Supporting conservationists' mental health through better working conditions

Biodiversity conservation work can be challenging but rewarding, and both aspects have potential consequences for conservationists' mental health. Yet, little is known about patterns of mental health among conservationists and its associated workplace protective and risk factors. A better understanding might help improve working conditions, supporting conservationists' job satisfaction, productivity, and engagement, while reducing costs from staff turnover, absenteeism, and presenteeism. We surveyed 2311 conservation professionals working in 122 countries through an internet survey shared via mailing lists, social media, and other channels. We asked them about experiences of psychological distress, working conditions, and personal characteristics. Over half were from and worked in Europe and North America, and most had a university-level education, were in desk-based academic and practitioner roles, and responded in English. Heavy workload, job demands, and organizational instability were linked to higher distress, but job stability and satisfaction with one's contributions to conservation were associated with lower distress. Respondents with low dispositional and conservation-specific optimism, poor physical health, and limited social support, women, and early-career professionals were most at risk of distress in our sample. Our results flag important risk factors that employers could consider, although further research is needed among groups underrepresented in our sample. Drawing on evidence-based occupational health interventions, we suggest measures that could promote better working conditions and thus may improve conservationists' mental health and abilities to protect nature.

Patient Reported Financial Distress and its Association with Quality of Life and Symptom Burden in Cancer Patients Reporting to a Public Facility in LMIC

PURPOSE/OBJECTIVE(S)

Financial distress (FD) associates with worse quality of life (QoL) and there is paucity of literature from low middle income setting (LMIC). We investigated the prevalence & impact of subjective FD on QoL & symptom burden in advanced cancer patients, reporting to a public facility.

MATERIALS/METHODS

Patients aged ≥18yrs with a diagnosis of cancer within 3months and without prior treatment were accrued. Subjective FD was assessed by EORTC QLQ-C30 and symptoms were assessed by ESAS-R at baseline and 3 months. Patients were classified as experiencing FD if they answered ≥2 on a Likert scale question (1-4 points) asking about FD and dichotomized as Grp 1: No FD and Grp 2: FD. Mean change in score was calculated by subtracting the baseline from the 3-month score for each subscale, minimal important difference (MID) was defined using an anchor of ≥ 10-point compared to baseline for Global Qol and compared between groups. We used Mann Whitney, independent sample t test and Fisher's exact test for determining the association between FD and QoL and symptom burden. A p-value < 0.05 was considered statistically significant.

RESULTS

Of the 100 patients participating in the study, 69% reported subjective financial distress at baseline, 10% had insurance coverage, 27% used distressed financing (borrowing :21%; sold off assets:6%) and debt accumulation was seen in 34% patients. Cost reduction strategies were adopted by 98% patients. Mean Global Health (GH), physical (PF), emotional function (EF) was significantly worse at all time-points in FD patients. Physical (pain, tiredness) and psychological symptom scores (anxiety, depression) were significantly higher at all time points for FD patients. Mean change score for subscales of QoL and symptom burden was not significantly different between groups from baseline to 3 months (Table1).MID for deterioration of Global Qol was Grp 1 vs 2; 21.1% vs 32.7%, p = 0.504.

CONCLUSION

Two-thirds of patients have FD at presentation and report worse quality of life and symptom burden at all time-points. Presence of FD is not associated with significant change in QoL scores or symptom burden over 3 months. Measures are warranted to screen and reduce FD.

A Dilp8-dependent time window ensures tissue size adjustment in Drosophila

The control of organ size mainly relies on precise autonomous growth programs. However, organ development is subject to random variations, called developmental noise, best revealed by the fluctuating asymmetry observed between bilateral organs. The developmental mechanisms ensuring bilateral symmetry in organ size are mostly unknown. In Drosophila, null mutations for the relaxin-like hormone Dilp8 increase wing fluctuating asymmetry, suggesting that Dilp8 plays a role in buffering developmental noise. Here we show that size adjustment of the wing primordia involves a peak of dilp8 expression that takes place sharply at the end of juvenile growth. Wing size adjustment relies on a cross-organ communication involving the epidermis as the source of Dilp8. We identify ecdysone signaling as both the trigger for epidermal dilp8 expression and its downstream target in the wing primordia, thereby establishing reciprocal hormonal feedback as a systemic mechanism, which controls organ size and bilateral symmetry in a narrow developmental time window.

