immediately after passing the critical and metabolically unstable phase of disease. It was possible to use these standard PN solutions also during a period of cholestasis and after the hospital discharge., Conclusions: The use of ready-to-use bags with standard solutions for PN in preterm infants complicated with surgical pathology is possible, feasible, safe and effective; it is recommendable to perform periodic clinical and laboratory evaluations.

We describe a unique cryogen-free closed-cycle refrigerator system using a beryllium-copper VX1 variant of the Paris-Edinburgh press, which enables approximately 3 GPa to be generated on a sample volume of 66 mm 3 , over the temperature range of 4 K-300 K. The main advantage of this system is its versatility; it has been designed to be fully compatible with the PEARL neutron powder-diffraction instrument at the ISIS facility, but is also compatible with several other instruments at the facility with minor modifications. We provide a full description of the system, along with representative data collected on PEARL from MnF 2 at 13 K and 2.4 GPa.

Background: Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM., Objective: This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM., Methods: Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants' experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion., Results: Overall, 93.9% (295/314) of all delivered surveys were initiated, and of those, 98.0% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message-based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants' perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience., Conclusions: EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance., (©Elaine Hsiang, Claudine Offer, Maximo Prescott, Amy Rodriguez, Emily Behar, Tim Matheson, Diane Santa Maria, Glenn-Milo Santos. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 29.04.2020.)

Background: The majority of tuberculosis (TB) cases in the UK occur among people born in high-burden countries (73%), and are concentrated in large urban centres. This study explores migrants' attitudes and beliefs towards TB in an English District where the incidence is higher than the UK average., Methods: Community engagement workers ran 26 focus groups using a standardized questionnaire. Purposeful sampling was used to obtain a cross-section of migrant communities. The summary reports were analysed using thematic analysis., Results: Most groups did not see TB as a current issue in their community and associated it either with the past or with their country of birth. It appeared to be rarely discussed in their communities and generally not noted as being associated with stigma., Conclusions: This study revealed a change in social attitudes to TB in migrant groups to those reported in previous literature. Stigma had considerably less effect than expected. However, the evidence revealed that these high-risk groups made the erroneous assumption that, by moving to a low incidence country, they were no longer at risk of the disease. TB services need to respond by revising the information that they provide to take into account the risk perception of these populations., (© The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Background: Rates of tuberculosis (TB) in UK South Asian communities are up to 17 times higher than in white British groups. Latent infection in new migrants provides only a partial explanation. We undertook a systematic review of the literature to establish existing knowledge about TB in South Asian communities., Methods: We undertook a search for literature relating to TB and its management in South Asian communities in the UK. Articles initially identified were screened for relevance. A narrative review of relevant articles was then conducted., Results: We found 18 relevant articles. Associated risk factors for TB included poverty, deprivation, return visits to the Indian subcontinent, history of close contact with a case, gender, religion, possible dietary factors such as Vitamin D deficiency, duration of stay in the UK and country of birth. However, the evidence for these factors was often conflicting or weak, and suggests that commonly proposed hypotheses may not provide robust explanations for the higher rates of diagnosis., Conclusions: Migration patterns and the demographic profile of the South Asian communities are constantly changing. Further research into the determinants of TB infection in these communities in the UK is urgently needed to inform the commissioning of TB health services., (© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: A number of significant recent research studies have used techniques of economic modelling to demonstrate the potential benefits of increasing breastfeeding rates in the UK overall, and specifically in neonatal care. This paper complements this growing body of evidence by presenting an economic analysis of data from an actual intervention, the 'Getting It Right From the Start' programme, which took place in the north of the UK during 2011-12, with the aim of increasing breastfeeding and kangaroo skin-to-skin care rates in neonatal units., Methods: 'Getting It Right from the Start' was a pragmatic, multifaceted programme of change delivered under the auspices of the regional Health Innovation and Education Cluster, of which 17 were established in the UK in 2010. It engaged with 18 neonatal units in two Neonatal Networks with the aim of increasing kangaroo skin-to-skin care and breastfeeding rates. As part of the evaluation of the programme, we conducted an economic study comparing the overall costs and benefits of the intervention., Results: Overall, the economic analysis demonstrated that for every £1 invested in the intervention to increase kangaroo skin-to-skin care and breastfeeding rates, between £4.00 and £13.82 of benefit was generated. This was spread across different healthcare settings and the timescale for the realisation of benefits will vary. The increases in kangaroo skin-to-skin care generated the greatest cost savings, with potential cost savings ranging between £668,000 (minimum cost assumptions) to more than £2 m (maximum cost assumptions). Increases in breastfeeding associated with the project generated between £68,486 and £582,432. The majority of the cost savings generated were associated with reductions in cases of gastroenteritis and necrotising enterocolitis., Conclusion: This was one of the first economic evaluations of an actual intervention to increase breastfeeding and kangaroo skin-to-skin care in neonatal units. It complements the existing economic models by demonstrating that a real intervention in clinical practice was both cost effective as well as clinically beneficial. Future interventions with similar methodology should be supported and considered likely to generate significant cost savings compared to outlay. Economic evaluation should be more frequently included in studies of practical interventions in clinical settings to increase breastfeeding.

