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While US patent law remains agnostic regarding morality issues, in Europe the patentability of processes for modifying the germline genetic identity of human beings is prohibited on moral grounds. The question is whether this provision will soon be open to interpretation as CRISPR, a new gene editing tool, means pressure may come to rethink the contour of legal concepts in light of beneficial applications. The chapter argues for banning patents claiming processes modifying the germline genetic identity of human on the basis of social justice considerations. I argue in particular that germline modification techniques will be too costly for public health systems to afford. Other technologies such as PGD give future parents the possibility to choose healthy embryos, and the preference for a genetically-related child will be dismissed if the modification is too expensive, as public health systems face difficult resource-allocation dilemmas. It will be unacceptable to allow patents if the inventions will only benefit well-to-do classes and create a system of competition between private clinics for costly therapies and services, including potentially off-label use of relevant technologies. The piece concludes with alternative possibilities for funding innovation as solutions to the problems described in the chapter.
The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.
To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.
A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.
Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.
The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.
Cystoisospora belli is a coccidian parasite of humans, with a direct fecal–oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.
Every research study that includes volunteer participants requires safety assurances in proportion to the risks of the study. Investigator-initiated clinical research can present unique regulatory challenges particularly for studies with a risk profile that warrants more oversight than minimal risk but less than for large, commercial, or high-risk research. The use of an independent safety officer (ISO) offers a middle way of right-sizing oversight to match the risk. ISOs are clinicians or researchers with relevant expertise who are independent of the investigator and the research study. Their relationship to the study is defined by a formal charter which is aligned with the protocol and Data and Safety Monitoring Plan to address the oversight process, responsibilities of the ISO, and clearly describe the variables to be monitored. The ISO responsibilities include reviewing safety data, adverse events, recruitment, demographics, study progress, data quality, protocol changes, and any new scientific information that pertains to the trial. Finally, the ISO reports in their review on any significant findings may propose modifications to the study or a need to stop the trial.
Human subcutaneous dirofilariosis has several clinical presentations. Many cases present as subcutaneous nodules, as a consequence of a local inflammatory reaction that encapsulates and destroys the worms. In addition, there are cases in which migrating worms located in the ocular area remain unencapsulated. In the present work, the levels of two pro-inflammatory eicosanoids, thromboxane B2 (TxB2) and leukotriene B4 (LTB4) are analysed by commercial Enzime-Linked immunosorbent assay (ELISA) in serum samples from 43 individuals, 28 diagnosed as having subcutaneous dirofilariasis presenting a subcutaneous nodule, five diagnosed as having dirofilariasis, in which the worms remained unencapsulated in the periphery of the eye, and ten healthy individuals living in a non-endemic area, used as controls. The worms were surgically removed, identifying Dirofilaria repens as the causative agent in all cases, by Polymerase Chain Reaction (PCR). Individuals with nodules showed significantly higher levels of TxB2 and LTB4 than healthy controls, whereas significant differences in LTB4 levels were observed between individuals with unencapsulated worms and healthy controls. It is speculated that the absence of LTB4 may contribute to the fact that worms remain unencapsulated as a part of immune evasion mechanisms.
There is no suitable vaccine against human visceral leishmaniasis (VL) and available drugs are toxic and/or present high cost. In this context, diagnostic tools should be improved for clinical management and epidemiological evaluation of disease. However, the variable sensitivity and/or specificity of the used antigens are limitations, showing the necessity to identify new molecules to be tested in a more sensitive and specific serology. In the present study, an immunoproteomics approach was performed in Leishmania infantum promastigotes and amastigotes employing sera samples from VL patients. Aiming to avoid undesired cross-reactivity in the serological assays, sera from Chagas disease patients and healthy subjects living in the endemic region of disease were also used in immunoblottings. The most reactive spots for VL samples were selected, and 29 and 21 proteins were identified in the promastigote and amastigote extracts, respectively. Two of them, endonuclease III and GTP-binding protein, were cloned, expressed, purified and tested in ELISA experiments against a large serological panel, and results showed high sensitivity and specificity values for the diagnosis of disease. In conclusion, the identified proteins could be considered in future studies as candidate antigens for the serodiagnosis of human VL.
Road traffic injuries are the leading cause of death among young people. Recognition of the contribution of impulsive behaviour may help novice drivers to behave more safely. Previously a brief intervention focusing on impulsive traffic behaviour conducted by psychologists in driving schools had been effective. The aim of this study was an independent re-evaluation of the effect of the intervention, as conducted by driving school teachers, and assessment of the potential associations with candidate genotypes.
