Synchronous recording of magnetocardiographic and electrocardiographic signals

We present a system for simultaneous recording of the electrocardiogram and the magnetocardiogram. The measurement system contained of printed carbon electrodes and SERF magnetometer. The use of this system confirms that the position of the end of the magnetic T wave extends further than the electric T wave, which is an important indicator for the diagnosis of cardiological patients and for drug arrhythmogenicity. We analyze this phenomenon in depth, and demonstrate, that it originates from the fundamental difference between electric and magnetic measurements. The measured value is always bipolar since the electric measurements require two electrodes. We demonstrate how the dual electric and magnetic measuring system adds a new information to the commonly used electrocardiographic diagnosis. The ECG should be interpreted as the spatial asymmetry of the electric cardiac potential, and not as the potential itself. The results seem to prove, that the relation between the magnetic and the electric imaging of neural activities may be broadly applied for the benefit of medical diagnosis in cardiology and many other fields, where the neural activity is measured. This is a pilot study which requires further confirmation at the clinical level.

Identification of Salivary Metabolic Signatures Associated with Primary Sjögren's Disease

Sjögren's disease (SjD) is the second most prevalent autoimmune disorder that involves chronic inflammation of exocrine glands. Correct diagnosis of primary SjD (pSjD) can span over many years since disease symptoms manifest only in advanced stages of salivary and lachrymal glandular destruction, and consensus diagnostic methods have critical sensitivity and selectivity limitations. Using nuclear magnetic resonance (NMR) spectroscopy, we determined the composition of metabolites in unstimulated saliva samples from 30 pSjD subjects and 30 participants who do not have Sjögren's disease (non-Sjögren's control group, NS-C). Thirty-four metabolites were quantified in each sample, and analysis was conducted on both non-normalized (concentration) and normalized metabolomics data from all study participants (ages 23-78) and on an age-restricted subset of the data (ages 30-70) while applying false discovery rate correction in determining data significance. The normalized data of saliva samples from all study participants, and of the age-restricted subset, indicated significant increases in the levels of glucose, glycerol, taurine, and lactate, as well as significant decreases in the levels of 5-aminopentanoate, acetate, butyrate and propionate, in subjects with pSjD compared to subjects in the NS-C group. Additionally, a significant increase in choline was found only in the age-restricted subset, and a significant decrease in fucose was found only in the whole study population in normalized data of saliva samples from the pSjD group compared to the NS-C group. Metabolite concentration data of saliva samples from all study participants, but not from the age-restricted subset, indicated significant increases in the levels of glucose, glycerol, taurine, and lactate in subjects with pSjD compared to controls. The study showed that NMR metabolomics can be implemented in defining salivary metabolic signatures that are associated with disease status, and can contribute to differential analysis between subjects with pSjD and those who are not affected with this disease, in the clinic.

Indoor grown cannabis yield increased proportionally with light intensity, but ultraviolet radiation did not affect yield or cannabinoid content

Cannabis (Cannabis sativa) flourishes under high light intensities (LI); making it an expensive commodity to grow in controlled environments, despite its high market value. It is commonly believed that cannabis secondary metabolite levels may be enhanced both by increasing LI and exposure to ultraviolet radiation (UV). However, the sparse scientific evidence is insufficient to guide cultivators for optimizing their lighting protocols. We explored the effects of LI and UV exposure on yield and secondary metabolite composition of a high Δ⁹-tetrahydrocannabinol (THC) cannabis cultivar 'Meridian'. Plants were grown under short day conditions for 45 days under average canopy photosynthetic photon flux densities (PPFD, 400-700 nm) of 600, 800, and 1,000 μmol m^-2 s^-1, provided by light emitting diodes (LEDs). Plants exposed to UV had PPFD of 600 μmol m^-2 s^-1 plus either (1) UVA; 50 μmol m^-2 s^-1 of UVA (315-400 nm) from 385 nm peak LEDs from 06:30 to 18:30 HR for 45 days or (2) UVA + UVB; a photon flux ratio of ≈1:1 of UVA and UVB (280-315 nm) from a fluorescent source at a photon flux density of 3.0 μmol m^-2 s^-1, provided daily from 13:30 to 18:30 HR during the last 20 days of the trial. All aboveground biomass metrics were 1.3-1.5 times higher in the highest vs. lowest PPFD treatments, except inflorescence dry weight - the most economically relevant parameter - which was 1.6 times higher. Plants in the highest vs. lowest PPFD treatment also allocated relatively more biomass to inflorescence tissues with a 7% higher harvest index. There were no UV treatment effects on aboveground biomass metrics. There were also no intensity or UV treatment effects on inflorescence cannabinoid concentrations. Sugar leaves (i.e., small leaves associated with inflorescences) of plants in the UVA + UVB treatment had ≈30% higher THC concentrations; however, UV did not have any effect on the total THC in thesefoliar tissues. Overall, high PPFD levels can substantially increase cannabis yield, but we found no commercially relevant benefits of adding UV to indoor cannabis production.