The complex microbial populations that colonize the human body form the human microbiome. The human microbiota may contain 1014) cells, an order of magnitude greater than the number of the human cells, and can express 100 times more genes than the human genome. The metagenome is the collective genomes of the human and its microbial flora. Major international colLaborative efforts currently explore the diverse human microbiomes from five different body areas: the nasopharyngeal, gastrointestinal and female urogenital tracts, the oral cavity and the skin. Defining the complexity of the human microbiome in health and disease will enhance the understanding of multiple pathological mechanisms and facilitate the development of novel diagnostic tools and therapeutic interventions.

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.

Background: Vasomotor nephropathy is a common renal dysfunction in very preterm neonates., Objective: To determine whether theophylline could prevent vasomotor nephropathy in very preterm infants with respiratory distress syndrome., Methods: A randomised, double blind, placebo controlled trial of 50 preterm infants of gestational age < or = 32 weeks needing assisted ventilation. Infants received an intravenous dose of theophylline (1 mg/kg) or placebo for three days. The 24 hour urine volume was measured daily. On days 2, 5, and 11, blood samples and 12 hour urine collections were analysed for electrolytes, creatinine, and urea., Results: On day 1, urine output was significantly higher in the theophylline (2.4 (0.9) ml/kg/h) than the placebo (1.6 (1.0) ml/kg/h; p = 0.023) group (values are mean (SD)). The incidence of oligoanuria was significantly lower in the theophylline treated (5%) than the placebo (33%) group. Twenty four hours after the first administration of theophylline/placebo, serum creatinine concentration was significantly lower in the theophylline (0.76 (0.23) mg/dl) than the placebo (1.0 (0.41) mg/dl; p = 0.025) group. On day 5 an increase in serum creatinine was observed in both groups. On day 11 a significant reduction in serum creatinine was observed, compared with day 5, with no difference between the two groups., Conclusion: The results suggest that, in very preterm infants with respiratory distress syndrome, early theophylline administration improves renal function during the first two days of life.

We retrospectively analyzed the outcome of hematopoietic stem cell transplantations (HSCT) performed at our Center between 1991 and 2002 in 11 unselected patients with Omenn syndrome, a variant of severe combined immunodeficiency. The patients' mean age at the time of the first HSCT was 8.4 months. Two patients received two, and one patient three, HSCT procedures. The resulting 15 HSCT derived in seven cases from HLA-haploidentical parents, in four patients from matched unrelated donors, in three cases from an HLA phenotypically identical related donor, and in one case from an HLA genotypically identical family donor. Nine out of 11 patients are alive and immunoreconstituted 30-146 months after transplantation. At the time of the most recent evaluation, all of the nine survivors had normal T-cell function, and eight of them had developed normal antibody production. This study demonstrates an overall mortality of 18.2%, which is substantially lower than previously reported. Early recognition of OS, rapid initiation of adequate supportive treatment and HSCT lead to improved outcome for this otherwise fatal disease, regardless of the origin and matching of hematopoietic stem cells.