Driving school students (mean age 22.5, SD=7.9) were divided into intervention (n=704) and control (n=737) groups. Driving school teachers were trained to administer the intervention which consisted of a lecture and group work (1.5 h in total) on impulsivity. Traffic offences and crashes were monitored during 3 years, using police and traffic insurance fund databases. Functional polymorphisms of the dopamine transporter (DAT) and serotonin transporter genes (DAT1 VNTR and 5-HTTLPR) were assessed.
The intervention significantly lowered general traffic risk and prevalence of traffic accidents. DAT1 VNTR 9R carriers, particularly males, had higher general traffic risk in the whole sample. Female 5-HTTLPR s’ allele carriers of the intervention group had the lowest general traffic risk. Intervention was most effective in female DAT1 VNTR 10R/10R homozygotes.
Brief impulsivity-centred intervention appears as a promising strategy for preventing risk-taking behaviour in novice drivers and can be fully integrated to driving school curriculum.
There is a paucity of information on hookworm species in humans, domestic animals and wildlife in southern Africa. Our study aimed to identify hookworm species from stray dogs, humans, and selected wildlife from South Africa. A total of 356 faecal samples were screened for the presence of hookworm-like eggs and subsequently coproculture from the positive samples was carried out to obtain larvae. Hookworm-like eggs were detected in 23.03% (82/356) of samples. Of these samples, 78/296 were from dogs, 3/50 from humans and 1/10 from wildlife. DNA was then isolated from the larvae of 55 positive samples, which were subjected to polymerase chain reaction (PCR), polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing of the nuclear ribosomal internal transcribed spacer (ITS1) and 5.8S rRNA region. Presence of Ancylostoma caninum, A. braziliense and A. ceylanicum-like species was recorded in stray dogs and A. caninum was recorded in wildlife and humans, using PCR-RFLP. Although PCR-RFLP results pointed to the presence of A. ceylanicum, we did not get a sequence that matched with A. ceylanicum from GenBank. This may have been due to the low proportion of A. ceylanicum larvae in our samples. Twenty-two of the 27 positive amplicons from stray dogs matched with A. caninum, three with A. braziliense and two had mixed infections of A. braziliense and A. caninum. Sequences from a lion and three humans matched with A. caninum. This is the first confirmation of a patent A. caninum infection in humans as evidenced by the presence of eggs in faeces, with the subsequent larvae from coproculture being identified as A. caninum.
Objectives: This report examined theta-band neurodynamics for potential biomarkers of brain health in athletes with concussion. Methods: Participants included college-age contact/collision athletes with (N=24) and without a history of concussion (N=16) in Study 1. Study 2 (N=10) examined changes over time in contact/collision athletes. There were two primary dependent variables: (1) theta-band phase-synchronization (e.g., functional connectivity) between medial and right-lateral electrodes; and (2) the within-subject correlation between synchronization strength on error trials and post-error reaction time (i.e., operationalization of cognitive control). Results: Head injury history was inversely related with medial-lateral connectivity. Head injury was also related to declines in a neurobehavioral measure of cognitive control (i.e., the single-trial relationship between connectivity and post-error slowing). Conclusions: Results align with a theory of connectivity-mediated cognitive control. Mild injuries undetectable by behavioral measures may still be apparent on direct measures of neural functioning. This report demonstrates that connectivity and cognitive control measures may be useful for tracking recovery from concussion. Theoretically relevant neuroscientific findings in healthy adults may have applications in patient populations, especially with regard to monitoring brain health. (JINS 2019, 25, 314–323)
Global climate change poses significant threats to the Caribbean islands. Yet, little is known about the long-term disturbance regimes in island ecosystems. This research investigates 2000 yr of natural and anthropogenic fire disturbance through the analysis of a latitudinal transect of sediment records from coastal salt ponds in the British Virgin Islands (BVI). The two research objectives in this study are (1) to determine the fire regime history for the BVI over the last 2000 yr and (2) to explore ecological impacts from anthropogenic landscape modification pre- and post-European settlement. The magnitude of anthropogenic landscape modification, including the introduction of agriculture, was investigated through a multiproxy approach using sedimentary records of fossil pollen and charcoal. Our results suggest fire regimes from Belmont Pond, Thatch Island, and Skeleton Pond have been influenced by human activity, particularly during the postsettlement era, from 500 cal yr BP to modern. Our results suggest that fire regimes during the Medieval Climate Anomaly were responding to changes in climate via dominant atmospheric drivers. The presettlement fire regimes from these islands suggest that fires occurred every 90 to 120 yr. This research represents a significant data contribution to a region with little disturbance and vegetation data available.
Dislocation of the cochlear implant magnet is an uncommon but recognised complication of magnetic resonance imaging in a patient with a cochlear implant.
