A rare case of a direct ocular contact burn to the right eye

Ocular thermal burns represent an oculoplastic emergency, with the potential for blindness owing to limbal ischaemia. We present a rare case of a 66-year-old man who sustained a direct thermal contact burn to the right eye.

When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted

BACKGROUND

The diagnosis and management of lobular neoplasia (LN) including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) remains controversial. Current management options after a core needle biopsy (CNB) with lobular neoplasia (LN) incorporating both ALH and LCIS include excision biopsy or careful clinical and radiologic follow up.

METHODS

A retrospective analysis of the surgical database at Cork University Hospital was performed to identify all core needle biopsies from January 1st 2010 to 31st December 2013 with a diagnosis of FA who subsequently underwent surgical excision biopsy. All cases with associated LN including ALH and classical LCIS were selected. We excluded cases with coexistent ductal carcinoma in situ (DCIS), invasive carcinoma, LN associated with necrosis, pleomorphic lobular carcinoma in situ (PLCIS) or lesions which would require excision in their own right (papilloma, radial scar, atypical ductal hyperplasia (ADH) or flat epithelial atypia (FEA)). Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded.

RESULTS

2878 consecutive CNB with a diagnosis of FA were identified. 25 cases had a diagnosis of concomitant ALH or classical LCIS. Our study cohort consisted of 21 women with a mean age 53 years (age range 41-70 years). The core biopsy diagnosis was of LCIS and FA in 16 cases and ALH and FA in 5 cases. On excision biopsy, a FA was confirmed in all 21 cases. In addition to the FA, residual LCIS was present in 14 cases with residual ALH in 2 cases. One of the twenty-one cases (4.8%) was upgraded to invasive ductal carcinoma on excision.

Hydrogels from amphiphilic star block copolypeptides

Star-shaped amphiphilic block copolymers form hydrogels as opposed to their linear counterparts.

Irish GP attitudes towards sickness certification and the 'fit note'

BACKGROUND

Sickness certification poses significant challenges to most general practitioners (GPs). As an alternative form of certification, in 2010, the UK implemented the 'fit note', which focuses on returning to work after illness. It has been well received in the UK but little is known of non-UK GP attitudes towards the fit note.

AIMS

To evaluate the challenges Irish GPs experience with the current sickness certification system and their attitudes towards the fit note.

METHODS

A questionnaire assessing attitudes, practices and preferences regarding the fit note was developed, piloted and posted to a representative sample of Irish GPs selected by systematic sampling. Descriptive statistics, chi-square tests and binary logistic regression were used to analyse the results.

RESULTS

Of 305 GPs surveyed, 64% (196) completed the survey. Ninety per cent (177) of responders reported a lack of available rehabilitation services for patients on sick leave and 66% (124) reported adverse effects of sickness certification on therapeutic relationships with patients. Those who indicated a preference for introducing the fit note (53%; 104) were significantly more likely to endorse both an excessive focus on disability [odds ratio (OR) = 3.16] and lack of GP training (OR = 2.04) in the sickness certification process.

CONCLUSIONS

Difficulties associated with sickness certification are apparent at GP-patient, GP-employer and GP-health service levels. Addressing these will require intervention at each of these levels and may be facilitated by challenging the assumption that illness equates to disability.

Novel mutation in insulin receptor gene identified after muscle biopsy in a Niuean woman with severe insulin resistance

BACKGROUND

Severe, early-onset insulin resistance in the absence of obesity, hepatic steatosis and dyslipidaemia is frequently attributable to a genetic defect affecting the insulin receptor. We describe a patient with severe insulin resistance in whom insulin receptor mutation analysis was mistakenly recorded as normal. Western blot analysis of skeletal muscle showed reduced insulin receptor protein and led to re-evaluation of the insulin receptor and the discovery of a novel mutation.