Associations between diet quality and chronic health conditions (CHCs) in adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study (SJLIFE)

12095

Background: Survivors of childhood cancer are at increased risk for early development of CHCs, including metabolic syndrome (MetS), low bone mineral density (LBMD), and gastrointestinal (GI) disease. Dietary modification is often recommended for prevention and/or treatment of these CHCs in non-cancer populations. However, associations between diet quality and severity of CHCs in adult survivors of childhood cancer are not well known. Methods: Adult survivors (≥10 years post-diagnosis) of childhood cancer who completed a clinical evaluation and Block Food Frequency Questionnaire were included. Diet quality was estimated using the Mediterranean diet score (aMED), with scores ranging from 0 to 9 (increased scores represent higher adherence to diet). CHCs were graded (modified CTCAE) and classified as “low” (grade ≤1 for LBMD and GI; grade ≤2 for MetS) or “high” (grade 2-4 for LBMD and GI; grade 3-4 for MetS). A multivariable linear regression model was used to estimate the mean aMED score by “low” or “high” disease category, with adjustment for age at evaluation, sex, race, education, total energy intake, adjusted BMI, physical activity, smoking, and alcohol consumption. Results: 2,822 survivors of childhood cancer (52.4% male, 83.1% non-Hispanic white) were included. The most prevalent diagnosis was acute lymphoblastic leukemia (34.1%). Time from primary diagnosis was 24.2±8.5 years and age at recruitment was 32.5±8.7 years. Lower adherence to aMED diet was associated with “high” MetS and LBMD, but not GI disease. See the Table for aMED multivariate-adjusted diet quality scores by CHC. Conclusions: In this cross-sectional analysis, MetS and LBMD were associated with poor adherence to the aMED diet. Although longitudinal investigation of associations between diet quality and CHCs in survivors of childhood cancer are needed to determine causal association between diet quality and CHCs in childhood cancer survivors, dietary interventions in early or late cancer survivors may help prevent development or progression of specific treatment related chronic conditions. [Table: see text]

Complex contraception provision during the COVID-19 pandemic, how did sexual health services fare?

Background

This study evaluated whether sexual health services (SHS) across the UK could meet the Faculty of Sexual and Reproductive Health (FSRH) standard for access by being able to offer an appointment for a long-acting reversible contraception (LARC) fitting within 2 weeks of initial contact.

Methods

SHSs offering LARCs were identified using the British Association for Sexual Health and HIV (BASHH) clinic database. During October 2020, all clinics open for more than 1 day a week were contacted by telephone. The researcher posed as a 20-year-old woman in a regular heterosexual relationship who was using condoms and requesting a contraceptive implant. Data collected included the time to wait to appointment and whether clinics offered bridging methods of contraception during any delay in appointment. It was also noted whether a local COVID-19 restriction was in place at the time of the call. The information collected was coded, and data was analysed using chi-square tests in SPSSv27.

