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Highlights • Histological characteristics of healthy equine temporomandibular joints (TMJs) were determined. • Articular surfaces of the equine TMJ are coated with fibrocartilage. • With the exception of the mandibular fossa, osseous aspects had a similar zonal pattern. • The lack of glycosaminoglycans in the mandibular fossa indicates low compressive loads in this area. • On the basis of similarities with human TMJs, the initial movement of the mandible in horses is likely to be translational. Abstract It has been assumed that dental conditions cause disorders of the equine temporomandibular joint (TMJ), due to biomechanical overload or aberrant loading. However, the incidence of published TMJ disorders in horses is low and this leads to the question whether the equine TMJ is adapted well to its biomechanical requirements or is able to remodel its articular surfaces in response to modified loading conditions. The aim of this study was to determine the histological characteristics of healthy equine TMJs. The tissue components of the articular surfaces of 10 TMJs obtained from horses without any clinical history of dental or TMJ disorders were analysed. Apart from the mandibular fossa of the temporal bone, the osseous aspects of the TMJ exhibited a uniform zoning pattern. The articular surfaces were composed of three tissue layers: (1) a superficial cell-rich dense connective tissue layer; (2) a middle fibrocartilage layer; and (3) a deep hyaline-like cartilage layer. The articular disc was composed of an inner core of fibrocartilage and hyaline-like cartilage meshwork covered with both cell-rich dense connective tissue and fibrocartilage at its dorsal and ventral aspects. In contrast, the mandibular fossa was only covered by a dense connective tissue, frequently supplemented by a synovial membrane, suggesting low biomechanical stress. Glycosaminoglycans, which are indicative of compressive loads, were predominantly present within the rostral part of the articular tubercle and the retroarticular process, the dorsal part of articular disc and the entire mandibular head, but were absent within the mandibular fossa. The results of this study suggest the presence of different biomechanical demands in the dorsal and ventral compartment of the equine TMJ. [ABSTRACT FROM AUTHOR]

In 2012, the orchid mealy bug Pseudococcus microcirculuswas first detected in situ in North America's more diverse orchid region, the Big Cypress Basin (Collier Co FL). A follow-up survey showed that the mealy bug is more widespread and found on epiphytic orchids in two locations, in both the Fakahatchee Strand State Preserve (sites B and F) and the Florida Panther National Wildlife Refuge (sites M and C). There, we collected mealy bugs ( n=54) from 35 orchid individuals and screened allelic variation at seven microsatellite loci. We estimated genetic diversity and differentiation among all sites and compared the variation among individuals collected on the same plant. Genetic differentiation between sites M and C ( F =0.03, P<0.01) and, M and B ( F =0.04, P<0.01) was detected. We also detected significantly lower mean pairwise relatedness among individuals from site B compared to all the other locations, and this population had the lowest inbreeding coefficient. Genetic diversity and mean pairwise relatedness were highly variable among plants with multiple individuals; however, plants from sites F and M tend to have collections of individuals with higher mean pairwise relatedness compared to sites B and C. Our results indicate that there is genetic diversity and differentiation among mealy bugs in these locations, and that collections of individuals on the same plant are genetically diverse. As such, the mealy bugs throughout these areas are likely to be genetically diverse and exist in multiple distinct populations. [ABSTRACT FROM AUTHOR]

In the last decade, the equine masticatory apparatus has received much attention. Numerous studies have emphasized the importance of the temporomandibular joint (TMJ) in the functional process of mastication. However, ultrastructural and histological data providing a basis for biomechanical and histopathological considerations are not available. The aim of the present study was to analyze the architecture of the collagen fiber apparatus in the articular surfaces of the equine TMJ to reveal typical morphological features indicating biomechanical adaptions. Therefore, the collagen fiber alignment was visualized using the split-line technique in 16 adult warmblood horses without any history of TMJ disorders. Within the central two-thirds of the articular surfaces of the articular tubercle, the articular disc and the mandibular head, split-lines ran in a correspondent rostrocaudal direction. In the lateral and medial aspects of these articular surfaces, the split-line pattern varied, displaying curved arrangements in the articular disc and punctual split-lines in the bony components. Mediolateral orientated split-lines were found in the rostral and caudal border of the articular disc and in the mandibular fossa. The complex movements during the equine chewing cycle are likely assigned to different areas of the TMJ. The split-line pattern of the equine TMJ is indicative of a relative movement of the joint components in a preferential rostrocaudal direction which is consigned to the central aspects of the TMJ. The lateral and medial aspects of the articular surfaces provide split-line patterns that indicate movements particularly around a dorsoventral axis. [ABSTRACT FROM AUTHOR]

