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The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.
A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.
Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.
Discussion and Conclusion:
These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.
Background: Spinal muscular atrophy (SMA) is a children’s neuromuscular disorder. Although motor neuron loss is a major feature of the disease, we have identified fatty acid abnormalities in SMA patients and in preclinical animal models, suggesting metabolic perturbation is also an important component of SMA. Methods: Biochemical, histological, proteomic, and high resolution respirometry were used. Results: SMA patients are more susceptible to dyslipidemia than the average population as determined by a standard lipid profile in a cohort of 72 pediatric patients. As well, we observed a non-alcoholic liver disease phenotype in apreclinical mouse model. Denervation alone was not sufficient to induce liver steatosis, as a mouse model of ALS, did not develop fatty liver. Hyperglucagonemia in Smn2B/-mice could explain the hepatic steatosis by increasing plasma substrate availability via glycogen depletion and peripheral lipolysis. Proteomic analysis identified mitochondrion and lipid metabolism as major clusters. Alterations in mitochondrial function were revealed by high-resolution respirometry. Finally, low-fat diets led to increased survival in Smn2B/-mice. Conclusions: These results provide strong evidence for lipid metabolism defects in SMA. Further investigation will be required to establish the primary mechanism of these alterations and understand how they lead to additional co-morbidities in SMA patients.
The disease caused by the influenza virus is a global public health problem due to its high rates of morbidity and mortality. Thus, analysis of the information generated by epidemiological surveillance systems has vital importance for health decision making. A retrospective analysis was performed using data generated by the four molecular diagnostic laboratories of the Mexican Social Security Institute between 2010 and 2016. Demographics, influenza positivity, seasonality, treatment choices and vaccination status analyses were performed for the vaccine according to its composition for each season. In all cases, both the different influenza subtypes and different age groups were considered separately. The circulation of A/H1N1pdm09 (48.7%), influenza A/H3N2 (21.1%), influenza B (12.6%), influenza A not subtyped (11%) and influenza A/H1N1 (6.6%) exhibited well-defined annual seasonality between November and March, and there were significant increases in the number of cases every 2 years. An inadequate use of oseltamivir was determined in 38% of cases, and the vaccination status in general varied between 12.1 and 18.5% depending on the season. Our results provide current information about influenza in Mexico and demonstrate the need to update both operational case definitions and medical practice guidelines to reduce the inappropriate use of antibiotics and antivirals.
The use of non-radioactive tracers for measuring certain clinically significant parameters by x-ray fluorescence analysis (XRFA) is well established at our institution (1,2). Among the technique's advantages are high accuracy, simplicity, cost effectiveness and reduced or eliminated radiation exposure to patients. One of the more versatile tracers is iodine, which has a low body toxicity and desirable chemical properties, e.g. it is easily bound to organic molecules. Other elements of interest are cesium (3), a potassium analogue of low toxicity; and xenon, the highest atomic number, stable, noble gas.
Objectives: Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact. Methods: Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis. Results: Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents’ executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were >0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25. Conclusions: A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237–248)
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
A raw clay from Uruguay was modified with aluminium to obtain an aluminium pillared clay (Al-PILC). The solids were characterized by scanning electron microscopy, X-ray diffraction and nitrogen adsorption-desorption isotherms. The Al-PILC retained the typical laminar structure of montmorillonite. The specific surface area and the microporous volume of the Al-PILC, 235 m2 g-1 and 0.096 cm3 g-1, respectively, were much higher than those of the clay. The phosphate adsorption capacity of the Al-PILC was higher than those of the clay. The phosphate adsorption kinetic followed the pseudo-first-order model for both, the clay and the Al-PILC, and the phosphate adsorption isotherm for the Al-PILC fit the Freundlich model.