Results

Of the 218 contactable clinics, 51.4% (n = 112) of clinics offered the patient an appointment within two weeks, and 66.1% (n = 144) of clinics could offer appointments within four weeks. 7.3% (n = 16) of clinics offered the patient adjunct bridging oral contraception until the time of appointment. Comparing the devolved nations, 11/17 (64.7%) clinics in Scotland, 8/13 (61.5%) clinics in Wales, 0/4 (0.0%) clinics in Northern Ireland and 93/182 (51.1%) clinics in England offered an appointment within two weeks with significant regional variation across England (p = .005). No statistically significant difference was demonstrated in access between clinics with or without high-level COVID-19 restrictions (p = .056).

Conclusion

The 2-week standard was met in just over half of the occasions, with significant variation across regions across the UK. The development of a national target for access may improve access to LARCs.

Evaluating the effects of social interaction on the results of preference assessments for leisure items

A variable that may influence the outcomes of stimulus preference assessments (SPAs) is whether social interaction is provided during the stimulus access period. In Experiment 1, we compared the outcomes of a Solitary paired stimulus preference assessment (PSPA) (toys only), Social PSPA (toys plus social interaction), and Combined PSPA (toys alone and toys plus social interaction) to determine whether the addition of social interaction influenced preference for toys in preschool children. In Experiment 2, we conducted a concurrent-operant reinforcer assessment to compare the reinforcing efficacy of stimuli with and without social interaction. Experiment 1 showed preference for toys was stable across assessments (Solitary and Social PSPAs) and most participants preferred toys plus social interaction when compared in a single assessment (Combined PSPA). Experiment 2 showed that results of the Combined PSPA in Experiment 1 predicted the outcome of most participants' reinforcer assessments.

Telephone-triage services do not lead to an increased wait time for assessment of gonorrhoea in symptomatic patients

In Spring 2017, Southampton and Portsmouth Sexual Health Services (SHSs) replaced an overstretched walk-in service with a telephone-triage service: patients calling that were symptomatic, vulnerable or at high risk of having an STI were invited into a clinic, whereas others were signposted to remote self-sample NHS postal testing services. This study aimed to establish whether patient care was disadvantaged by the introduction of the triage service. Electronic patient notes for all patients attending for treatment of gonorrhoea for two years before and for two years after the service change were interrogated; the site of infection and duration of symptoms before testing were compared. Of all patients attending for treatment of gonorrhoea in the study period, 499 patients (39% of cases) were symptomatic at testing: 364 had urethral symptoms, 45 had rectal symptoms and 18 had pharyngeal symptoms. 72.4% of patients with urethral symptoms were seen after the introduction of the triage system. Median wait times for patients with urethral symptoms rose from 6 (IQR = 3–7) to 7 (IQR = 3.75–14) days – although this increase was not statistically significant (p = 0.064). There was not a statistically significant difference between the rectal symptom groups (p = 0.422) and too few patients attended with pharyngeal symptoms to warrant analysis. Despite some outliers, the telephone-triage service did not increase wait times for patients attending STI services with symptomatic gonorrhoea and may have inadvertently increased access to services for those most at risk.

Does online sexually transmitted infection screening compromise care? A service evaluation comparing the management of chlamydial infection diagnosed online and in clinic

Patient demand on sexual health services in the United Kingdom is so high that many services have introduced online screening to accommodate more patients. There are concerns that these services may not be accessible to all. This service evaluation was undertaken to determine whether online screening is accessible by those patients most at need by comparing the demographics and number of asymptomatic chlamydial infections detected online and in clinic. No difference was found in the age nor level of deprivation, demonstrating that online services are an accessible way to screen for sexually transmitted infections without overburdening established services.

The Short-Term Effects of Prunes in Preventing Inflammation and Improving Indices of Bone Health in Osteopenic Men

Objectives

Osteoporosis is a public health concern for both women and men. Chronic inflammation contributes to bone loss; therefore, foods rich in antioxidants, such as prunes, are of great interest. Previously, dietary intervention with prunes has been shown to prevent orchidectomy-induced decreases in BMD, microstructure, and biomechanics in male rats; however, there is a need for this to be studied in a clinical setting in adult males.