This paper reports a case of cochlear implant magnet dislocation despite head bandaging. The patient subsequently underwent endoscopic repositioning of the magnet under general anaesthesia. The cochlear implant system was tested intra-operatively and confirmed to be functioning. The patient was well at follow up and the small wound healed well with no complications.
This report presents the endoscopic technique as a viable minimally invasive surgical approach to address cochlear implant magnet dislocation.
There is much epidemiological evidence suggesting a reduced risk of development of type 2 diabetes (T2D) in habitual coffee drinkers, however to date there have been few longer-term interventions, directly examining the effects of coffee intake on glucose and lipid metabolism. Previous studies may be confounded by inter-individual variation in caffeine metabolism. Specifically, the rs762551 SNP in the CYP1A2 gene has been demonstrated to influence caffeine metabolism, with carriers of the C allele considered to be of a ‘slow’ metaboliser phenotype. This study investigated the effects of regular coffee intake on markers of glucose and lipid metabolism in coffee-naïve individuals, with novel analysis by rs762551 genotype. Participants were randomised to either a coffee group (n 19) who consumed four cups/d instant coffee for 12 weeks or a control group (n 8) who remained coffee/caffeine free. Venous blood samples were taken pre- and post-intervention. Primary analysis revealed no significant differences between groups. Analysis of the coffee group by genotype revealed several differences. Before coffee intake, the AC genotype (‘slow’ caffeine metabolisers, n 9) displayed higher baseline glucose and NEFA than the AA genotype (‘fast’ caffeine metabolisers, n 10, P<0·05). Post-intervention, reduced postprandial glycaemia and reduced NEFA suppression were observed in the AC genotype, with the opposite result observed in the AA genotype (P<0·05). These observed differences between genotypes warrant further investigation and indicate there may be no one-size-fits-all recommendation with regard to coffee drinking and T2D risk.
The intermittent energy restriction (IER) approach to weight loss involves short periods of substantial (>70 %) energy restriction (ER) interspersed with normal eating. Studies to date comparing IER to continuous energy restriction (CER) have predominantly measured fasting indices of cardiometabolic risk. This study aimed to compare the effects of IER and CER on postprandial glucose and lipid metabolism following matched weight loss. In all, twenty-seven (thirteen male) overweight/obese participants (46 (sem 3) years, 30·1 (sem 1·0) kg/m2) who were randomised to either an IER intervention (2638 kJ for 2 d/week with an overall ER of 22 (sem 0·3) %, n 15) or a CER intervention (2510 kJ below requirements with overall ER of 23 (sem 0·8) %) completed the study. Postprandial responses to a test meal (over 360 min) and changes in anthropometry (fat mass, fat-free mass, circumferences) were assessed at baseline and upon attainment of 5 % weight loss, following a 7-d period of weight stabilisation. The study found no statistically significant difference in the time to attain a 5 % weight loss between groups (median 59 d (interquartile range (IQR) 41–80) and 73 d (IQR 48–128), respectively, P=0·246), or in body composition (P≥0·437). For postprandial measures, neither diet significantly altered glycaemia (P=0·266), whereas insulinaemia was reduced comparatively (P=0·903). The reduction in C-peptide tended (P=0·057) to be greater following IER (309 128 (sem23 268) to 247781 (sem20 709) pmol×360 min/l) v. CER (297 204 (sem25 112) to 301 655 (sem32 714) pmol×360 min/l). The relative reduction in TAG responses was greater (P=0·045) following IER (106 (sem30) to 68 (sem 15) mmol×360 min/l) compared with CER (117 (sem 43) to 130 (sem 31) mmol×360 min/l). In conclusion, these preliminary findings highlight underlying differences between IER and CER, including a superiority of IER in reducing postprandial lipaemia, which now warrant targeted mechanistic evaluation within larger study cohorts.
This paper presents a dialogue about the question of symmetry and asymmetry in human–thing relations, and the links between such asymmetries and those encountered in power relations amongst humans. The conversation discusses various issues, such as whether symmetry is possible in any kind of relation, how one defines asymmetry, whether there are different kinds of asymmetry, and how inequality between humans is related to the asymmetries in human–thing entanglements. The last issue is considered especially important in light of the various critiques that have been levelled at actor networks and other relational materialisms for their weakened political stance insofar as sources of inequality and injustice are so widely distributed that they become, in effect, apolitical.
Necrotising otitis externa can be a devastating form of otitis externa. It typically tends to affect patients who are immunocompromised or diabetic. To date, there is very little in the literature about necrotising otitis externa in the immunocompetent patient population.