Mechanisms ensuring developmental precision are poorly understood. Here Blanco-Obregon et al. report reciprocal feedback between Dilp8 and Ecdysone, two hormones required during a precise time window of Drosophila development for organ size adjustment.

216 Open Versus Minimally Invasive Surgery (MIS) Transforaminal Lumbar Interbody Fusion (TLIF): A Single-Centre Experience

Introduction

Transforaminal Lumbar Interbody Fusion (TLIF) is a technique used for the management of various pathologies such as degenerative disc disease, recurrent disc herniations and spondylolisthesis, to mention the most common indications. There is an ongoing debate regarding the use of open versus minimally invasive techniques for TLIF. Each has its own advantages and disadvantages. In the present study, we aim to present our experience regarding the use of open vs MIS TLIF at Stepping Hill Hospital in Manchester.

Method

A retrospective observational cohort study involving 60 patients was conducted at Stepping Hill Hospital in the UK. Patients who had TLIF surgery between 2019 and 2020 were included. Patients were consecutively allocated to either the open TLIF or the MIS TLIF group. Data were collected from hospital records including pre- and post-operative follow up notes. We also assessed pain score using the visual analogue scale.

Results

26 patients underwent MIS TLIF whereas 34 patients underwent an open procedure. The MIS group showed better outcomes compared to the open group in terms of post-operative complications, improvement of symptoms and the average hospital stay: 7.6% vs 8.8%, 73.7% vs 58.8% and 1.82 vs 2.76 days, however, the open group had a lower rate of metalwork failure 8.8% vs 11.5% in the MIS.

Conclusions

Our study showed that MIS TLIF at our unit seems to result in better outcomes related to symptoms alleviation, post-operative complications and less hospital stay despite having a slightly higher rate of metalwork failure.

Resistant Cytomegalovirus Infection in Solid-organ Transplantation: Single-center Experience, Literature Review of Risk Factors, and Proposed Preventive Strategies

BACKGROUND

Cytomegalovirus (CMV) infection causes morbidity and mortality in solid-organ transplant recipients. Drug-resistant CMV is an emerging problem with poor survival outcomes and limited therapeutic options. In this study we comprehensively address the issue of drug resistance in CMV when compared with standard therapies, such as ganciclovir (GCV) and foscarnet.

METHODS

We conducted a retrospective review of adult patients diagnosed with CMV after solid-organ transplant at our center between 2013 and 2017, and identified 7 resistant CMV cases. To study risk factors in the published literature, we performed an extensive database search.

RESULTS

All patients had documented UL97 mutations, and 3 patients harbored both UL97 and UL54 mutations. For cases with increasing viral load or failure to achieve clinical improvement despite optimal therapy, genetic resistance testing was carried out. Patients received GCV and foscarnet combination therapy. As an adjunct, CMV immunoglobulin, cidofovir, and leflunomide were added. Risk factors, including donor⁺/recipient^- serostatus, persistent high viral replication, prolonged therapeutic GCV exposure (>2.5 months), and allograft rejection, were assessed.

CONCLUSION

Patients at risk, especially those with D⁺/R^- serostatus, should be judiciously monitored for resistance. Prolonged intravenous GCV exposure increases the risk for development of drug resistance. Therefore, precise guidelines are required for prevention of long-term GCV/VGCV exposure. Investigation regarding interferon-gamma release assay and adoptive transfer of T cells in diagnosed CMV patients is warranted to improve future prophylactic and management strategies against CMV, with a potential to reduce the requirement for available toxic antiviral drugs.