CASE REPORT

A Niuean women, first evaluated at age 6 years for severe acanthosis nigricans, hirsutism, poor growth and cognitive impairment, had extremely elevated fasting insulin levels of 10740 IU/l (fasting reference range 4-24 IU/l) and a normal glucose concentration (4.9 mmol/l). Diabetes was diagnosed at age 9 years and metformin treatment introduced. By age 14 years, she developed refractory hyperglycaemia despite metformin, rosiglitazone and 240 IU insulin daily. Insulin receptor genetic analysis was documented as normal. At age 23 years, with a blood glucose concentration of 37 mmol/l and an HbA1c concentration of 116 mmol/mol, U500 insulin 2000 IU/day was required for glycaemic control. She developed severe proliferative diabetic retinopathy with neovascular glaucoma leading to blindness. There was no renal dysfunction, dyslipidaemia or hepatic steatosis. A muscle biopsy was performed to evaluate the insulin signalling pathway and showed reduced insulin receptor protein. Sequencing of the insulin receptor showed a homozygous p.Val1010Leu missense mutation.

CONCLUSION

This patient illustrates the use of muscle biopsy in the evaluation of a patient with unexplained severe insulin resistance. This approach may usefully be applied to other cases of severe insulin resistance, where genetic testing for known mutations in the insulin signalling pathway has been negative.

Progression of diabetic retinopathy after bariatric surgery

AIM

To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes.

METHOD

We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics.

RESULTS

Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity.

CONCLUSIONS

A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.

Association between breastfeeding and body mass index at age 6-7 years in an international survey

BACKGROUND

Breastfeeding is believed to reduce children's risk for obesity but data are conflicting. It is also uncertain if breastfeeding has different effects on obesity in high- and low-income countries.

OBJECTIVES

This study aimed to investigate the association between having been breastfed and body mass index (BMI) in 6- to 7-year-old children in a large international survey.

METHODS

Parents/guardians reported whether their child had been breastfed and their current height and weight. Some centres measured height and weight directly. Analyses adjusted for whether height and weight were reported or measured, child's age, sex, country gross national income and centre.

RESULTS

Data were available for 76,635 participants from 31 centres in 18 countries. Reported breastfeeding rates varied from 27 to 98%. After adjusting for potential confounders, the estimated BMI difference was 0.04 kg m(-2) lower among those who had been breastfed (P = 0.07). The risk for being overweight or obese was slightly lower among breastfed children (odds ratio = 0.95, P = 0.012). There was no evidence that the association between breastfeeding and BMI was different in lower income countries compared with higher income countries.

CONCLUSIONS

The findings suggest that breastfeeding has little impact on children's BMI. Increasing breastfeeding is unlikely to reduce the global epidemic of childhood obesity.

Trace element inhibition of phytase activity

Nowadays, 70 % of global monogastric feeds contains an exogenous phytase. Phytase supplementation has enabled a more efficient utilisation of phytate phosphorous (P) and reduction of P pollution. Trace minerals, such as iron (Fe), zinc (Zn), copper (Cu) and manganese (Mn) are essential for maintaining health and immunity as well as being involved in animal growth, production and reproduction. Exogenous sources of phytase and trace elements are regularly supplemented to monogastric diets and usually combined in a premix. However, the possibility for negative interaction between individual components within the premix is high and is often overlooked. Therefore, this initial study focused on assessing the potential in vitro interaction between inorganic and organic chelated sources of Fe, Zn, Cu and Mn with three commercially available phytase preparations. Additionally, this study has investigated if the degree of enzyme inhibition was dependent of the type of chelated sources. A highly significant relationship between phytase inhibition, trace mineral type as well as mineral source and concentration, p < 0.001 was verified. The proteinate sources of OTMs were consistently and significantly less inhibitory than the majority of the other sources, p < 0.05. This was verified for Escherichia coli and Peniophora lycii phytases for Fe and Zn, as well as for Cu with E. coli and Aspergillus niger phytases. Different chelate trace mineral sources demonstrated diversifying abilities to inhibit exogenous phytase activity.