Aim Elderly patients may be at higher risk of postoperative complications, particularly infective, than younger patients. Method We prospectively followed 163 consecutive patients undergoing elective laparoscopic resection for cancer. We compared patients < 65, 65-80 and > 80 years of age at the time of surgery. Results Seventy (42.9%) patients had no complication; 93 (57.1%) had at least one complication following surgery and in 20 (12.3%) this was major. There was no difference in major complications between the groups (P = 0.47). Patients over 65 years of age were more likely to have a complication of any severity [< 65 years, 39.3%; 65-80 years, 69.3%; and > 80 years, 63.0% (P = 0.002)]. The frequency of gastrointestinal complications (30.1%) was similar in the groups (P= 0.29), as was wound infection (25.2%) (P= 0.65). There was an increase in the frequency of infectious complications, especially chest infection, with age, from 14.8% in patients < 65 years, to 22.7% in patients 65-80 years, to 44.4% in patients > 80 years (P = 0.01). Multivariate analysis showed no increase in overall complications in elderly patients, but Stage II or Stage III cancer (OR = 2.59, P= 0.04) and increasing body mass index (BMI) (OR = 1.07 for each unit increase in BMI, P = 0.04) were related to complications. Age remained the only predictor of an infective complication on multivariate analysis. Patients > 80 years of age had 4.21 times the OR of an infective complication (P = 0.03). Conclusion Older patients are more susceptible to infective complications postoperatively, particularly chest complications. Surgeons should alter their practice to reduce morbidity, such as adopting protocols requiring early physiotherapy. [ABSTRACT FROM AUTHOR]

International concerns about the performativity agenda in schools gives rise to concerns about the neglect of a holistic approach to teaching and learning. Whilst schools in England and Wales are legally obliged to promote the spiritual, moral, social and cultural (SMSC) development of children, little is known about how initial teacher training providers prepare trainees to do so. This project aims to address this gap in the literature. This paper details the findings of phase one of a National Survey which investigates trainers’ approaches to delivery and their views on the place of SMSC in primary schools. Findings suggest that trainers value SMSC, but time devoted to it is relatively low and policy changes are perceived to threaten SMSC’s security. The paper argues that it is vital that trainers empower trainees to understand the importance of holistic themes of their respective curricula, informed by critical engagement with theory, in order to avoid them being overshadowed by the performativity discourse. [ABSTRACT FROM PUBLISHER]

Background Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. Aims To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. Methods Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. Results Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. Conclusions Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done. [ABSTRACT FROM AUTHOR]

The article focuses on chronological development of the International Labour Organization's (ILO) Workers with Family Responsibilities Convention, 1981, No. 156 with respect to work and family. Topics discussed include the role of work-family convention in serving the international community, relationship of equality with social inclusion, and the laws regulating equality and discrimination in employment. It further discusses international bill of rights for equality.

Purpose: The purposes of this study were to assess the working definition of a colorectal anastomotic leak among colorectal surgeons and to survey the current approach to investigation and management of a patient with a suspected anastomotic leak. Methods: Online survey consisting of nine questions regarding the definition, assessment and investigation of anastomotic leaks was conducted. Of the 738 eligible ACP members contacted, 210 responded (28.4 %). Results: Results demonstrated that 94.2 % of surgeons agreed 'extravasation of contrast on enema' and 91.8 % agreed 'faecal material seen in drains/from the wound' constituted a clinical leak. Only 69.2 % agreed that a leak was 'intra-abdominal sepsis requiring a laparotomy', and about half agreed that radiological collections constituted a leak when either treated with antibiotics (46.6 %) or with percutaneous drainage (51.4 %). Serial clinical examination was the perceived most sensitive clinical feature for a leak, with 75 % of surgeons ranking this in their top three choices. Surgeons radiologically confirm a leak on average in 80.2 % of cases. A CT with rectal contrast for a left-sided leak was selected by 42.9 % of respondents. For a right-sided/small bowel anastomosis, 44.5 % selected a CT with oral contrast and 43.4 % a CT with IV contrast. Conclusions: There is still significant heterogeneity between surgeons in what they define as an anastomotic leak. Most surgeons valued clinical examination as the most sensitive initial tool for leak detection; however, radiology has a major role in the confirmation of clinical leaks in colorectal patients. There is an increasing need to be able to classify and grade anastomotic leaks, both to improve the care of patients and for audit purposes. [ABSTRACT FROM AUTHOR]