Evolution of Family Medicine in Kenya (1990s to date): a case study

Background: Successful Family Medicine practices and academic programmes are found in western countries, Australia, Singapore, Cuba and among other non-western countries. Documenting the enablers and challenges of different contexts would, it is hoped, inform current and future process of developing academic and practice programmes in Family Medicine in countries where the discipline is starting. Methods: A qualitative study was undertaken that conducted a focused literature review and in-depth interviews of key informants on the early development of the Family Medicine in Kenya. All interviews were audio recorded. Pattern matching, explanation building, time-series analysis and logic models were used in analysis. Results: Representatives of Kenyan and foreign organisations worked well as a team to write and implement the first curriculum of Family Medicine. The challenges include lack of teachers; starting a graduate programme in medical schools that did not have one and starting these health services delivery departments in a system that did not have any. Conclusions: The main enablers of the evolution of Family Medicine in Kenya include committed partnerships and teamwork among Kenyan and non-Kenyan stakeholders. The challenges include the lack of Kenyan teachers of the programme and the introduction of a new discipline. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: /10.1080/20786190.2016.12481420

The database of the PREDICTS (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems) project

The PREDICTS project-Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)-has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity.

Retargeted adenoviruses for radiation-guided gene delivery

The combination of radiation with radiosensitizing gene delivery or oncolytic viruses promises to provide an advantage that could improve the therapeutic results for glioblastoma. X-rays can induce significant molecular changes in cancer cells. We isolated the GIRLRG peptide that binds to radiation-inducible 78 kDa glucose-regulated protein (GRP78), which is overexpressed on the plasma membranes of irradiated cancer cells and tumor-associated microvascular endothelial cells. The goal of our study was to improve tumor-specific adenovirus-mediated gene delivery by selectively targeting the adenovirus binding to this radiation-inducible protein. We employed an adenoviral fiber replacement approach to conduct a study of the targeting utility of GRP78-binding peptide. We have developed fiber-modified adenoviruses encoding the GRP78-binding peptide inserted into the fiber-fibritin. We have evaluated the reporter gene expression of fiber-modified adenoviruses in vitro using a panel of glioma cells and a human D54MG tumor xenograft model. The obtained results demonstrated that employment of the GRP78-binding peptide resulted in increased gene expression in irradiated tumors following infection with fiber-modified adenoviruses, compared with untreated tumor cells. These studies demonstrate the feasibility of adenoviral retargeting using the GRP78-binding peptide that selectively recognizes tumor cells responding to radiation treatment.

Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System

Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from "offers" to completed transplants. Offers were divided into individual segments called 1-way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty-one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The "offer" and 1-way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year.

The PREDICTS database: a global database of how local terrestrial biodiversity responds to human impacts

Biodiversity continues to decline in the face of increasing anthropogenic pressures such as habitat destruction, exploitation, pollution and introduction of alien species. Existing global databases of species’ threat status or population time series are dominated by charismatic species. The collation of datasets with broad taxonomic and biogeographic extents, and that support computation of a range of biodiversity indicators, is necessary to enable better understanding of historical declines and to project – and avert – future declines. We describe and assess a new database of more than 1.6 million samples from 78 countries representing over 28,000 species, collated from existing spatial comparisons of local-scale biodiversity exposed to different intensities and types of anthropogenic pressures, from terrestrial sites around the world. The database contains measurements taken in 208 (of 814) ecoregions, 13 (of 14) biomes, 25 (of 35) biodiversity hotspots and 16 (of 17) megadiverse countries. The database contains more than 1% of the total number of all species described, and more than 1% of the described species within many taxonomic groups – including flowering plants, gymnosperms, birds, mammals, reptiles, amphibians, beetles, lepidopterans and hymenopterans. The dataset, which is still being added to, is therefore already considerably larger and more representative than those used by previous quantitative models of biodiversity trends and responses. The database is being assembled as part of the PREDICTS project (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems – http://www.predicts.org.uk). We make site-level summary data available alongside this article. The full database will be publicly available in 2015.

Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India

Background:

Hepatitis is an inflammatory disease of the liver. In sever cases, it may lead to permanent liver damage including liver cirrhosis or hepato-cellular carcinoma and may ultimately lead to death. Health-care workers (HCWs), due to their regular contact with patients are at a high-risk of acquiring this disease.

Aim:

The aim of this study was to assess the knowledge and attitude toward hepatitis B and C infection among the health-care interns and correlate the level of awareness to the attitude they behold toward the disease.

Subjects and Methods:

A closed ended questionnaire consisting of questions to evaluate the knowledge regarding hepatitis B and C infection and attitude of the (HCWs/interns) was duly filled by 255 participants including, 100 dental, 100 medical, and 55 nursing interns. Statistical analysis was carried out using the Chi-square test, ANOVA test, post-hoc test and Pearson's correlation.

