Podoconiosis in the Ethiopian Rift Valley - Role of beryllium and zirconium

A geogenic origin has been proposed in the aetiology of non-filarial elephantiasis of the feet and legs, recently renamed podoconiosis. Soil collected in an area of the Ethiopian Rift Valley, the borough of Ocholo, known for its high prevalence of podoconiosis (5.06%), has been submitted to mineral analysis. High values of sulphur (S), cerium (Ce), lanthanum (La) and neodymium (Nd), typical for basaltic bedrocks, were found. Of special interest were the values for zirconium (Zr) and beryllium (Be), 618 +/- 87 ppm and 4.6 +/- 0.5 ppm respectively, twice as high as those recorded for soils sampled in neighbouring areas where the prevalence of podoconiosis is low. To be noted also, a high content in vanadium, above 250 ppm, in half of the soil samples collected in this region. Year-long exposure of unprotected feet to Zr and Be, known for their ability to induce granuloma formation in the lymphoid tissue of man, and present in a clay rich in colloidal silica particle, highly abrasive to skin, is doubtlessly a factor involved in the development of lymph node sclerosis leading to elephantiasis.

Toxoplasmosis during pregnancy and infancy. A new approach for Switzerland.

In recent years it has become evident that screening for and treatment of acute toxoplasmosis during pregnancy may have no measurable impact on vertical transmission and neonatal morbidity and mortality. A broad lack of evidence with regard to many aspects of congenital toxoplasmosis has been recognised in a common European initiative (EUROTOXO) which reviewed several thousand published papers on the subject of toxoplasmosis during pregnancy and childhood. It was therefore clear that the strategies currently implemented in our country would, on closer inspection, no longer withstand the claim for evidence-based procedures. The arguments and call for a change of paradigm in Switzerland which follow here are the result of a national consensus-finding process involving experts from various specialities, including gynaecology/obstetrics, paediatrics/neonatology, infectiology, ophthalmology and laboratory medicine, together with representatives of the public health authorities.

Hypocretin (orexin) biology and the pathophysiology of narcolepsy with cataplexy.

The discovery of hypocretins (orexins) and their causal implication in narcolepsy is the most important advance in sleep research and sleep medicine since the discovery of rapid eye movement sleep. Narcolepsy with cataplexy is caused by hypocretin deficiency owing to destruction of most of the hypocretin-producing neurons in the hypothalamus. Ablation of hypocretin or hypocretin receptors also leads to narcolepsy phenotypes in animal models. Although the exact mechanism of hypocretin deficiency is unknown, evidence from the past 20 years strongly favours an immune-mediated or autoimmune attack, targeting specifically hypocretin neurons in genetically predisposed individuals. These neurons form an extensive network of projections throughout the brain and show activity linked to motivational behaviours. The hypothesis that a targeted immune-mediated or autoimmune attack causes the specific degeneration of hypocretin neurons arose mainly through the discovery of genetic associations, first with the HLA-DQB1*06:02 allele and then with the T-cell receptor α locus. Guided by these genetic findings and now awaiting experimental testing are models of the possible immune mechanisms by which a specific and localised brain cell population could become targeted by T-cell subsets. Great hopes for the identification of new targets for therapeutic intervention in narcolepsy also reside in the development of patient-derived induced pluripotent stem cell systems.

Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

The last resort : spa therapy and the docile body in Victorian St. Catharines /

By relying on existing cultural models, the Victorian spa promoted health and wellness. Advertising, together with other forms of promotion, strengthened the legitimacy of its claims to cure a variety of health problems. By the use of some links to science and a mystical folk belief about the efficacy of the local mineral waters, three spas emerged in St.Catharines: the Stephenson House, the WeIland House, and the Springbank. As the twentieth century approached, the spa movement declined and institutionalized medicine struggled to establish a monopoly on health care. This thesis argues that the health spas in St. Catharines occupied that transitional space in nineteenth century medicine between home remedy and hospital. The interplay between scientific discovery and business enterprise produced a climate in which the Victorian health resort flourished. This phenomenon, combined with the various maladies brought on by industrialization, nineteenth-century lifestyle, and the absence of medical options, created a surge in the popularity of health spas and mineral spring therapies. By the tum of the twentieth century, interest in mineral water treatments had declined. The health resorts that had blossomed between 1850 and 1899 began to experience a serious decrease in business. This popular movement became outmoded in the face of emerging medical and scientific knowledge. In St. Catharines, the last resort to remain standing, the WeIland House, finished out the city's spa era as a hospital.