Aim Stapled transanal rectal resection ( STARR) is used for patients with obstructive defaecation syndrome ( ODS) not responding to conservative management. Reports indicate mixed results and there are no studies publishing the long-term outcome. Method Following full investigation, 37 patients with ODS underwent a STARR procedure by one of the authors ( SP) between 2005 and 2010. Results The median (range) patient age was 53.0 (28-79) years and all were female. Median (range) follow up was 13 (0-57) months, and nine (24.3%) patients were followed for longer than 24 months. Eighteen patients had undergone at least one (and often multiple) previous gynaecological procedures, including hysterectomy ( n = 14), colposuspension ( n = 3), vaginal rectocele repair ( n = 4) and pelvic floor repair ( n = 5). Four patients had had at least one previous rectal operation [stapled anopexy ( n = 3) and Delorme's procedure ( n = 2)]. One patient did not attend for postoperative follow up. Of the remaining 36 patients, 18 had resolution of obstructive symptoms. Of the 18 with residual symptoms, 17 eventually reported the same level of symptoms as before the STARR procedure. There was a significant correlation between the presence of residual symptoms and long-term ODS recurrence ( P < 0.0005). For those with residual symptoms, the mean (95% CI) time to symptom recurrence was 3 (2.86-11.81) months. Twenty (56%) patients were satisfied with the outcome from the STARR procedure. Conclusion Residual symptoms are a strong indicator of long-term failure. STARR was effective for symptom resolution in 50% of patients. Those who had undergone pelvic floor or rectal prolapse surgery were significantly more likely to experience recurrent symptoms. [ABSTRACT FROM AUTHOR]

Objectives Abdominal wall hernias are common. Various authors all quote the following order (in decreasing frequency): inguinal, femoral, umbilical followed by rarer forms. But are these figures outdated? We investigated the epidemiology of hernia repair (retrospective review) over 30 years to determine whether the relative frequencies of hernias are evolving. Design All hernia repairs undertaken in consecutive adult patients were assessed. Data included: patient demographics; hernia type; and operation details. Data were analysed using Microsoft Excel 2007 and SPSS. Setting A single United Kingdom hospital trust during three periods: 1985-1988; 1995-1998; and 2005-2008. Main outcomemeasures Frequency data of different hernia types during three time periods, patient demographic data. Results Over the three time periods, 2389 patients underwent 2510 hernia repairs (i.e. including bilateral and multiple hernias in a single patient). Inguinal hernia repair was universally the commonest hernia repair, followed by umbilical, epigastric, para-umbilical, incisional and femoral, respectively. Whereas femoral hernia repair was the second commonest in the 1980s, it had become the fifth most common by 2005- 2008.While the proportion of groin hernia repairs has decreased over time, the proportion of midline abdominal wall hernias has increased. Conclusion The current relative frequency of different hernia repair type is: inguinal; umbilical; epigastric; incisional; para-umbilical; femoral; and finally other types e.g. spigelian. This contrasts with hernia incidence figures quoted in common reference books. [ABSTRACT FROM AUTHOR]