Methods

Thirty-five men between the ages of 55 and 80 with moderate bone loss were included. The men were randomized into one of three groups: 100 g prunes daily, 50 g prunes daily, or control group. All three groups also consumed a multivitamin containing 450 mg calcium and 800 IU vitamin D. Serum samples from the baseline and three-month time points were analyzed for biomarkers of bone turnover, inflammation, and oxidative stress.

Results

After three months, daily consumption of 100 g prunes was associated with a significant decrease in serum concentrations of osteocalcin (P < 0.001). Consumption of 50 g of prunes was associated with significant decreases in systolic blood pressure, and serum osteocalcin concentrations (P = 0.040), and an increase in the OPG: RANKL ratio (P = 0.041). There were also significant decreases in systolic blood pressure, OPG (P = 0.004), RANKL (P = 0.010), and osteocalcin (P = 0.049) in control group. There was a significant group*time effect for changes in OPG (P = 0.019) and the OPG: RANKL ratio (P = 0.029).

Conclusions

Decreases in osteocalcin indicate a decrease in bone turnover, and a higher OPG: RANKL ratio indicates that more RANKL is bound to OPG, and not to osteoclasts, thus downregulating osteoclast activity. Therefore, regular consumption of either 100 g or 50 g dried plum for three months may make some contributions to bone formation and bone turnover activity, and minimal contribution to decreasing inflammation and improving bone density and quality.

Funding Sources

USDA/NIFA, California Prune Board, and Shaklee.

Alterations in Gut Health, Bone and Inflammatory Biomarkers, and Blood Flow After Three Months of Prune Consumption

Objectives

Inflammation has been shown to play a role in a variety of disease states including osteoporosis and cardiovascular disease. Leaky gut has been implicated in contributing to these inflammatory states. The purpose of this study was to determine the effect of daily prune consumption on inflammatory markers, bone density, and cardiovascular health in an osteopenic male population.

Methods

Twenty-eight healthy men between the ages of 55 and 80, whose lumbar spine bone mineral density (BMD) t-score was between −1.0 and −2.5 were randomized to 0, 50, or 100 g of prunes and 450 mg calcium and 800 IU vitamin D daily for three-months. Participants kept daily logs for the assessment of compliance. DXA scan, blood, anthropometrics, blood pressure (BP), BMD, mean arterial pressure (MAP), and resting blood flow (BF) were collected at baseline and at three months. Serum and plasma samples were subjected to ELISA for the assessment of inflammatory markers including C-reactive protein (CRP), tumor necrosis factor- alpha (TNF-α), and interluekin-6 (IL-6). Bone turnover markers included osteoprotegerin (OPG) and the receptor activator of nuclear factor kappa-Β ligand (RANKL). Gut health was assessed by the measurement of serum lipopolysaccharide binding protein (LBS) and zonulin. Blood flow was assessed via strain-gauge plethysmography.

Results

All participants were compliant with the daily supplements. Mean baseline total bone mass was 3004 ± 472 g. Pre- and post-treatment data were analyzed (mean ± SD, pre vs post) for body weight (85.7 ± 13.4 vs 84.6 ± 12.9), waist to hip ratio (0.96 ± 0.063 vs 0.97 ± 0.014), resting blood flow (3.07 ± 1.25 vs. 3.92 ± 1.10), and mean arterial pressure (92.7 ± 10.0 vs 91.1 ± 9.5), all at P > 0.05.

Conclusions

While statistical comparisons did not reveal any significant changes in this preliminary data set with the addition of prunes to the diet, additional parameters of inflammation, bone density and turnover, and gut health are currently being evaluated.

Funding Sources

California Dried Plum Board.

Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts

We report the use of a sacral plexus catheter for continuous local anaesthetic infusion in a patient with a unilateral sacral ala fracture following a fall from a horse. Although sacral plexus blockade has been well described for lower limb surgery, an ultrasound-guided continuous catheter technique for conservatively managed fractures has not been described. Despite appropriate oral analgesia, the patient reported severe pain, particularly in the right gluteal region, which meant she was unable to sit upright or take deep breaths. A sacral plexus catheter was inserted with ultrasound guidance and an initial bolus of 30 ml levobupivicaine 0.25% was delivered followed by infusion of 8 ml.h^-1 levobupivicaine 0.125%. Daily follow-up and assessment were provided by the acute pain team. We judged the procedure to be a success as measured by an improvement in mobilisation, deep breathing, cough and patient satisfaction.

Dietary Protein Intake Associations with Insulin Resistance, BMI, Body Composition and Other Metabolic Markers in Subjects with Prediabetes and Type 2 Diabetes Mellitus (P08-020-19)

Objectives

The incidence of prediabetes and type 2 diabetes mellitus (T2DM) continues to increase and many individuals are not aware of having early stages of the disease until symptoms develop. Much focus has been on carbohydrate consumption for this population, with no established recommendations for protein intake and source. Therefore, the objective of this study was to examine the relationship between protein intake (amount and source) on glycemic control, and indices of cardiovascular health in individuals with prediabetes and T2DM.

Methods

Sixty-two overweight and obese men and women with prediabetes or T2DM, between the ages of 45–75 years participated in this study. Participants were stratified based on their protein intake: below (<0.8 g/kg body weight (bw); n = 17), meeting (0.8–1.0 g/kg bw; n = 22), and above (≥1.0 g/kg bw; n = 23) recommended levels. Measurements included blood biomarkers (lipid panel and glycemic control), anthropometric parameters, food records, and body composition, which were assessed for each group using one-way ANOVA and Pearson correlation coefficient for overall associations. Significance was accepted at (P ≤ 0.05).

Results

Body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in participants who consumed below recommended levels compared to above (35.1 ± 1.3 vs. 28.3 ± 0.9 kg/m2; 118.7 ± 3.2 vs. 105.2 ± 1.8 cm; 109.1 ± 2. vs. 96.8 ± 2.5 cm, respectively). Fat-to-lean mass (FM/LM) ratio was significantly lower in participants who consumed above recommended when compared to below and recommended levels (0.63 ± 0.03; 0.81 ± 0.04; 0.78 ± 0.07). Insulin resistance tended to be lower (3.53 ± 0.55 vs 5.19 ± 0.94; P = 0.09) in the above recommended group compared to below. Higher animal-to-plant protein ratios were significantly associated with higher insulin secretion (r = 0.259). Higher animal protein was associated with significantly lower triglyceride concentrations (r = 0.263).

Conclusions

These findings suggest that consumption of ≥1.0 g/kg bw protein was associated with lowered insulin resistance, in addition to lower BMI, HC, WC, and FM, without adverse effects on lipid profiles in this population. Additionally, increased animal protein may be associated with better outcomes for this population.

Funding Sources

There are no funding sources to disclose for this study.

Insight into Bone Protective Mechanisms of Dried Plum Using an Ovariectomized Rat Model (OR18-06-19)

Objectives

Osteoporosis may result in fracture with dire consequences. For instance, 40% of people with their second hip fracture die within two years. Aside from pharmaceutical interventions, that are not free of side effects, identifying edible and safe foods to prevent bone loss is of importance. We and others have shown that dried plum (DP) prevents loss of bone both in ovariectomized (Ovx) rat models as well as postmenopausal women. Hence, the purpose of this study was to examine the bone protective mechanism of action of DP, a rich source of phenolic and flavonoid compounds, in preventing bone loss using a rat model of ovarian hormone deficiency.

Methods

Forty-eight 90-day old female Sprague-Dawley rats were divided into four groups: sham-operated (Sham), Ovx, Ovx + 5% DP (low-dose, LD), and Ovx + 25% DP (high-dose, HD). Treatments started immediately after surgery and continued for 45 days. Animals were either fed a semi-purified diet, or a similar diet in which 5% or 25% of the diet (w/w) consisted of DP. All diets were made isocaloric and isonitrogenous containing 0.4% calcium and 0.3% phosphorus. Food intake, bone mineral density, bone mineral content, body/organ weight, blood biomarkers of bone metabolism, and static bone histomorphometry were assessed.