Recent results of medium wave infrared compressive sensing

The application of compressive sensing (CS) for imaging has been extensively investigated and the underlying mathematical principles are well understood. The theory of CS is motivated by the sparse nature of real-world signals and images, and provides a framework in which high-resolution information can be recovered from low-resolution measurements. This, in turn, enables hardware concepts that require much fewer detectors than a conventional sensor. For infrared imagers there is a significant potential impact on the cost and footprint of the sensor. When smaller focal plane arrays (FPAs) to obtain large images are allowed, large formats FPAs are unnecessary. From a hardware standpoint, this benefit is independent of the actual level of compression and effective data rate reduction, which depend on the choice of codes and information recovery algorithm. Toward this end, we used a CS testbed for mid-wave infrared (MWIR) to experimentally show that information at high spatial resolution can be successfully recovered from measurements made with a small FPA. We describe the highly parallel and scalable CS architecture of the testbed, and its implementation using a reflective spatial light modulator and a focal plane array with variable pixel sizes. We also discuss the impact of real-world devices and the effect of sensor calibration that must be addressed in practice. Finally, we present preliminary results of image reconstruction, which demonstrate the testbed operation. These results experimentally confirm that high-resolution spatial information (for tasks such as imaging and target detection) can be successfully recovered from low-resolution measurements. We also discuss the potential system-level benefits of CS for infrared imaging, and some of the challenges that must be addressed in future infrared CS imagers designs.

Plume moths of Malawi (Lepidoptera: Pterophoridae)

A review of Pterophoridae of Malawi is presented; 96 species from 35 genera and five subfamilies are recorded. Fourteen species are described as new: Agdistis nyasa Kovtunovich & Ustjuzhanin sp. nov., Platyptilia mugesse Kovtunovich & Ustjuzhanin sp. nov., Stenoptilia juniper Kovtunovich & Ustjuzhanin sp. nov., Sphenarches mulanje Kovtunovich & Ustjuzhanin sp.nov., Marasmarcha lamborni Kovtunovich & Ustjuzhanin sp. nov., Arcoptilia malawica Kovtunovich & Ustjuzhanin sp. nov., Apoxyptilus uzumarus Kovtunovich & Ustjuzhanin sp. nov., Gypsochares murphy Kovtunovich & Ustjuzhanin sp. nov., Crassuncus livingstoni Kovtunovich & Ustjuzhanin sp. nov., Hellinsia namizimu Kovtunovich & Ustjuzhanin sp. nov., Hellinsia сhewa Kovtunovich & Ustjuzhanin sp. nov., Picardia leza Kovtunovich & Ustjuzhanin sp. nov., Picardia raymondi Kovtunovich & Ustjuzhanin sp. nov., Picardia tumbuka Kovtunovich & Ustjuzhanin sp. nov. New synonymies are established for 10 species: Deuterocopus deltoptilus Meyrick, 1930 = Deuterocopus socotranus Rebel, 1907 syn. nov.; Deuterocopus henrioti Bigot & Boireau, 2006 = Deuterocopus socotranus Rebel, 1907 syn. nov.; Platyptilia periacta Meyrick, 1910 = Platyptilia farfarella Zeller, 1867 syn. nov.; Platyptilia claripicta Fletcher, 1910 = Platyptilia farfarella Zeller, 1867 syn. nov.; Platyptilia pygmaeana Strand, 1913 = Sphenarches anisodactylus (Walker, 1864) syn. nov.; Exelastis bergeri Bigot, 1969 = Exelastis crudipennis (Meyrick, 1932) syn. nov.; Prichotilus tanzanicus Gielis, 2011 = Prichotilus tara Ustjuzhanin and Kovtunovich, 2011 syn. nov.; Crassuncus chappuisi Gibeaux, 1994 = Crassuncus ecstaticus (Meyrick, 1932) syn. nov.; Paulianilus lolibai Arenberger, 2011 = Hellinsia madecasseus (Bigot, 1964) syn. nov.; Pterophorus purus Meyrick, 1913 = Crassuncus pacifica (Meyrick, 1911) syn. nov. New combinations are established for six species: Marasmarcha bengtssoni (Gielis, 2009) comb. nov.; Marasmarcha locharcha (Meyrick, 1924) comb. nov.; Marasmarcha rubriacuta (Gielis, 2009) comb. nov.; Procapperia insomnis (Townsend, 1956) comb. nov.; Crassuncus ecstaticus (Meyrick, 1932) comb. nov.; Crassuncus colubratus (Meyrick, 1909) comb. nov. For Stenoptilia viettei Gibeaux, 1994, Sphenarches bifurcatus Gielis, 2009, Crassuncus ecstaticus (Meyrick, 1932) images of the male genitalia are presented for the first time, for Marasmarcha bengtssoni (Gielis, 2009), and Stenodacma cognata Gielis, 2009 female genitalia are illustrated for the first time. Species of wide pantropical or cosmopolitan distribution are not reported as new for the fauna of Malawi.  However, 65 species of Pterophoridae are reported for the fauna of Malawi for the first time.  One of them, Stenoptilia viettei Gibeaux, 1994, described from Madagascar, is reported for continental Africa for the first time. 