Results:

Although most of the interns were aware of the existence of hepatitis B and C infection, the level of awareness regarding the modes of transmission and vaccination was found to be dissatisfactory. Awareness level regarding the infection among nursing interns was statistically significantly lower than the dental and medical interns. A direct positive correlation as found between awareness score and behavior score, which reveals that interns with better awareness level had better attitudes toward the infection and prevention of its transmission.

Conclusion:

There is an urgent need to increase the level and quality of training among HCWs to prevent the spread of hepatitis B virus and hepatitis C virus.

Using macrophage activation to augment immunotherapy of established tumours

Background:

Successful immunotherapy will require alteration of the tumour microenvironment and/or decreased immune suppression. Tumour-associated macrophages (TAMs) are one major factor affecting tumour microenvironment. We hypothesised that altering TAM phenotype would augment the efficacy of immunotherapy.

Methods:

We and others have reported that 5,6-Dimethylxanthenone-4-acetic-acid (DMXAA, Vadimezan) has the ability to change TAM phenotypes, inducing a tumour microenvironment conducive to antitumour immune responses. We therefore combined DMXAA with active immunotherapies, and evaluated anti-tumour efficacy, immune cell phenotypes (flow cytometry), and tumour microenvironment (RT–PCR).

Results:

In several different murine models of immunotherapy for lung cancer, DMXAA-induced macrophage activation significantly augmented the therapeutic effects of immunotherapy. By increasing influx of neutrophils and anti-tumour (M1) macrophages to the tumour, DMXAA altered myeloid cell phenotypes, thus changing the intratumoural M2/non-M2 TAM immunoinhibitory ratio. It also altered the tumour microenvironment to be more pro-inflammatory. Modulating macrophages during immunotherapy resulted in increased numbers, activity, and antigen-specificity of intratumoural CD8⁺ T cells. Macrophage depletion reduced the effect of combining immunotherapy with macrophage activation, supporting the importance of TAMs in the combined effect.

Conclusion:

Modulating intratumoural macrophages dramatically augmented the effect of immunotherapy. Our observations suggest that addition of agents that activate TAMs to immunotherapy should be considered in future trials.

From bathymetry to bioshields: a review of post-tsunami ecological research in India and its implications for policy

More than half a decade has passed since the December 26th 2004 tsunami hit the Indian coast leaving a trail of ecological, economic and human destruction in its wake. We reviewed the coastal ecological research carried out in India in the light of the tsunami. In addition, we also briefly reviewed the ecological research in other tsunami affected countries in Asia namely Sri Lanka, Indonesia, Thailand and Maldives in order to provide a broader perspective of ecological research after tsunami. A basic search in ISI Web of Knowledge using keywords "tsunami" and "India" resulted in 127 peer reviewed journal articles, of which 39 articles were pertaining to ecological sciences. In comparison, Sri Lanka, Indonesia, Thailand and Maldives had, respectively, eight, four, 21 and two articles pertaining to ecology. In India, bioshields received the major share of scientific interest (14 out of 39) while only one study (each) was dedicated to corals, seagrasses, seaweeds and meiofauna, pointing to the paucity of research attention dedicated to these critical ecosystems. We noted that very few interdisciplinary studies looked at linkages between pure/applied sciences and the social sciences in India. In addition, there appears to be little correlation between the limited research that was done and its influence on policy in India. This review points to gap areas in ecological research in India and highlights the lessons learnt from research in other tsunami-affected countries. It also provides guidance on the links between science and policy that are required for effective coastal zone management.

Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics

We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection.In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 +/- 6.53 and 9.83 +/- 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 +/- 11.26 and 15.20 +/- 10.21V (P < 0.02), ankle brachial ratio was 1.05 +/- 0.19 and 1.14 +/- 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively.In the diabetic and the control group, VPT was 15.62 +/- 10.39 and 8.36 +/- 3.61 V (P < 0.01), ankle brachial ratio was 1.14 +/- 0.18 and 1.15 +/- 0.12, and the questionnaire scores were 57% and 40.3%, respectively.In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes.