Results

The right femoral and the 4th lumbar vertebrae density were significantly (P < 0.05) lower in the Ovx control rats compared to Sham. The loss of density in both bones were completely prevented by HD-DP (P < 0.05). The HD-DP increased insulin-like growth factor-1 (IGF-1) significantly (P < 0.05) from 110 ± 4 ηmol/L to 135 ± 4 ηmol/L. In terms of bone histomorphometry, % bone area was significantly (P < 0.05) decreased as a result of Ovx and HD-DP nearly prevented this decrease (P > 0.05). Although the endosteal perimeter (mm2) was not statistically different from other groups, the endosteal perimeter of the HD-DP group was 13.6% lower than that of the Ovx group.

Conclusions

The bone protective effects of DP may, in part, be explained by an increase in IGF-1, which is strongly correlated with bone formation, and a decrease in the endosteal perimeter, which is increased in ovarian hormone deficiency and postmenopausal women. Future studies should examine radiolabeling compounds in DP to see how they contribute to its bone protective effects.

Funding Sources

There have been no funding sources.

Fat Intake Associations with Metabolic Profile and Body Composition in Subjects with Prediabetes and Type 2 Diabetes (P08-029-19)

Objectives

Prevalence of prediabetes and type 2 diabetes is increasing in the United States, and can result in other disease states, such as heart disease and obesity. Fat consumption has become more common, due to new dietary recommendations as well as the rise in popularity of high fat diets. It is therefore of interest to analyze the associations of the prediabetic and type 2 diabetic state with regard to fat consumption as well as metabolic biomarkers and anthropometrics to draw possible connections between dietary patterns and physiological responses to them.

Methods

The biomarkers (lipid panel and glycemic control), anthropometric data, body composition (dual energy x-ray absorptiometry) and food records of 62 prediabetic or type 2 diabetic participants were obtained. Correlations from the aforementioned variables were assessed using Pearson correlation coefficient in SPSS. Significance was accepted at P ≤ 0.05.

Results

Low density lipoprotein (LDL) cholesterol was negatively associated with polyunsaturated fat consumption (r2 = –0.258, P < 0.05). Additionally, total fat (r2 = –0.300, P < 0.05) and trans fatty acid (r2 = –0.258, P < 0.05) intake was negatively associated with arm lean mass. High density lipoprotein (HDL) was negatively associated with arm (r2 = –0.305, P < 0.05) and leg lean mass (r2 = –0.360, P < 0.01), as well as android (r2 = –0.343, P < 0.01), gynoid (r2 =–0.353, P < 0.01), and total lean mass (r2 = –0.353, P < 0.01). Total fat and specific fat intake were not significantly associated with other metabolic biomarkers.

Conclusions

Fat has become less demonized as high fat diets have become more popular and as nutritional recommendations have changed, but in the absence of ketosis it may not be as beneficial for diabetic and prediabetic populations. Interestingly, fat intake was not negatively or positively associated with any biomarkers, except for the case of polyunsaturated fat intake, which was associated with lower LDL levels. Surprisingly HDL levels were associated with decreased levels of lean mass. Future interventional studies are needed to further examine the effects of fat intake, including amount and sources, in this population.

Funding Sources

N/A.

The Short-Term Effect of Dried Plums on Inflammation and Indices of Bone Health in Osteopenic Men (P01-027-19)

Objectives

Osteoporosis has significant public health importance for both women and men, where 54% of the U.S. population age 50 and older have low bone mineral density (BMD). Chronic inflammation alters bone remodeling, which is one contributor to bone loss; therefore, foods rich in antioxidants, such as dried plums (DP, Prunus domestica L.), are of great interest for preventing chronic inflammation. Previously, dietary intervention with DP has been shown to prevent orichidectomy-induced decreases in BMD, microstructure, and biomechanics in male rats; however, this has yet to be studied in a clinical setting in adult males.