Effect of direct neuroradiologist participation in physician marketing on imaging volumes in outpatient radiology

BACKGROUND AND PURPOSE

Over the past several years, decreased demand for and increased supply of imaging services has increased competition among outpatient imaging centers in the United States. This study hypothesizes that using a radiology sales representative and neuroradiologist as a team in marketing and sales will increase imaging referrals in outpatient imaging.

MATERIALS AND METHODS

From January to December 2009, baseline monthly physician referral data of CT and MR scans of 19 referring clinicians (neurologists, neurosurgeons, and anesthesiologists) to an outpatient radiology group were collected. During that time, a nonphysician radiology sales representative visited the referring clinicians' offices every 2 weeks. From January to June 2010, the same radiology sales representative visited the referring clinicians' offices every 2 weeks but was accompanied by a neuroradiologist once a month. From July 2010 to June 2011, the same radiology sales representative visited the referring clinicians' offices twice a month without a neuroradiologist.

RESULTS

Cross-sectional imaging referral volumes were approximately 2.5 times greater during the 6-month period using the neuroradiologist for direct physician-to-physician marketing when compared with the volumes achieved with the sales representative alone, and continued neuroradiologist involvement in marketing and sales is required to maintain referral volumes over time.

CONCLUSIONS

The impact on imaging referral volumes during the 6-month use of the neuroradiologist for direct physician-to-physician marketing in this study supports the assertion that neuroradiologist visits are an important element in establishing and maintaining a relationship with the referring clinician's office and thereby maximizing imaging referrals.

Lower glycemic fluctuations early after bariatric surgery partially explained by caloric restriction

BACKGROUND

We assessed the acute impact of laparoscopic Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) compared to caloric-matched control group without surgery on glucose excursion in obese patients with type 2 diabetes, and examined if this was mediated by changes in insulin resistance, early insulin response or glucagon-like peptide (GLP)-1 levels.

METHODS

Six-day subcutaneous continuous glucose monitoring (CGM) recordings were obtained from patients beginning 3 days before GBP (n = 11), SG (n = 10) or fasting in control group (n = 10). GLP-1, insulin and glucose were measured during 75 g oral glucose tolerance testing at the start and end of each CGM.

RESULTS

Post-operative hyperglycaemia occurred after both surgeries in the first 6 h, with a more rapid decline in glycaemia after GBP (p < 0.001). Beyond 24 h post-operatively, continuous overlapping of net glycaemia action reduced from baseline after GBP (median [interquartile range]) 1.6 [1.2-2.4] to 1.0 [0.7-1.3] and after SG 1.4 [0.9-1.8] to 0.7 [0.7-1.0]; p < 0.05), similar to controls (2.2 [1.7-2.5] to 1.3 [0.8-2.8] p < 0.05). Higher log GLP-1 increment post-oral glucose occurred after GBP (mean ± SE, 0.80 ± 0.12 vs. 0.37 ± 0.09, p < 0.05), but not after SG or control intervention. Among subgroup with baseline hyperglycaemia, a reduction in HOMA-IR followed GBP. Reduction in time and level of peak glucose and 2-h glucose occurred after both surgeries but not in controls.

CONCLUSIONS

GBP and SG have a similar acute impact on reducing glycaemia to caloric restriction; however, with a superior impact on glucose tolerance.

Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise

Background There is no defined set of criteria for diagnosing erosive lichen planus affecting the vulva (ELPV) and there is geographical variation in management.

Objectives To reach consensus on clinicopathological diagnostic criteria for ELPV.

Methods This was a three-stage international electronic-Delphi exercise with a subsequent formal feedback process. In the first two rounds participants were asked to rate the importance of a list of clinicopathological criteria. Responses from round 1 were summarized and presented in round 2, along with additional criteria suggested by participants. In round 3, participants were asked to rate the items that had reached consensus as ‘essential’ or ‘supportive’ features in diagnosing ELPV. Consensus was defined as being reached if 75% of participants agreed on the importance of an item.

Results A total of 73 experts representing dermatology, gynaecology, histopathology and genitourinary medicine participated; 69 (95%) completed all three rounds. Consensus was achieved for the following ‘supportive’ diagnostic criteria: (i) well-demarcated erosions/erythematous areas at the vaginal introitus; (ii) presence of a hyperkeratotic border to lesions and/or Wickham striae in surrounding skin; (iii) symptoms of pain/burning; (iv) scarring/loss of normal architecture; (v) presence of vaginal inflammation; (vi) involvement of other mucosal surfaces; (vii) presence of a well-defined inflammatory band involving the dermoepidermo junction; (viii) presence of an inflammatory band consisting predominantly of lymphocytes; and (ix) signs of basal layer degeneration. It was suggested that at least three supportive features should be present to make a diagnosis of ELPV, although this number is subject to further discussion.

Conclusions This study has identified a diagnostic dataset for ELPV that can be adopted into clinical practice and clinical trials.

An update to depression case management by practice nurses in primary care: a service evaluation

There is a recognized need to enhance non-pharmaceutical interventions in a way that is more accessible to the primary care population. Collaborative care has been shown to have a positive impact upon depression symptoms and a core element of the collaborative care approach is the case manager. This paper is a service evaluation of a collaborative care intervention that uses primary care nurses as the depression case manager and is a follow-up to the service audit carried out by Ekers and Wilson. The results support the notion that primary care nurses are ideally placed for delivering care to depressed patients; especially in cases were a patient also has a comorbid long-term medical condition. There is a recognized need to enhance non-pharmaceutical interventions for depression in the primary care. This service evaluation of collaborative care for depression by primary care practice nurses is an update of Ekers and Wilson (2008), reporting outcomes 5 years following initial training. From an initial 13 trained practice nurses, three provided anonymized data. Mean post-treatment Patient Health Questionnaire-9 (PHQ9) score was 8 [standard deviation (SD) 6.53, n = 185], indicating a mean positive change in depression symptom level of 8.9 [SD 7.01, 95% confidence interval (CI) 7.89-9.93, P < 0.001]. Subgroup analysis for patients identified with a comorbid long-term conditions (LTC) mean post-treatment PHQ9 score was 9 (SD 7.72, n = 33), indicating a mean positive change in depression symptom level of 8.1 (SD 5.79, 95% CI 6.04-10.41, P < 0.001). Nurses provided feedback on the intervention showing potential areas that would benefit from further detailed qualitative review. It was concluded that primary care practice nurses would be ideally placed to deliver collaborative care to depression patients with comorbid LTCs.

Antibiotic treatment during infancy and increased body mass index in boys: an international cross-sectional study

OBJECTIVE

To investigate whether antibiotic exposure during the first year of life is associated with increased childhood body mass index (BMI).

DESIGN

Secondary analysis from a multi-centre, multi-country, cross-sectional study (The International Study of Asthma and Allergies in Childhood Phase Three).

SUBJECTS

A total of 74 946 children from 31 centres in 18 countries contributed data on antibiotic use in the first 12 months of life and current BMI.