Results of letrozole in postmenopausal women after tamoxifen treatment for advanced breast cancer

AIM

To analyze overall and progression-free survival after letrozole in postmenopausal women with advanced breast cancer who failed after tamoxifen therapy.

MATERIALS AND METHODS

This is a retrospective analysis of 95 patients with breast cancer who were postmenopausal and had failed after tamoxifen therapy. Dose of letrozole was 2.5 mg daily until disease progressed. Patients had estrogen receptor- and/or progesterone receptor-positive tumors or both receptors were unknown. One complete course of (6 cycles) chemotherapy for metastatic disease was allowed. The primary end point was time to progression (TTP). Secondary end points included overall objective response rate (ORR), its duration, time to treatment failure (TTF), overall survival and tolerability.

RESULTS

Median TTP was 10 months. ORR was 21% with complete response rate of 9%. Nine patients died of disease during treatment. Median overall survival was 36 months. Median time to response was three months and median duration of response was 13 months. Time to chemotherapy was 13.5 months and TTF was 9.3 months. Treatment failure was seen in 76% of patients. Disease progression was the main cause for treatment failure. Treatment was well-tolerated by all patients.

CONCLUSION

This retrospective analysis shows that letrozole is quite effective as second line therapy in postmenopausal patients with advanced breast cancer who had failed after tamoxifen therapy.

Natural M-segment reassortment in Potosi and Main Drain viruses: implications for the evolution of orthobunyaviruses

Recently, we identified Batai virus as the M-segment reassortment partner of Ngari virus. Extension of genetic analyses to other orthobunyaviruses related to the Bunyamwera serogroup indicates additional natural genome reassortments. Whereas the relative phylogenetic positions of all three genome segment sequences were similar for Northway and Kairi viruses, the relative positions of Potosi and Main Drain virus M-segment sequences diverged from those of their S- and L-segments. Our findings indicate M-segment reassortment in Potosi and Main Drain viruses and demonstrate natural genome reassortment as a driving force in the evolution of viruses of the Bunyamwera serogroup.

Pyrazinamide induced hyperuricaemia presenting as severe bilateral leg cramps

Pyrazinamide is one of the first line drugs used for the treatment of tuberculosis. Hepatotoxicity and hyperuricaemia are important and common untoward effects seen after administration of pyrazinamide. The drug inhibits elimination of urates resulting in hyperuricaemia, the presenting features of which are arthralgia, arthritis or even gout. A-case of bilateral leg cramps due to hyperuricaemia following pyrazinamide therapy is reported here.

Flexible intramedullary nailing of displaced diaphyseal forearm fractures in children

INTRODUCTION

This study analyses the results of 50 displaced diaphyseal forearm fractures in children treated with flexible intramedullary nailing.

METHODS

Between 1999 and 2002 we treated 50 children aged between 5 and 15 years, with diaphyseal fractures of the forearm using Flexible intramedullary nailing (FIN). Both bones were fractures in 45 patients, radius only in 4 and ulna only in 1. The indications for fixation were instability (26), re-displacement (20), and open fractures (4).

RESULTS

24 patients were reduced closed, followed by nailing, while 26 fractures required open reduction of either one bone(16 cases) or both bones(10 cases) prior to nailing. Bony union of all fractures was achieved by an average of 7 weeks (range 6 weeks to 4 months) with one delayed union. Pronation was restricted by an average of 20 degrees in 9 patients. Two patients developed post operative compartment syndrome requiring fasciotomy. Three patients were lost to follow-up.

INTERPRETATION

FIN led to early bony union with acceptable bony alignment in all 47 patients available at final follow-up. We therefore recommend FIN for the treatment of unstable diaphyseal forearm fractures in children.

Utilisation of redundant time on trauma list for carpal tunnel decompression

This audit reviewed the trauma theatre time utilisation during April 2000 to March 2001. Instead of a scheduled 8 30 am start, first patient was on the table by only 9 40 am because of various reasons. To use this redundant time carpal tunnel release was started under local anaesthesia, as first case. On re-auditing, it was found that the patient for carpal tunnel release was on the table at 8 44 am. The first trauma case was on the table at 9 46 am. This simple idea has helped in the performing of an additional case every day with a delay to the trauma list of only six minutes (p<0.05).