Immune potential and differentiation of equine induced pluripotent stem cells (eiPSC)

Induced pluripotent stem cells (iPSC) have the capacity to self renew and differentiate into a myriad of cell types making them potential candidates for cell therapy and regenerative medicine. The goal of this thesis was to determine the characteristics of equine iPSC (eiPSC) that can be harnessed for potential use in veterinary regenerative medicine. Trauma to a horse’s limb often leads to the development of a chronic non-healing wound that lacks a keratinocyte cover, vital to healing. Thus, the overall hypothesis of this thesis was that eiPSC might offer a solution for providing wound coverage for such problematic wounds. Prior to considering eiPSC for clinical applications, their immunogenicity must be studied to ensure that the transplanted cells will be accepted and integrate into host tissues. The first objective of this thesis was to determine the immune response to eiPSC. To investigate the immunogenicity of eiPSC, the expression of major histocompatibility complex (MHC) molecules by the selected lines was determined, then the cells were used in an intradermal transplantation model developed for this study. While transplantation of allogeneic, undifferentiated eiPSC elicited a moderate cellular response in experimental horses, it did not cause acute rejection. This strategy enabled the selection of weakly immunogenic eiPSC lines for subsequent differentiation into lineages of therapeutic importance. Equine iPSC offer a potential solution to deficient epithelial coverage by providing a keratinocyte graft with the ability to differentiate into other accessory structures of the epidermis. The second objective of this thesis was to develop a protocol for the differentiation of eiPSC into a keratinocyte lineage. The protocol was shown to be highly efficient at inducing the anticipated phenotype within 30 days. Indeed, the eiPSC derived vi keratinocytes (eiPSC-KC) showed both morphologic and functional characteristics of primary equine keratinocytes (PEK). Moreover, the proliferative capacity of eiPSC-KC was superior while the migratory capacity, measured as the ability to epithelialize in vitro wounds, was comparable to that of PEK, suggesting exciting potential for grafting onto in vivo wound models. In conclusion, equine iPSC-derived keratinocytes exhibit features that are promising to the development of a stem cell-based skin construct with the potential to fully regenerate lost or damaged skin in horses. However, since eiPSC do not fully escape immune surveillance despite low MHC expression, strategies to improve engraftment of iPSC derivatives must be pursued.

Molecular Epidemiology of Escherichia coli isolates from Environmental, Food and Clinical Sources