The present paper discusses both the clinical and radiological findings in three cases of necrotising otitis externa in an immunocompetent patient cohort. The common factor among all three patients was their advanced age.
Diagnosing necrotising otitis externa can be challenging because of the potentially non-specific symptoms and the absence of early radiological signs, particularly if patients are neither immunocompromised nor diabetic. Elderly patients should be considered in the same light as immunocompromised and diabetic patients in the context of necrotising otitis externa.
The aim of this study is to look at an Irish population in relation to the online gambling activities people are engaging with, the reasons for gambling online, their attitudes to online gambling and the financial/mental health consequences of online gambling.
The outline for this study was adapted from a study by McCormack et al. (2014) in relation to online gambling, with the aim of replicating this study in an Irish population. An online survey consisting of 11 categories related to online gambling was advertised online over a 7-month period. Participants answered on activities gambled online, devices used, duration of time gambling, as well mental health/financial consequences of their gambling.
A total of 208 users participated in the online survey. The most popular gambling activity played was Sports Betting (26.9%) and the most commonly used device was Mobile app (68.6%). The main reason for gambling online was ‘To win money’ (84.6%), the main reason for ending gambling sessions – ‘Had something else to do’ (67.3%) and the most prominent emotion experienced – Excitement (60.6%). There were findings related to the severity of gambling addiction (75% – had to borrow or sell to fund gambling) and their attitudes towards online gambling (strongly agreed – 39.9% – The potential dangers of gambling should be advertised).
Online gamblers in Ireland share similar behavioural profiles to online gamblers in the United Kingdom and worldwide. The majority of participants in this research have been adversely affected from both a mental and financial perspective due to their gambling behaviours.
Periodic outbreaks of West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and to a lesser extent, California serogroup viruses (CSGV), have been reported in parts of Canada in the last decade. This study was designed to provide a broad assessment of arboviral activity in Quebec, Canada, by conducting serological surveys for these arboviruses in 196 horses, 1442 dogs and 485 humans. Sera were screened by a competitive enzyme linked immunosorbent assay and positive samples confirmed by plaque reduction neutralisation tests. The percentage of seropositive samples was 83·7%, 16·5%, 7·1% in horses, 18·8%, 0·6%, 0% in humans, 11·7%, 3·1%, 0% in adult dogs and 2·9%, 0·3%, 0% in juvenile dogs for CSGV, WNV and EEEV, respectively. Serological results in horses and dogs appeared to provide a meaningful assessment of risk to public health posed by multiple arboviruses.
In the Welfare Quality® assessment protocol for broilers, the touch test is included to assess the human–animal relationship in the flock. The test is designed to measure the animals’ fear of humans, assuming that broilers will withdraw from the observer if they are fearful. However, many broilers close to slaughter age have impaired walking ability, and the results from the touch test may thus be biased by lameness and poor leg health. As the touch test is currently being used in several countries to assess human–animal relationship in broilers, there is an urgent need to examine this potential relationship for a further validation of the test. In the present study, fear of humans was assessed in 50 randomly selected Norwegian broiler flocks, using the touch test as described in the Welfare Quality® protocol for ty broilers. Leg health was assessed by examining the gait of 150 random birds in each of the flocks, using a six-point gait score scale from 0 to 5. The coefficient for the relationship between touch test score and gait score was 0.034 (P<0.001), indicating that the animals express less fear as assessed by the touch test when the gait scores increase. This implies that the touch test may be confounded by impaired walking ability and therefore might be a suboptimal method of assessing fear of humans and human–animal relationship in broilers. In conclusion, the results from this study suggests that the touch test must be further validated in broilers and perhaps be replaced with a fear test that doesn’t rely on walking ability.
Objectives: Dysbiosis of the gut microbiome is implicated in numerous human health conditions. Animal studies have linked microbiome disruption to changes in cognitive functioning, although no study has examined this possibility in neurologically healthy older adults. Methods: Participants were 43 community-dwelling older adults (50–85 years) that completed a brief cognitive test battery and provided stool samples for gut microbiome sequencing. Participants performing≥1 SD below normative performance on two or more tests were compared to persons with one or fewer impaired scores. Results: Mann Whitney U tests revealed different distributions of Bacteroidetes (p=.01), Firmicutes (p=.02), Proteobacteria (p=.04), and Verrucomicrobia (p=.003) between Intact and Impaired groups. These phyla were significantly correlated with cognitive test performances, particularly Verrucomicrobia and attention/executive function measures. Conclusions: The current findings suggest that composition of the gut microbiome is associated with cognitive test performance in neurologically healthy older adults. Future studies are needed to confirm these findings and explore possible mechanisms. (JINS, 2017, 23, 700–705)