METHODS

Parents/guardians of children aged 5-8 years completed questionnaires that included questions about their children's current height and weight, and whether in the child's first 12 months of life, they had received any antibiotics, paracetamol, were breastfed or the mother/female guardian smoked cigarettes, and whether the child had wheezed in the past 12 months. A general linear mixed model was used to determine the association of antibiotic exposure with BMI, adjusting for age, sex, centre, BMI measurement type (self-reported or measured), maternal smoking, breastfeeding, paracetamol use, gross national income and current wheeze.

RESULTS

There was a significant interaction between sex and early-life antibiotic exposure. Early-life antibiotic exposure was associated with increased childhood BMI in boys (+0.107 kg m(-2), P<0.0001), but not in girls (-0.008 kg m(-2), P=0.75) after controlling for age, centre and BMI measurement type. The association remained in boys (+0.104 kg m(-2), P<0.0007), after adjustment for maternal smoking, breastfeeding, paracetamol use and current wheeze. There was no interaction between age, maternal smoking, breastfeeding, paracetamol use, gross national income and current wheeze in the association between early antibiotic exposure and BMI.

CONCLUSIONS

Exposure to antibiotics during the first 12 months of life is associated with a small increase in BMI in boys aged 5-8 years in this large international cross-sectional survey. By inference this provides additional support for the importance of gut microbiota in modulating the risk of obesity, with a sex-specific effect.

Changes in chemical composition and digestibility of three maize stover components digested by white-rot fungi

Maize stover (total stem and leaves) is not considered a ruminant feed of high nutritive value. Therefore, an improvement in its digestibility may increase the viability of total forage maize production systems in marginal growth regions. The objective of this study was to describe the changes in chemical composition during the storage of contrasting components of maize stover (leaf, upper stem and lower stem) treated with either of two lignin degrading white-rot fungi (WRF; Pleurotus ostreatus, Trametes versicolor). Three components of maize stover (leaf, upper stem and lower stem), harvested at a conventional maturity for silage production, were digested with either of two WRF for one of four digestion durations (1-4 months). Samples taken prior to fungal inoculation were used to benchmark the changes that occurred. The degradation of acid detergent lignin was observed in all sample types digested with P. ostreatus; however, the loss of digestible substrate in all samples inoculated with P. ostreatus was high, and therefore, P. ostreatus-digested samples had a lower dry matter digestibility than samples prior to inoculation. Similarly, T. veriscolor-digested leaf underwent a non-selective degradation of the rumen-digestible components of fibre. The changes in chemical composition of leaf, upper stem and lower stem digested with either P. ostreatus or T. veriscolor were not beneficial to the feed value of the forage, and incurred high DM losses.

Parkinson's disease: how is employment affected?

BACKGROUND

Rates of unemployment and early retirement are increased in Parkinson's disease (PD) and contribute to disease burden.

AIMS

To investigate time to loss of employment from PD onset and predictors of continued employment; to identify common issues and possible interventions in the workplace.

METHODS

Eighty-eight patients with PD diagnosed at age≤65 years took part in a retrospective cohort study. Veterans RAND Short Form-36 and an employment survey were administered.

RESULTS

Unemployment rates for males were increased compared to the general Irish population (standardized ratio of 1.6, 95% CI 1.2-2.2, P<0.05). There was no significant difference for females. Median retirement age was 58 years for males and 61 years for females compared to 63.5 and 65 years, respectively, in the general population. In survival analysis, median time to loss of employment was 7 years (95% CI 4.8-9.2). After 5 years, 40% remained working and 14% after 10 years. Early age of PD onset (P<0.001), early diagnosis (P<0.002) and high scores in vitality (P<0.005) were associated with prolonged employment. There was no association with sex, education, type or hours of work. Slowness, fatigue and tremor were the most challenging symptoms at work. Changes in work schedule and type of work were suggested helpful adjustments.

CONCLUSION

Loss of employment places a significant socioeconomic burden on young PD patients. More detailed examination of specific issues and reasonable adjustments is needed, along with patient and employer education.