In the present study diversity of E. coli in the water samples of Cochin estuary were studied for a period of 3 years ranging from January 2010- December 2012. The stations were selected based on the closeness to satellite townships and waste input. Two of the stations (Chitoor and Thevara) were fixed upstream, two in the central part of the estuary namely Bolgatty and Off Marine Science Jetty, and one at the Barmouth. Diversity was assessed in terms of serotypes, phylogenetic groups and genotypes. Two groups of seafood samples such as fish and shellfish collected from the Cochin estuary were used for isolation of E. coli. One hundred clinical E. coli isolates were collected from one public health centre, one hospital and five medical labs in and around Cochin City, Kerala. From our results it was clear that pathogen cycling is occurring through food, water and clinical sources. Pathogen cycling through food is very common and fish and shellfish that harbour these strains might pose potential health risk to consumer. Estuarine environment is a melting pot for various kinds of wastes, both organic and inorganic. Mixing up of waste water from various sources such as domestic, industries, hospitals and sewage released into these water bodies resulting in the co-existence of E. coli from various sources thus offering a conducive environment for horizontal gene transfer. Opportunistic pathogens might acquire genes for drug resistance and virulence turning them to potential pathogens. Prevalence of ExPEC in the Cochin estuary, pose threat to people who use this water for fishing and recreation. Food chain also plays an important role in the transit of virulence genes from the environments to the human. Antibiotic resistant E. coli are widespread in estuarine water, seafood and clinical samples, for reasons well known such as indiscriminate use of antibiotics in animal production systems, aquaculture and human medicine. Since the waste water from these sources entering the estuary provides selection pressure to drug resistant mutants in the environment. It is high time that the authorities concerned should put systems in place for monitoring and enforcement to curb such activities. Microbial contamination can limit people’s enjoyment of coastal waters for contact recreation or shellfish-gathering. E. coli can make people sick if they are present in high levels in water used for contact recreation or shellfish gathering. When feeding, shellfish can filter large volumes of seawater, so any microorganisms present in the water become accumulated and concentrated in the shellfish flesh. If E. coli contaminated shellfish are consumed the impact to human health includes gastroenteritis, urinary tract infections (UTIs), and bacteraemia. In conclusion, the high prevalence of various pathogenic serotypes and phylogenetic groups, multidrug-resistance, and virulence factor genes detected among E. coli isolates from stations close to Cochin city is a matter of concern, since there is a large reservoir of antibiotic resistance genes and virulence traits within the community, and that the resistance genes and plasmid-encoded genes for virulence were easily transferable to other strains. Given the severity of the clinical manifestations of the disease in humans and the inability and/or the potential risks of antibiotic administration for treatment, it appears that the most direct and effective measure towards prevention of STEC and ExPEC infections in humans and ensuring public health may be considered as a priority.

Integrated Livelihoods and Landscape Approach for Smallholders in Northern Thailand

This paper examines the strategies and techniques researched and implemented by the International Union for Conservation of Nature (IUCN) in villages in the vicinity of Doi Mae Salong in Chiang Rai Province, Thailand. The strategies revolve around the paradigm linking poverty alleviation, conservation and landscape restoration. IUCN and its partners specifically researched and implemented schemes directed toward diversification of the household economy through alternative and sustainable intensified agriculture techniques based on balancing conservation and livelihood objectives. The projects aimed to reduce poverty and build the resilience of smallholders through decentralised governance arrangements including land use planning schemes and stakeholder negotiation. Considering the agro-ecological system on a catchment-wide scale enhances the conceptual understanding of each component, collectively forming a landscape matrix with requisite benefits for biodiversity, smallholder livelihoods and ecosystem services. In particular, the role of enhancing ecosystem services and functions in building socio-ecological resilience to vulnerabilities such as climate and economic variability is paramount in the process.

Factors influencing the use of selected inputs in yam production in Nigeria and Ghana

In West Africa, yam can be an important crop to reduce poverty and hunger if Research and Development measures identify and properly engage its key production factors for enhanced outputs and better income. Data from 1400 households in Ghana and Nigeria were collected in a multistage random sampling survey (and complementary data from 76 farm family fields) with a structured questionnaire and qualitative interview questions. The results showed that yam is produced mainly with crude inputs/technologies to reduce high dependence on labour, seed production and control of pests and diseases. Yam is produced widely with purchased inputs including seed yam and hired labour; chemical fertiliser, herbicide and pesticides are less often used. Analyses of determinants of use of purchased inputs reveal three serious impediments to expansion in yam production: the increasing scarcity and high cost of hired labour, shortage of suitable land and poor farm roads. As employment opportunities for unskilled labour in urban centres are presently expanding, increased yam production will be hard to achieve without labour-saving inputs for at least some of the production tasks, especially seedbed preparation and weeding, and without improvement in infrastructure.