Human papillomavirus (HPV) is a DNA virus linked to mucosal and cutaneous carcinogenesis. More than 200 different HPV types exist. We carried out a transversal study to investigate the prevalence of HPV types in two regions of Mexico. A total of 724 genital and non-genital samples from women (F) and men (M) were studied; 241 (33%) from North-Eastern (NE) and 483 (66%) from South-Central (SC) Mexico. The overall prevalence was 87%. In genital lesions from females, the NE group showed a prevalence of HPV types 16 (37%), 6 (13%), 59 (6%), 11, 18 and 66 (5.4% each); and the SC group showed types 6 (17%), 16 (15%), 11 (14.5%), 18 (12%) and 53 (6%). In the genital lesions from males, NE group showed types 16 (38%), 6 (21%), 11 (13%) and 59 plus 31 (7.5%) and the SC group showed types 6 (25%), 11 (22%), 18 (17%) and 16 (11.5%). When the two regions were compared, a higher prevalence of low-risk HPV 6 and 11 was found in the SC region and of high-risk HPV 59, 31 and 66 (the latter can also be present in benign lesions) in the NE region. Our findings complement efforts to understand HPV demographics as a prerequisite to guide and assess the impact of preventive interventions.
Palmer amaranth control has become a major challenge for multiple cropping systems across the southeastern and midwestern United States. Despite extensive research on herbicide-resistance evolution, little research has been done exploring how Palmer amaranth might also be evolving other adaptive traits in response to different selection forces present in agricultural fields and the enrichment of soils with nutrients such as nitrogen. The objective of the present study was to determine whether Palmer amaranth populations have evolved different morphology and growth patterns in response to glyphosate use and fertilization history. Ten Palmer amaranth populations, including glyphosate-resistant (GR) and glyphosate-susceptible (GS) populations, were collected from different cropping systems with histories of high and low nitrogen fertilization in the states of Florida and Georgia. All populations were grown in pots filled with soil fertilized with either 0 or 40 kgNha−1, and their response to nitrogen was compared for morphological, growth, and nutrient-use traits. Populations differed in how they modified their morphology and growth in response to N, with major differences in traits such as foliar area, branch production, leaf shape, and canopy architecture. Populations with high nitrogen-fertilization histories had higher (>43%) nutrient-use efficiency (NUE) than populations with low nitrogen-fertilization histories. Similarly, GR populations have evolved higher NUE (>47%) and changed canopy architecture more than GS populations in response to nitrogen fertilization. The results of the present study highlight the importance of paying more attention to adaptations to cultural practices that might increase weediness and how genetic changes in traits involved in morphology and metabolism might favor compensatory mechanisms increasing the fitness of the population carrying herbicide-resistant traits.
Two separate experiments were conducted in 2015 and 2016 in Citra, FL to investigate the effects of preplant application timing of 2,4-D and dicamba on sesame stand and yield. Nonlinear regression analysis was performed to determine the application timing that caused 10% stand or yield reduction (GR10) compared to the nontreated control (NTC) and expressed as d before planting (DBP; longer intervals indicate more injury). Likewise, regression analysis was used to determine sesame stand that resulted in 10% yield reduction (YR10) expressed as plants m−1 row. Stand measured 3 wk after planting (WAP) revealed 2,4-D applied at 0.53 kg ae ha−1 to be the least injurious treatment to sesame stand (GR10=6.4 DBP). Conversely, dicamba at 1.12 kg ha−1 produced a GR10 of 15.7 DBP for sesame stand at 3 WAP. 2,4-D applied at 0.53 and 1.06 kg ha−1 and dicamba applied at 0.56 kg ha−1 had the lowest GR10 for yield of 2, 3.7, and 3 DBP, respectively. Dicamba applied at 1.12 kg ha−1 proved to be the most injurious treatment to yield, which produced a GR10 value of 10.3 DBP. To simulate possible stand losses associated with dicamba or 2,4-D and the subsequent effect on yield, a separate experiment was conducted in which sesame was thinned to various plant densities and yield was recorded to determine the relationship between plant stand and seed yield. The regression analysis of these data was then compared to that of the experiment treated with 2,4-D and dicamba to separate any physiological effects of the herbicides that would lead to yield reduction from yield effects due to stand loss only. Rate constants were compared and no statistical differences were detected between herbicide and non-herbicide treatments, suggesting that yield reductions that occur from preplant applications of 2,4-D and dicamba were purely due to stand reductions.