Epstein--Barr virus (EBV) is associated with Hodgkin's disease (HD). However, EBV-positive Reed--Sternberg (RS) cells and EBV-positive B lymphocytes co-exist in the same EBV-positive lymph node affected by HD. In a previous report, using total lymph node DNA, the presence of two distinct EBV strains was demonstrated, but their cellular localization (i.e. RS cells vs B lymphocytes) could not be determined. To address this question, three patients with EBV-associated HD were selected in the present study and single-cell PCR of the latent membrane protein-1 (LMP-1) gene from isolated RS cells was performed. In one case, it was clear that RS cells and B lymphocytes were infected by different EBV strains. In the two remaining cases, only one band was detected from total lymph node DNA. However, single-cell PCR showed that RS cells in each sample were infected by single EBV strains, which were different from those detected in lymphoblastoid cell lines derived from EBV-positive B lymphocytes of lymph node cell suspensions from these two patients.

The B30.2 domain is a conserved domain of around 170 amino acids. It is found associated with different protein domains: immunoglobulin domain in the case of butyrophilin and Ring Finger domain in the case of Ret Finger Protein. B30.2 should therefore be considered a migratory domain. We here report new members of these families as well as new protein families having the B30.2 domain, and we tentatively propose a general function for this domain.

We present the cloning, structural analysis, and mapping of new members belonging to two multigenic families, the B30-RING finger family and the B7.1-B7.2 family, as well as two genes derived by exon shuffling from members of these families. Eight new members were found and three of them map to the human major histocompatibilitiy complex (MHC) region. Phylogenic and physical mapping analysis allowed us to decipher the evolutionary story of these two multigenic families and to shed light on the evolution of the MHC region. We also show that a deductive analysis can be used to predict the existence of a given gene.

New members of the butyrophilin (BT) gene family have been identified by cDNA and genomic cloning. Six genes are described: BT2. 1, 2.2, 2.3, and BT3.1, 3.2, and 3.3. BT2, BT3, and BT form three distinct subfamilies sharing about 95% amino acid identity at the intra subfamily level and 50% identity at the interfamily level. All the BT2 and BT3 subfamily members map close to BT in the juxta-telomeric region of the major histocompatibility complex. The BT2 members have the canonical structural organization of BT, i.e., two immunoglobulin domains followed by a transmembrane anchor and a B30.2 intracytoplasmic domain. In the BT3 subfamily, only BT3.3 has the structural organization of BT. The two other genes, BT3.1 and BT3.2, code for putative protein without the B30.2 domain. In the case of BT3.2, this is due to an Alu insertion in the B30.2 coding exon, leading to a new polyadenylation site.

Human myelin oligodendrocyte glycoprotein (MOG), a myelin component of the central nervous system, is a candidate target antigen for autoimmune-mediated demyelination. We have isolated and sequenced part of a cosmid clone that contains the entire human MOG gene. The primary nuclear transcript, extending from the putative start of transcription to the site of poly(A) addition, is 15,561 nucleotides in length. The human MOG gene contains 8 exons, separated by 7 introns; canonical intron/exon boundary sites are observed at each junction. The introns vary in size from 242 to 6484 bp and contain numerous repetitive DNA elements, including 14 Alu sequences within 3 introns. Another Alu element is located in the 3'-untranslated region of the gene. Alu sequences were classified with respect to subfamily assignment. Seven hundred sixty-three nucleotides 5' of the transcription start and 1214 nucleotides 3' of the poly(A) addition sites were also sequenced. The 5'-flanking region revealed the presence of several consensus sequences that could be relevant in the transcription of the MOG gene, in particular binding sites in common with other myelin gene promoters. Two polymorphic intragenic dinucleotide (CA)n and tetranucleotide (TAAA)n repeats were identified and may provide genetic marker tools for association and linkage studies.

Sigmoid volvulus is an emergency which requires rapid diagnosis and immediate adequate treatment. Diagnosis is primarily radiological. Emergency laparotomy carries a high mortality and should therefore not be the immediate treatment. In our opinion, detorsion by colonoscopy under radiological control is a promising form of treatment. Selective resection of the sigmoid, thereby removing the cause of the abnormality, should not be forgotten, since this prevents recurrences. For this method, mortality after adequate gut preparation is only 5.4%. An exception to the above is gangrene of the bowel, when an emergency laparotomy cannot be avoided.