Lungurra Ngoora--a pilot model of care for aged and disabled in a remote Aboriginal community--can it work?

INTRODUCTION

The literature on the health of and services for older Aboriginal and Torres Strait Islander populations is relatively sparse. This study explored the development and implementation of a locally designed community service model of care for older people, and people with disability and/or mental health problems in remote Aboriginal Australia.

METHODS

Based on extensive community consultation with older people, families, carers, community members and stakeholders, a model of care was developed to address unmet needs for the target population and their carers in the remote community of Looma, in the Kimberley region of Australia. The model was implemented and evaluated over 12 months. The main outcome measures included the number of services (including home services, meals, transport, respite, personal care and advocacy) provided. Outcomes of community participation, capacity building, resources, partnerships, workforce, service delivery and cultural protection were assessed qualitatively by an external evaluator.

RESULTS

The number of people receiving community care services in Looma increased from eight to 22, and services increased in all domains from 140 total services delivered for 1 month at baseline to 2356 by the final month of the program.

CONCLUSIONS

The Lungurra Ngoora community care service model pilot project demonstrated a successful collaborative service model that addressed the care needs of older persons, those with disability and mental illness, and their carers in this remote community. The developmental approach, and model structure, could serve as a template for future delivery of services in remote Aboriginal communities.

An electrospun polydioxanone patch for the localisation of biological therapies during tendon repair

Rotator cuff tendon pathology is thought to account for 30-70 % of all shoulder pain. For cases that have failed conservative treatment, surgical re-attachment of the tendon to the bone with a non-absorbable suture is a common option. However, the failure rate of these repairs is high, estimated at up to 75 %. Studies have shown that in late disease stages the tendon itself is extremely degenerate, with reduced cell numbers and poor matrix organisation. Thus, it has been suggested that adding biological factors such as platelet rich plasma (PRP) and mesenchymal stem cells could improve healing. However, the articular capsule of the glenohumeral joint and the subacromial bursa are large spaces, and injecting beneficial factors into these sites does not ensure localisation to the area of tendon damage. Thus, the aim of this study was to develop a biocompatible patch for improving the healing rates of rotator cuff repairs. The patch will create a confinement around the repair area and will be used to guide injections to the vicinity of the surgical repair. Here, we characterised and tested a preliminary prototype of the patch utilising in vitro tools and primary tendon-derived cells, showing exceptional biocompatibility despite rapid degradation, improved cell attachment and that cells could migrate across the patch towards a chemo-attractant. Finally, we showed the feasibility of detecting the patch using ultrasound and injecting liquid into the confinement ex vivo. There is a potential for using this scaffold in the surgical repair of interfaces such as the tendon insertion in the rotator cuff, in conjunction with beneficial factors.

Anal human papillomavirus infection in a street-based sample of drug using HIV-positive men

HIV facilitates an increase in human papillomavirus (HPV)-associated conditions. HIV-positive men living in a substance use context in Los Angeles, USA, were recruited using respondent-driven sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. A total of 316 evaluable men were enrolled in the study. The prevalence of any HPV, high-risk (HR) infection and multiple-type infection was highest for men who have sex with men (MSM) (93.9%, 64.6% and 29.7%, respectively). When any HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence, respectively, with similarly high rates maintained up to age 49 years. The individual's use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV detection. In this marginalized population, high prevalence rates of anal HPV and HR-HPV occurring over a wide age range may increase the individual's risk for anal dysplasia and anal cancer.

Improved neuropsychological and neurological functioning across three antiretroviral regimens in diverse resource-limited settings: AIDS Clinical Trials Group study a5199, the International Neurological Study

BACKGROUND

AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings.

METHODS

Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations.

RESULTS

The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P < .05) with the exception of semantic verbal fluency. No differences in neurological and neuropsychological functioning between treatment regimens were detected (P > .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01).

CONCLUSIONS

The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization -recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction.

CLINICAL TRIALS REGISTRATION

NCT00096824.