Fast Learning by Bounding Likelihoods in Sigmoid Type Belief Networks

Sigmoid type belief networks, a class of probabilistic neural networks, provide a natural framework for compactly representing probabilistic information in a variety of unsupervised and supervised learning problems. Often the parameters used in these networks need to be learned from examples. Unfortunately, estimating the parameters via exact probabilistic calculations (i.e, the EM-algorithm) is intractable even for networks with fairly small numbers of hidden units. We propose to avoid the infeasibility of the E step by bounding likelihoods instead of computing them exactly. We introduce extended and complementary representations for these networks and show that the estimation of the network parameters can be made fast (reduced to quadratic optimization) by performing the estimation in either of the alternative domains. The complementary networks can be used for continuous density estimation as well.

Moderating effects of management control systems and innovation on performance. Simple methods for correcting the effects of measurement error for interaction effects in small samples

In the accounting literature, interaction or moderating effects are usually assessed by means of OLS regression and summated rating scales are constructed to reduce measurement error bias. Structural equation models and two-stage least squares regression could be used to completely eliminate this bias, but large samples are needed. Partial Least Squares are appropriate for small samples but do not correct measurement error bias. In this article, disattenuated regression is discussed as a small sample alternative and is illustrated on data of Bisbe and Otley (in press) that examine the interaction effect of innovation and style of use of budgets on performance. Sizeable differences emerge between OLS and disattenuated regression

Concordancia en interpretación electrocardiográfica en síndromes coronarios agudos entre especialistas del servicio de urgencias y cardiólogos

Introducción: El ECG es una herramienta básica en el estudio del dolor torácico, no hay evidencia que demuestre si la interpretación electrocardiográfica de los especialistas de medicina interna y emergencias es similar a la de cardiólogos en casos de SCA. El propósito de este estudio es determinar si existe concordancia en interpretación de los hallazgos electrocardiográficos más frecuentes en la fase aguda de los síndromes coronarios. Metodología: Estudio retrospectivo de concordancia diagnóstica electrocardiográfica, realizado en un hospital universitario de cuarto nivel. Se escogieron los hallazgos electrocardiográficos más frecuentes en síndromes coronarios agudos para ser evaluados por 3 diferentes especialidades y se hizo el análisis de concordancia mediante el cálculo estadístico kappa. Resultados: Se analizaron 200 electrocardiogramas aleatorizados, de pacientes con SCA entre noviembre de 2012 a abril de 2013. La edad promedio fue 65,14 años, la mayoría hombres (62,5%), la hipertensión arterial y enfermedad coronaria fueron las comorbilidades más frecuentes. Se encontró un grado de concordancia moderada (k = 0.61 – 0.80, p <0.001) entre cardiólogos vs emergenciólogos y cardiólogos vs internistas, excepto en lesión subendocárdica (k = 0.11 y 0.24 respectivamente), hubo un grado de concordancia débil (k = 0.41 – 0.60, p <0.001) entre emergenciólogos e internistas. El hallazgo en el que hubo grado de concordancia muy bueno (k > 0.81) fue bloqueo de rama izquierda. Conclusión: Existe grado de concordancia moderada en la lectura electrocardiográfica en la mayoría de variables en relación con síndrome coronario agudo entre los especialistas de medicina interna y emergencias al compararlo con cardiólogos.