Colorectal Nurse Specialist (CNS) clinics for postoperative follow up of colorectal cancer aim to maintain clinical efficacy while reducing costs. We prospectively studied the efficacy and financial implications of such a clinic This was a prospective study of all patients attending CNS clinics over 3 years. A lower-risk protocol for patients with Dukes A was used over 3 years and a higher-risk protocol for patients with Dukes B, C or D was used over 5 years. Department of Health Pricing Charts were used to cost the follow-up protocols, and adjustment was performed to calculate the cost of each quality adjusted life year (QALY) gained. One hundred and ninety-three patients entered into this nurse-led follow-up protocol implemented by the CNS clinic between 2005 and 2007. The Dukes stages and proportions of patients in each stage were as follows: stage A, 13%; stage B, 8%; stage C, 36.3%; and stage D, 9.3%. Ninety-seven per cent underwent curative treatment and 2.6% had palliative treatment. Twenty-one per cent of patients developed recurrent disease. Overall actuarial 5-year survival was 80% and recurrences had a 30% 5-year actuarial survival. The total cost per patient for 3 years of follow up was £1506 and £1179 for lower-risk rectal and nonrectal cancers, respectively. The adjusted cost for each QALY gained for lower-risk tumours was £1914. The total cost per patient with higher-risk tumours was £1814 and £1487 for rectal and nonrectal tumours, respectively. The adjusted cost for each QALY gained was £2180 for higher-risk tumours. This clinic demonstrated cost-effective detection of recurrent disease. Computed tomography (CT) was the most sensitive alert test. As all recurrences were detected within 4 years, we suggest that this is the indicated time to follow up. [ABSTRACT FROM AUTHOR]

Cyclic vomiting syndrome (CVS) was initially described in children but can occur in all age groups. Cyclic vomiting syndrome is increasingly recognized in adults. However, the lack of awareness of CVS in adults has led to small numbers of diagnosed patients and a paucity of published data on the causes, diagnosis and management of CVS in adults. This article is a state-of-knowledge overview on CVS in adults and is intended to provide a framework for management and further investigations into CVS in adults. [ABSTRACT FROM AUTHOR]

Obesity and lack of physical activity have been inconsistently associated with pancreatic cancer. Using data from a self-administered baseline questionnaire (1995-1996), the authors investigated the association between adiposity and physical activity and pancreatic cancer in 495,035 participants of the National Institutes of Health-AARP Diet and Health Study who were aged 50-71 years. To avoid the influence of subclinical disease, follow-up time started 1 year after baseline, and subjects with a body mass index (BMI) of <18.5 kg/m(2) were excluded. A subcohort (n = 302,060) completed a second questionnaire with information about physical activity and waist and hip circumference. During follow-up though 2000, 654 pancreatic cancer cases were identified. The authors used Cox proportional hazard models to generate adjusted hazard ratios and 95% confidence intervals. Compared with those with a BMI of 18.5-<25, those with a BMI of >/=35 had a 45% greater pancreatic cancer risk (95% confidence interval (CI): 1.04, 2.02; p(trend) = 0.02). Significant positive associations for BMI were observed among nonsmokers (for BMI > or =35: hazard ratio = 1.70, 95% CI: 1.14, 2.53; p(trend) = 0.004) but not recent smokers (p(interaction) = 0.08). Waist circumference was positively associated with pancreatic cancer (fourth vs. first quartile: hazard ratio = 2.53, 95% CI: 1.13, 5.65; p(trend) = 0.04) in women but not men. The authors observed no association with physical activity. Their results suggest a positive association between adiposity and pancreatic cancer. [ABSTRACT FROM AUTHOR]

ATM and ATR are two related kinases essential for signalling DNA damage. Although ATM is thought to be the principle kinase responsible for signalling ionising radiation (IR)-induced DNA damage, ATR also contributes to signalling this form of genotoxic stress. However, the molecular basis of differential ATM and ATR activation in response to IR remains unclear. Here, we report that ATR is recruited to sites of IR-induced DNA damage significantly later than activation of ATM. We show that ATR is recruited to IR-induced nuclear foci in G1 and S phase of the cell cycle, supporting a role for ATR in detecting DNA damage outside of S phase. In addition, we report that recruitment of ATR to sites of IR-induced DNA damage is concomitant with appearance of large tracts of single-stranded DNA (ssDNA) and that this event is dependent on ATM and components of the Mre11/Rad50/Nbs1 (MRN) protein complex.Oncogene (2006) 25, 3894–3904. doi:10.1038/sj.onc.1209426; published online 13 February 2006 [ABSTRACT FROM AUTHOR]