Stemming from The Worldwide Donkey Breeds Project, an initiative aiming at connecting international researchers and entities working with the donkey species, molecularly tested pedigree analyses were carried out to study the genetic diversity, structure and historical evolution of the Andalusian donkey breed since the 1980s to infer a model to study the situation of international endangered donkey breeds under the remarkably frequent unknown genetical background status behind them. Demographic and genetic variability parameters were evaluated using ENDOG (v4.8). Pedigree completeness and generation length were quantified for the four gametic pathways. Despite mean inbreeding was low, highly inbred animals were present in the pedigree. Average coancestry, relatedness, and non-random mating degree trends were computed. The effective population size based on individual inbreeding rate was about half when based on individual coancestry rate. Nei’s distances and equivalent subpopulations number indicated differentiated farms in a highly structured population. Although genetic diversity loss since the founder generations could be considered small, intraherd breeding policies and the excessive contribution of few ancestors to the gene pool could lead to narrower pedigree bottlenecks. Long average generation intervals could be considered when reducing inbreeding. Wright’s fixation statistics indicated slight inbreeding between farms. Pedigree shallowness suggested applying new breeding strategies to reliably estimate descriptive parameters and control the negative effects of inbreeding, which could indeed, mean the key to preserve such valuable animal resources avoiding the extinction they potentially head towards, making the present model become an international referent when assessing endangered donkey populations.
Palmer amaranth’s ability to evolve resistance to different herbicides has been studied extensively, but there is little information about how this weed species might be evolving other life-history traits that could potentially make it more aggressive and difficult to control. We characterized growth and morphological variation among 10 Palmer amaranth populations collected in Florida and Georgia from fields with different cropping histories, ranging from continuous short-statured crops (vegetables and peanut) to tall crops (corn and cotton) and from intensive herbicide use history to organic production. Palmer amaranth populations differed in multiple traits such as fresh and dry weight, days to flowering, plant height, and leaf and canopy shape. Differences between populations for these traits ranged from 36% up to 87%. Although glyphosate-resistant (GR) populations collected from cropping systems including GR crops exhibited higher values of the aforementioned variables than glyphosate-susceptible (GS) populations, variation in traits was not explained by glyphosate resistance or distance between populations. Cropping system components such as crop rotation and crop canopy structure better explained the differences among populations. The higher growth of GR populations compared with GS populations was likely the result of multiple selection forces present in the cropping systems in which they grow rather than a pleiotropic effect of the glyphosate resistance trait. Results suggest that Palmer amaranth can evolve life-history traits increasing its growth and reproduction potential in cropping systems, which explains its rapid spread throughout the United States. Furthermore, our findings highlight the need to consider the evolutionary consequences of crop rotation structure and the use of more competitive crops, which might promote the selection of more aggressive biotypes in weed species with high genetic variability.
The concept of treating mass casualties in major disasters, particularly at or near airports, has gained considerable momentum in recent years (1). Major urban airports are almost without exception, plagued by access road traffic problems even under normal circumstances. Given a disaster within the confines of an airport, emergency equipment and medical support are found to be mired in a morass of sightseer and emergency service vehicles, compounding the congestion already present immeasurably (2).
Evolving from experiences gained over the past 30 years in handling masses of casualties resulting from aircraft disasters, we at Kennedy Airport have developed a Mobile Emergency Hospital which now serves as the “workshop” for stabilizing large numbers of injuries prior to subsequent transfer to definitive hospitals. The keys to this plan are the Trauma Team support used in conjunction with the mobile hospitals.
The ideal trauma team consists of 2 surgeons or trauma-trained physicians, one surgical nurse and one medical or 2 surgical technicians. These teams can be varied according to the immediate situation, time of day, available physicians, nurses and technicians. Anesthesiologists respond either individually or as members of some of the teams reporting directly to the operating units on arrival.
For an efficient response plan to function, previous liaison must be established primarily with teaching hospitals with a surgical staff that includes surgery and trauma residents. The Kennedy plan has a working arrangement with the New York Medical College and 8 of its affiliated major teaching hospitals in Manhattan, as well as in the main campus at Valhalla, which maintains an associated Burn Center.
At the John F. Kennedy International Airport in New York City, disaster planning has been an integral part of the airport operations for the past 28 years. Through the Medical Office, emergency medical teams have been recruited from all ranks of airport personnel and trained in rescue and resuscitation. Following the crash of a commercial B 727 aircraft in 1976 and the resulting crippling traffic jams in the vicinity of the airport, a new concept was added to the disaster plan. This concept involves bringing the hospital, its facilities and its personnel to the scene.