Functional studies of the deubiquitinating enzymes USP19, USP4 and UCH-L1

El marcaje de proteínas con ubiquitina, conocido como ubiquitinación, cumple diferentes funciones que incluyen la regulación de varios procesos celulares, tales como: la degradación de proteínas por medio del proteosoma, la reparación del ADN, la señalización mediada por receptores de membrana, y la endocitosis, entre otras (1). Las moléculas de ubiquitina pueden ser removidas de sus sustratos gracias a la acción de un gran grupo de proteasas, llamadas enzimas deubiquitinizantes (DUBs) (2). Las DUBs son esenciales para la manutención de la homeostasis de la ubiquitina y para la regulación del estado de ubiquitinación de diferentes sustratos. El gran número y la diversidad de DUBs descritas refleja tanto su especificidad como su utilización para regular un amplio espectro de sustratos y vías celulares. Aunque muchas DUBs han sido estudiadas a profundidad, actualmente se desconocen los sustratos y las funciones biológicas de la mayoría de ellas. En este trabajo se investigaron las funciones de las DUBs: USP19, USP4 y UCH-L1. Utilizando varias técnicas de biología molecular y celular se encontró que: i) USP19 es regulada por las ubiquitin ligasas SIAH1 y SIAH2 ii) USP19 es importante para regular HIF-1α, un factor de transcripción clave en la respuesta celular a hipoxia, iii) USP4 interactúa con el proteosoma, iv) La quimera mCherry-UCH-L1 reproduce parcialmente los fenotipos que nuestro grupo ha descrito previamente al usar otros constructos de la misma enzima, y v) UCH-L1 promueve la internalización de la bacteria Yersinia pseudotuberculosis.

Resiliencia organizacional y capital psicológico

Desde la noción universal sobre la empresa como un sistema de interacción con un entorno determinado para alcanzar un objetivo, de manera planificada y en función de satisfacer las demandas de un mercado mediante la actividad económica, su viabilidad, sostenibilidad y crecimiento dependerán, por supuesto, de una serie de estrategias adecuadas no solo para tales fines, sino también para enfrentar diversidad de agentes endógenos y exógenos que puedan afectar el normal desempeño de su gestión. Estamos hablando de la importancia de la resiliencia organizacional y del Capital Psicológico. En un escenario tan impredecible como el de la economía mundial, donde la constante son los cambios en su comportamiento —unos propios de su dinámica e interdependencia, naturales de fenómenos como la globalización, y otros derivados de eventos disruptivos— hoy más que nunca es necesario implementar el modelo de la empresa resiliente, que es aquella entidad capaz de adaptarse y recuperarse frente a una perturbación. Al mismo tiempo, más allá de su tamaño, naturaleza u objeto social, es indispensable reconocer básicamente que toda organización está constituida por personas, lo cual implica la trascendencia que para su funcionamiento tiene el factor humano-dependiente, y por lo tanto se crea la necesidad de promover el Capital Psicológico y la resiliencia a nivel de las organizaciones a través de una cultura empresarial.

Correlación y concordancia entre ecocardiografía y cateterismo cardiaco derecho para determinación de la presión sistólica de arteria pulmonar

Introducción. El cateterismo cardiaco derecho representa el estándar de referencia para el diagnóstico de hipertensión pulmonar, sin embargo el rendimiento de la ecocardiografía como estudio inicial ha mostrado buena correlación con las variables medidas por cateterismo. El presente estudio pretende describir el grado de correlación y concordancia entre la ecocardiografía y el cateterismo cardiaco derecho para la medición de la presión sistólica de la arteria pulmonar. Materiales y métodos. Se realizó un estudio observacional retrospectivo de los pacientes sometidos a cateterismo cardiaco derecho entre los años 2009 a 2014 y se compararon con los datos de ecocardiograma más cercano a este cateterismo, teniendo en cuenta la presión sistólica de la arteria pulmonar (PSAP) en las dos modalidades diagnósticas mediante correlación y concordancia estadística según los coeficientes de Pearson y el índice de Lin respectivamente. Resultados. Se recolectaron un total de 169 pacientes con un índice de correlación (r) obtenido para la medición de PSAP del total de la muestra de 0.73 p < 0.0001 mostrando un grado de correlación alto para toda la muestra evaluada. El análisis de concordancia obtenido para toda la población a partir del índice de Lin fue de 0.71 lo que determinó una pobre concordancia. Discusión. Se encontró buena correlación entre ecocardiografía y cateterismo cardiaco derecho para la medición de la PSAP, sin embargo la concordancia entre los métodos diagnósticos es pobre, por tanto el ecocardiograma no reemplaza al cateterismo cardiaco derecho como estudio de elección para diagnóstico y seguimiento de pacientes con hipertensión pulmonar.