Methods

One-hundred and sixty osteopenic men are being recruited from the greater Tallahassee, Florida area to examine the effects of DP on BMD, bone biomarkers, and inflammation after one year of regular consumption. The present analysis is of a subset of this population, documenting the effects of two doses of DP on biomarkers of inflammation and bone metabolism in men after three months of consumption. Twenty-seven men between the ages of 55 and 80 with moderate bone loss (T-score between −0.1 and −2.5 SD below the mean) were included. The men were randomized into one of three groups: 100 g DP, 50 g DP, or control group, with all three groups given a multivitamin containing 450 mg calcium and 800 IU vitamin D (Shaklee Corporation). Serum samples from the baseline and three-month time points were analyzed for C-reactive protein (CRP) and bone-specific alkaline phosphatase (BAP). DXA scans of the lumbar vertebrae alongside TBS iNnsight® software were used to generate trabecular bone score (TBS).

Results

Three months of DP consumption was associated with numerical increases in BAP in both the 100 g (6.5%, P = 0.14) and 50 g (6.3%, P = 0.3) DP groups, numerical decreases in CRP in both the 100 g (−8.8%, P = 0.75) and 50 g (−8.5%, P = 0.71) DP groups, and minimal change in TBS in both the 100 g (0.37%, P = 0.71) and 50 g (−0.55%, P = 0.44) DP groups.

Conclusions

Regular consumption of either 100 g or 50 g DP for three months may contribute to increases in bone formation and decreases in inflammation, however not to an extent that affects bone quality. Three months of consumption may not be long enough to manifest changes in bone; therefore, further analysis of data after six months and one year of DP consumption in a larger number of men is warranted.

Funding Sources

USDA-NIFA, Shaklee Corporation, California Dried Plum Board.

2017 European guidelines for the management of genital herpes

Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

What impact has tendering had on trainees? Results of a national survey by British Association for Sexual Health and HIV Trainees' Collaborative for audit, research and quality improvement projects

In April 2013, local authorities gained responsibility for commissioning sexual health services in England. With many services going out to tender and resultant change in services or service provider, there is anecdotal evidence that this has impacted on the education, training and morale of genitourinary medicine (GUM) trainees. The aim of this study was to evaluate the impact of tendering on GUM trainees. An electronic survey designed by the British Association for Sexual Health and HIV Trainees' Collaborative for Audit, Research and Quality Improvement Projects (T-CARQ) was distributed to GUM trainees and newly appointed consultants. Eighty-two individuals responded (74% GUM trainees, 25% newly appointed consultants, 1% locum appointed for service). Sixty-three per cent (45/72) had experience of training within a service which was being tendered. Of these, 59% (24/41) felt their training was not considered during the tendering process and 20% (8/41) felt that it was. Forty-four per cent (18/41) felt adequately supported. Thirty per cent (12/40) reported active participation in the tendering process. On a scale of 0 (no impact) to 5 (major impact), the median score for impact of tendering on training was 2. The positive/negative impact of tendering on different training elements was rated: other than management experience the overall impact on all parameters was negative, namely morale, senior support and education. In conclusion, this survey describes the variable impact of service tendering on GUM training. Our recommendations for maintaining training standards despite tendering include actively involving trainees and education partners, inclusion of specialist GUM training in service specifications, development of guidance for commissioners and services for the management of GUM training within tendering.

Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey

STUDY DESIGN

This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards.

METHODS

In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic 'patients' contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression analyses. In March 2015, a convenience sample (one in four) of clinics was visited by researchers with the same clinical symptoms. Ability to achieve a same-day consultation and waiting time were assessed.

RESULTS

In 2015, 90.8% of clinics offered symptomatic 'patients' an appointment within 48 hours when contacted by telephone, compared with 95.5% in 2014 (aOR=0.46 (0.26 to 0.83); p<0.01). The decline was greatest in women (96.0% to 90.1%; p<0.05), and clinics in England (96.2% to 90.7%; p<0.01). For asymptomatic patients, the proportion offered an appointment within 48 hours increased from 50.7% in 2014 to 74.5% in 2015 (aOR=3.06 (2.23 to 4.22); p<0.001), and in both men (58.2% to 90.8%; p<0.001) and women (49.0% to 59.6%; p<0.01). In adjusted analysis, asymptomatic women were significantly less likely to be offered an appointment than asymptomatic men (aOR=0.33 (0.23 to 0.45); p value<0.001). 95% of clinics were able to see symptomatic patients attending in person.