A new piece of equipment, known as a Mobile Emergency Hospital was designed from existing airport equipment, with the cooperation of the airlines, the operating authority of the airport, and other interested parties. Two such vehicles are now in constant readiness at the airport and together provide 12 monitored ICU beds, a 16-bed burn unit, 2 operating rooms and 72 other stretcher-beds to be used for the stabilization of critically ill patients prior to their transfer to an appropriate definitive care facility. A newer modularized version which incorporates these features, for use in any type disaster, is currently being developed. These mobile hospitals, together with two inflatable structures maintained at the airport, are supplemented by Mobile Emergency Rescue Vehicles (MERV vans) maintained at local hospitals by the Emergency Medical Service Systems (EMSS) of New York City. Together they provide the on-site Resuscitation and Stabilization Center in the event of a disaster.
What exactly comprises a “disaster?” The American College of Emergency Physicians has defined the term as “a sudden massive disproportion between hostile elements of any kind and survival resources that are available to counterbalance these hostile elements in the shortest period of time” (1).
In a small airport supporting a town of 10,000 an aircraft accident involving 4 or 5 casualties can constitute a disaster by this definition, whereas at Kennedy Airport (JKF) with its large depots of medical support, and where our experience in this area has been considerable, it would take many more casualties to qualify as a disaster. “Black Sunday” at Tenerife, with 500 casualties in a single incident (2), focused world attention on the need for more adequate casualty care of air crashes at airports, particularly at airports that handle wide-bodied jets. In our efforts to improve the methods of “bringing the hospital to the emergency rather than the emergency to the hospital,” the “workshop” at Kennedy Airport has evolved over the years from a cumbersome inflatable unit with limited mobility, to a Mobile Emergency Hospital with a capacity of 100 beds and an operating room (3).
In the past year, we have developed an even more practicable Mobile Emergency Hospital, the size of a standard cargo container, 40 feet long by 8 feet wide and 8 feet high with 4-wheel drive and self-propelled at 55 miles per hour, capable of being lifted by helicopter, flown in a Lockheed C130 or cargo 747, placed on a railroad flat-bed or transported as a container on the deck of a ship (4,5).
Investigating whether high-risk human papillomavirus (HR-HPV) types tend to become grouped in a particular way and whether factors are associated with such grouping is important for measuring the real impact of vaccination. In total, 219 women proving positive for HPV as detected by real-time PCR were included in the study. Each sample was analysed for detecting and quantifying six viral types and the hydroxymethylbilane synthase gene. Multiple correspondence analysis led to determining grouping patterns for six HR-HPV types and simultaneous association with multiple variables and whether viral load was related to the coexistence of other viral types. Two grouping profiles were identified: the first included HPV-16 and HPV-45 and the second profile was represented by HPV-31, HPV-33 and HPV-58. Variables such as origin, contraceptive method, births and pregnancies, educational level, healthcare affiliation regime, atypical squamous cells of undetermined significance and viral load were associated with these grouping profiles. Different socio-demographic characteristics were found when coinfection occurred by phylogenetically related HPV types and when coinfection was due to non-related types. Biological characteristics, the number of viral copies, temporality regarding acquiring infection and competition between viral types could influence the configuration of grouping patterns. Characteristics related to women and HPV, influence such interactions between coexisting HPV types reflecting the importance of their evaluation.
A latent tuberculosis infection (LTBI) prevalence survey was conducted using tuberculin skin test (TST) and Quantiferon test (QFT) in 1218 healthcare workers (HCWs) in Medellín, Colombia. In order to improve the prevalence estimates, a latent class model was built using a Bayesian approach with informative priors on the sensitivity and specificity of the TST. The proportion of concordant results (TST+,QFT+) was 41% and the discordant results contributed 27%. The marginal estimate of the prevalence P(LTBI+) was 62·1% [95% credible interval (CrI) 53·0–68·2]. The probability of LTBI+ given positive results for both tests was 99·6% (95% CrI 98·1–99·9). Sensitivity was 88·5 for TST and 74·3 for QFT, and specificity was 87·8 for TST and 97·6 for QFT. A high LTBI prevalence was found in HCWs with time-accumulated exposure in hospitals that lack control plans. In a context of intermediate tuberculosis (TB) incidence it is recommended to use only one test (either QFT or TST) in prevalence surveys or as pre-employment tests. Results will be useful to help implement TB infection control plans in hospitals where HCWs may be repeatedly exposed to unnoticed TB patients, and to inform the design of TB control policies.