Increased dietary protein intake rapidly (3 h) decreases hepatic malic enzyme and increases hepatic histidase mRNA expression in broiler chicks. A series of experiments was conducted to determine the role that glucagon or a specific mixture of dietary amino acids might have in regulating the rapid changes in mRNA expression of these enzymes, when dietary protein intake is increased. Three hours after the injection of glucagon (240 μg/kg of BW) into the brachial vein of broiler chicks, hepatic malic enzyme mRNA expression was significantly lower and hepatic histidase mRNA expression was significantly greater than the level detected in saline-injected chicks. In addition, broiler chicks fed a high (40 g/100 g of diet) protein diet had significantly higher plasma glucagon levels at 1 and 3 h after initial access to this diet than broiler chicks fed a basal (22 g/100 g of diet) protein diet. The plasma glucagon concentration, however, was not different between the chicks fed the 2 dietary protein levels at 2 h after the initial access to the 2 diets. When a mixture of indispensable or dispensable amino acids was added to the basal diet to equal the concentrations of the individual indispensable or dispensable amino acids in the high protein diet, hepatic mRNA expression of malic enzyme and histidase were intermediate to the expression found in chicks fed the basal and high protein diet. The results indicate that glucagon may mediate the changes in the mRNA expression of malic enzyme and histidase in response to dietary protein intake and that total amino acid intake rather than the ingestion of specific amino acids regulates the mRNA expression of malic enzyme and histidase in chicks. [ABSTRACT FROM AUTHOR]

Socio-emotional selectivity theory posits that as individuals age, they desire less social stimulation and novelty, and tend to select close, reliable relationships to meet their emotional needs. Residence in congregate facilities affords social exposure, yet does not guarantee access to close relationships, so that loneliness may be a result. Further, the gerontology literature has suggested that loneliness in late life may be a risk factor for serious mental health concerns such as depression. This article examined data on loneliness and depressive symptoms from older adults aged 60-9 8, residing in two age-segregated independent living facilities. Overlap between those scoring in the depressed range on the Geriatric Depression Scale and those scoring more than one standard deviation above the mean on the UCLA Loneliness Scale was less than 50%, although zero-order correlation of the two continuous scores was moderately high. Potential risk and resilience factors were regressed on the continuous scores of the two scales in separate hierarchical multiple regression analyses. Depression was predicted by being older, number of chronic health conditions, grieving a recent loss, fewer neighbor visitors, less participation in organized social activities and less church attendance. Grieving a recent loss, receiving fewer visits from friends, and having a less extensive social network predicted loneliness. In addition, loneliness scores explained about 8% of the unique variance in depression scores, suggesting it is an independent risk factor for depressive symptoms. Loneliness scores were seen to be more widely dispersed in these respondents, with less variance explained by the available predictors. Suggestions are made for addressing loneliness in older adults as a means of preventing more serious mental health consequences. [ABSTRACT FROM AUTHOR]

Focuses on the composition and distribution of Pythium communities in wheat fields in eastern Washington State. Identification of species using classical methods and by sequencing the internal transcribed spacer region of the recombinant DNA; Correlation of soil type and precipitation.

Examines the theoretical justifications for the anti-discrimination protection for working parents in Australia. Implication of discrimination, voluntaries and employment; Analysis of the tort principles; Factors affecting the justification for protecting working parents.

Revisions of clinical psychological tests are occurring at more frequent intervals than in the past. These revisions involve such practical issues as the goals of the revision, the economic considerations relating to the revision, the methodology of the revision, and the degree to which the revision meets the available scientific and ethical standards governing the use of these tests in individual assessment. A tension between practical and ethical issues in the test revision process is inevitable and demands the best of psychologists in their decision making. Test developers, psychologists, patients, and consumers of the test interpretations and recommendations have legitimate interests and a stake in seeing that test revisions are applied with maximal effectiveness and fairness in the broadest sense. [ABSTRACT FROM AUTHOR]

Studies the long-term effects of severe penetrating head injury on adjustment levels. Examines 41 World War II veterans who suffered penetrating injury to the brain were interviewed 40 years after their initial injury using the Washington Psycho-Social Seizure Inventory (WPSI). Method and results.

The attitudes of 233 relatives to autopsy of elderly medical patients (mean age 82 years) who died in a district general hospital were examined prospectively. Forty-three (18%) relatives were asked permission for autopsy, 24 (56%) agreed and 19 (44%) refused. Of 190 (82%) relatives whose permission was not sought, 109 (57%) would have agreed and 81 (43%) would have refused permission had they been asked. Advancement of medicine and reassurance about the correct diagnosis were the main reasons for consent, while dislike of autopsy, family distress at disfigurement of the body and the patient 'having suffered enough' were the main reasons for refusal. Living near rather than with the deceased (64% vs 45%; chi 2 = 6.985, p = 0.01) and being a male rather than female relative (63% vs 49%; chi 2 = 3.879, p = 0.05) were predictive of a positive response to autopsy. Of the 39 autopsies performed, 24 (9.6%) followed relatives' permission and 15 (6%) were at the request of the coroner. The overall autopsy rate of 16% was lower than the rate recommended for medical audit (35%). Although there is a need for educating relatives about the benefits of autopsy, a more urgent study is required to find reasons for the low request by medical staff. [ABSTRACT FROM AUTHOR]

Abstract Adult mosquitoes, Anopheles gambiae Giles and Culex quinquefasciatus Say (Diptera: Culicidae), were exposed for 3 min to replicate samples of polyester netting cut from replicate bednets treated with pyrethroid insecticide formulations at the recommended concentration (alphacypermethrin SC at 40 mg ai/m2 ; cyfluthrin EW at 50 mg ai/m2 ; deltamethrin WT at 25 mg ai/m2 ), or treated with only a quarter of those dosages. After 4 months domestic use of the bednets in Malawi, chemical assays showed that pyrethroid deposits on the netting were somewhat less than the target concentrations. Comparing the pyrethroid bioassay results with Anopheles at both treatment concentrations, deltamethrin gave significantly higher mortality (99.7–100%) than the other compounds (alphacypermethrin 94–96%, cyfluthrin 80–89%). Culex bioassay mortality was lower (alphacypermethrin 56–74%; cyfluthrin 63–65%; deltamethrin 50–81%) and results with the three pyrethroid insecticides at their recommended doses did not differ significantly. [ABSTRACT FROM AUTHOR]

Using bovine plasma albumin as an antigen anaphylactic sensitivity was found to be highly heritable, h²=0·92 (0·54 to 1·0). [ABSTRACT FROM AUTHOR]

The surface adhesion between C. elegans and the agar plates on which they are commonly grown has yet to be accurately quantified. C. elegans is a scientifically important species of nematode whose simple structure allowed the first mapping of the complete nervous system in a multicellular organism. One of the current topics of research in the C. elegans community is the investigation of neuronal function in locomotion. Models of locomotion are used in these studies to aid in determination of the functions of specific neurons involved in locomotion. The adhesion force plays a critical role in developing these models. This paper presents the experimental determination of the adhesion energy of a representative sample of C. elegans. Adhesion energy was determined by a direct pull-off technique. In this approach, nematodes are anesthetized to prevent movement and secured to a small load cell before an agar plate is slowly brought into contact with the specimen and then removed. The maximum tensile force is then fit to a JKR-type adhesion model, which assumes that the nematode is a cylinder in order to determine the adhesion energy. Repeated adhesions are also investigated to determine the importance of drying on the measured adhesion force. From these experiments, the adhesion energy was found to be W = 4.94 ± 1.19 mJ/m2. Limited experiments on the rol-6 cuticle mutant found a lower adhesion energy W = 2.65 ± 1.16 mJ/m2 for these animals. [ABSTRACT FROM AUTHOR]

Background: It is now well established that susceptibility to inflammatory bowel disease is in part genetic, with one localization on chromosome 6 ( IBD3 ) having been replicated in a number of populations. A candidate in that region, TNF-α , contains polymorphisms in the promoter region that appear to be associated with disease. Methods: More than 600 individuals from 170 multiplex IBD families were genotyped for four polymorphisms in the TNF-α gene and analysed for association. Results and Conclusion: A strong association was observed between transmission of the -857 C allele and disease. This effect was strongest in those families in which the NOD2 risk alleles are also segregating, supporting the existence of an interaction between IBD3 and IBD1 on chromosome 16. [ABSTRACT FROM AUTHOR]

Submesoscale dynamics play a key role in setting the stratification of the ocean surface mixed layer and mediating air-sea exchange, making them especially relevant to anthropogenic carbon uptake and primary productivity in the Southern Ocean. In this paper, a series of offline-nested numerical simulations is used to study submesoscale flow in the Drake Passage and Scotia Sea regions of the Southern Ocean. These simulations are initialized from an ocean state estimate for late April 2015, with the intent to simulate features observed during the Surface Mixed Layer at Submesoscales (SMILES) research cruise, which occurred at that time and location. The nested models are downscaled from the original state estimate resolution of 1/12° and grid spacing of about 8 km, culminating in a submesoscale-resolving model with a resolution of 1/192° and grid spacing of about 500 m. The submesoscale eddy field is found to be highly spatially variable, with pronounced hot spots of submesoscale activity. These areas of high submesoscale activity correspond to a significant difference in the 30-day average mixed layer depth between the 1/12° and 1/192° simulations. Regions of large vertical velocities in the mixed layer correspond with high mesoscale strain rather than large . It is found that is well correlated with the mesoscale density gradient but weakly correlated with both the mesoscale kinetic energy and strain. This has implications for the development of submesoscale eddy parameterizations that are sensitive to the character of the large-scale flow. [ABSTRACT FROM AUTHOR]

Objective: To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal–white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods: All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results: Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11–0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65–24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01–9.09). Conclusions: Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it. What is known about this topic? Australian cancer care providers deliver inequitable access and outcomes for First Nations Australians. Systemic and personal racism experienced by First Nations patients are thought to contribute to these inequities. What does this paper add? This paper documents the presence of cancer centre employee racial bias and reiterates the need for further research to document the effect of racism on cancer care outcomes for First Nations patients. What are the implications for practitioners? Healthcare practitioners, similar to other Australians, have implicit bias against First Nations Australians. Previous studies suggest that the presence of bias affects treatment options and outcomes for people of colour. In order to eliminate racism and associated inequities in cancer care services, multi-faceted anti-racism approaches are required. [ABSTRACT FROM AUTHOR]

BACKGROUND: To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS: A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS: In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05–7.54; p = 0.039). CONCLUSION: Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) is becoming widely used for mediastinal lymph node staging in patients with known or suspected lung cancer. While a substantial number of case series have evaluated test performance of this investigation, the small sample sizes limited the ability to accurately evaluate the precision of EBUS-TBNA as a staging modality. A systematic review was performed of published studies evaluating EBUS-TBNA for mediastinal lymph node staging to ascertain the pooled sensitivity and specificity of this investigation. Methods: A literature search was constructed and performed by a professional medical librarian to identify the literature from 1960 to February 2008. Pooled specificity and sensitivity was estimated from the extracted data with an exact binomial rendition of the bivariate mixed-effects regression model. Results: Of 365 publications, 25 were identified in which EBUS-TBNA was specifically focused on mediastinal node staging. Of these, only 10 had data suitable for extraction and analysis. The overall test performance was excellent with an area under the summary receiver operating characteristics curve of 0.99 (95% CI 0.96 to 1.00); similarly, EBUS-TBNA had excellent pooled specificity of 1.00 (95% CI 0.92 to 1.00) and good pooled sensitivity of 0.88 (95% CI 0.79 to 0.94). Conclusions: EBUS-TBNA has excellent overall test performance and specificity for mediastinal lymph node staging in patients with lung cancer. The results compare favourably with published results for computed tomography and positron emission tomography [ABSTRACT FROM AUTHOR]

Aim There are many surgical techniques that deal with external rectal prolapse but perineal procedures have the advantage of reduced invasiveness. Therefore, despite concerns regarding high recurrence rates, the technique is still used by many surgeons. Method This manuscript and video describe our early clinical experience using the Harmonic scalpel in 11 consecutive patients who underwent a Delorme's procedure for external rectal prolapse. Results The median age of patients was 76 (range: 30-94) years. There were no intra-operative complications, and the median operative time was 78 min. Intra-operative blood loss was minimal (mean 45 ml; range 20-70 ml). Median length of stay was 2 (range: 0-8) days. Overall morbidity and recurrence were both 18%, with a median follow-up of 15 (range: 1-23) months. Nine patients were operated on by a senior trainee with consultant supervision. Conclusion The advantages of this device are mainly those of ease of mucosal dissection, minimal blood loss and shorter operative time in comparison with published series. [ABSTRACT FROM AUTHOR]

Background: Effective strategies are needed to facilitate the prompt diagnosis and treatment of tuberculosis in countries with a high burden of the disease.Methods: We conducted a cluster-randomized trial in which Ugandan community health centers were assigned to a multicomponent diagnostic strategy (on-site molecular testing for tuberculosis, guided restructuring of clinic workflows, and monthly feedback of quality metrics) or routine care (on-site sputum-smear microscopy and referral-based molecular testing). The primary outcome was the number of adults treated for confirmed tuberculosis within 14 days after presenting to the health center for evaluation during the 16-month intervention period. Secondary outcomes included completion of tuberculosis testing, same-day diagnosis, and same-day treatment. Outcomes were also assessed on the basis of proportions.Results: A total of 20 health centers underwent randomization, with 10 assigned to each group. Of 10,644 eligible adults (median age, 40 years) whose data were evaluated, 60.1% were women and 43.8% had human immunodeficiency virus infection. The intervention strategy led to a greater number of patients being treated for confirmed tuberculosis within 14 days after presentation (342 patients across 10 intervention health centers vs. 220 across 10 control health centers; adjusted rate ratio, 1.56; 95% confidence interval [CI], 1.21 to 2.01). More patients at intervention centers than at control centers completed tuberculosis testing (adjusted rate ratio, 1.85; 95% CI, 1.21 to 2.82), received a same-day diagnosis (adjusted rate ratio, 1.89; 95% CI, 1.39 to 2.56), and received same-day treatment for confirmed tuberculosis (adjusted rate ratio, 2.38; 95% CI, 1.57 to 3.61). Among 706 patients with confirmed tuberculosis, a higher proportion in the intervention group than in the control group were treated on the same day (adjusted rate ratio, 2.29; 95% CI, 1.23 to 4.25) or within 14 days after presentation (adjusted rate ratio, 1.22; 95% CI, 1.06 to 1.40).Conclusions: A multicomponent diagnostic strategy that included on-site molecular testing plus implementation supports to address barriers to delivery of high-quality tuberculosis evaluation services led to greater numbers of patients being tested, receiving a diagnosis, and being treated for confirmed tuberculosis. (Funded by the National Heart, Lung, and Blood Institute; XPEL-TB ClinicalTrials.gov number, NCT03044158.). [ABSTRACT FROM AUTHOR]

Robots have been widely used in rehabilitation. Among the various applications, robots have been developed to assist children with motor disabilities in play and academic activities. Several studies have shown the efficacy of these robotic tools, not only for allowing children to actively participate in the activities, with direct impact on the development of their cognitive, social, and linguistic skills, but also as a means to assess children's understanding of cognitive concepts, when standard tests cannot be used due to physical or language limitations. In this paper the use of robots for assistive play is reviewed from the perspectives of rehabilitation engineering and robot design, aiming at defining a set of desirable characteristics for such robots. Commercially available robots are then surveyed in comparison to the defined characteristics to evaluate to what extent they can be used as assistive robots for play, learning and cognitive development. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated the potential of robots as assistive tools for play activities. Through the use of robots, children with motor impairments may be able to manipulate objects and engage in play activities as their typically developing peers, thus having the same opportunities to learn cognitive, social, motor and linguistic skills. Robot use can also provide a proxy measure of disabled children's cognitive abilities by comparing their performance with that of typically developing children. This paper reports a study with eighteen typically developing children aged three, four and five years to assess at which ages the cognitive concepts of causality, negation, binary logic, and sequencing are demonstrated during Lego robot use. [ABSTRACT FROM AUTHOR]