CONCLUSIONS

Access to GUM services has worsened for those with symptoms suggestive of an acute STI and is significantly poorer for asymptomatic women. This evidence may support the reintroduction of process targets.

EARLY CAREER NURSES AND MIDWIVES NEED JOBS

One of the many important roles the ANMF undertakes, as the national professional and industrial organisation for nurses and midwives in Australia, is monitoring and promoting employment opportunities for early career nurses and midwives (previously referred to as graduates).

SAFETY AND SECURITY IS EVERYONE'S BUSINESS

Workplace safety and security should be a given but as we all know this is not always the case.

Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial

Purpose

Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC.

Methods

Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat.

Results

Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032).

Conclusion

MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity.

NURSE PRACTITIONERS -- THE ANSWER FOR AGED CARE

The nurse practitioner role is now well established in Australia, with these nurses driving clinical leadership and innovation, across a diversity of care settings. The aged care sector, however, was slower than other areas to create positions for nurse practitioners.

Omega-3 fatty acids modulate neonatal cytokine response to endotoxin

Neonatal immune response is characterized by an uncompensated pro-inflammatory response that can lead to inflammation-related morbidity and increased susceptibility to infection. We investigated the effects of long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) docosahexaenoic acid (DHA) or eicosapentaenoic acid (EPA) pre-treatment on cytokine secretion to low-concentration endotoxin (lipopolysaccharide, LPS) in THP-1 monocytes and neonatal cord blood (CB) from healthy full-term infants. Pre-treatment of THP-1 cells, with either n-3 PUFA at 25 or 100 μM significantly reduced IL-6, IL-10, and IL-12 secretion while DHA, but not EPA, reduced TNF-α response to LPS. DHA inhibition was stronger compared to EPA and effective at the low concentration. The same concentrations of n-3 PUFAs inhibited IL-12 but not IL-10 cytokine response in whole CB from 9 infants pre-treated for 24 h. To assess clinical relevance for acute response to LPS, the effects of low-concentration DHA at 25 μM or 12.5 μM were assessed before and after LPS exposure of isolated CB mononuclear cells from 20 infants for 1 h. When added before or after LPS, physiologic DHA treatment produced significant concentration-dependent inhibition of TNF-α, IL-6, IL-1β, and IL-8 secretion. The results demonstrate prophylactic and therapeutic modulation of neonatal cytokine response to LPS and provide proof-of-concept that low-concentration administration of n-3 PUFA could attenuate or resolve neonatal inflammatory response.

WE MAKE A DIFFERENCE

Back in 2009 Julianne used this column to raise the issue of the importance of language 'in the way we describe ourselves as nurses and midwives, what it is that we do and what that means to both ourselves and others'. Her assertion was that when attempting to define nursing or midwifery, or the role of a nurse or a midwife, the definition never seems to adequately address all that a nurse or midwife is, or does. We are not 'just a nurse' or 'just a midwife'.

Excipients in Oral Antihistamines Can Perpetuate Allergic Contact Dermatitis

Propylene glycol is a well-documented causative agent of allergic contact dermatitis (ACD). It is also reported to cause systemic dermatitis after ingestion of foods or medicines containing it and after intravenous injection of a medicine with propylene glycol in its base. We describe two adolescents with sensitivity to propylene glycol confirmed by patch testing whose dermatitis improved dramatically after cessation of oral antihistamines containing propylene glycol. We report these cases to alert providers to the potential for worsening of ACD due to systemic exposure to propylene glycol in patients with a cutaneous sensitivity to the allergen.

2014 UK national guideline for the management of anogenital herpes

These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline.