The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework.

BACKGROUND: Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents. OBJECTIVES: To increase knowledge of the socioeconomic impact of TB on children and adolescents. METHODS: We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically. RESULTS: Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group. CONCLUSION: The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.

Nurse-led primary health care for homeless men: a multimethods descriptive study.

AIM: To explore the primary healthcare needs and health service use of homeless men in inner Sydney. BACKGROUND: People experiencing homelessness have greater health needs than the general population and place high demands on tertiary care, which is expensive and may not be the optimum service for their needs. Accessible, approachable and affordable primary healthcare services could improve the health of homeless persons and potentially decrease costs to the healthcare system. METHODS: A multimethod design using a cross-sectional survey (n = 40) and administrative data (n = 2 707 daily summaries) collected from a nurse-led primary healthcare clinic for homeless men in Sydney. FINDINGS: Survey respondents were aged 27-76 years. Health problems reflected multimorbidity, with mental health issues present in almost all respondents. The majority had attended the clinic more than 20 times in the past year and said the services, treatments and referrals helped them avoid the emergency department. Administrative data indicated that medication administration was the most frequent service provided. Referrals to other health services doubled over the 7-year period. DISCUSSION: Multiple morbidities, particularly mental health issues, are associated with homelessness. A proactive approach by nurses including preventative services appeared to overcome barriers to health service use. CONCLUSION: This nurse-led primary healthcare clinic highlights the importance of providing services to homeless men with multiple comorbidities. Respect and trust in addition to easy access to health services appear to be important facilitators of health service use. IMPLICATIONS FOR NURSING, AND IMPLICATIONS FOR HEALTH POLICY: A greater number of primary health services that collaborate with specialist services, including nurse-led clinics, may facilitate health care for persons who are homeless, reducing the burden on acute services.

Sensing sulfur-containing gases using titanium and tin decorated zigzag graphene nanoribbons from first-principles.

Atom implantation in graphene or graphene nanoribbons offers a rich opportunity to tune the material structure and functional properties. In this study, zigzag graphene nanoribbons with Ti or Sn adatoms stabilised on a double carbon vacancy site are theoretically studied to investigate their sensitivity to sulfur-containing gases (H2S and SO2). Due to the abundance of oxygen in the atmosphere, we also consider the sensitivity of the structures in the presence of oxygen. Density functional theory calculations are performed to determine the adsorption geometry and energetics, and nonequilibrium Green's function method is employed to compute the current-voltage characteristics of the considered systems. Our results demonstrate the sensitivity of both Ti- and Sn-doped systems to H2S, and the mild sensitivity of Ti-doped sensor systems to SO2. The Ti-doped sensor structure exhibits sensitivity to H2S with or without oxidation, while oxidation of the Sn-doped sensor structure reduces its ability to adsorb H2S and SO2 molecules. Interestingly, oxygen dissociates on the Ti-doped sensor structure, but it does not affect the sensor's response to the H2S gas species. Oxidation prevents the dissociation of the H-S bond when H2S adsorbs on the Ti-doped structure, thus enhancing its reusability for this gas species. Our study suggests the potential of Ti- and Sn-doped graphene in selective gas sensing, irrespective of the sensing performance of the bulk oxides.

Biological-to-electronic interface with pores of ATP synthase subunit C in silicon nitride barrier.

An oscillator pore is identified that generates intermittent, large amplitude, ionic current in the plasma membrane. The pore is thought to be composed of 10-12 units of subunit c of ATP synthase. Pore opening and closing is a co-operative process, dependent on the release, or binding, of as many as six calcium ions. This mechanism suggests a more general method of co-operative threshold detection of chemical agents via protein modification, the output being directly amplified in a circuit. Here the authors describe steps in the development of a sensor of chemical agents. The subunit c pore in a lipid bilayer spans a nanometer-scale hole in a silicon nitride barrier. Either side of the barrier are electrolyte solutions and current through the pore is amplified by circuitry. The techniques of laser ablation, electron beam lithography and ion beam milling are used to make successively smaller holes to carry the lipid patch. Holes of diameter as small as 20 nm are engineered in a silicon nitride barrier and protein activity in lipid membranes spanning holes as small as 30 nm in diameter is measured. The signal-to-noise ratio of the ionic current is improved by various measures that reduce the effective capacitance of the barrier. Some limits to scale reduction are discussed.

Correlation of computed tomography and postmortem findings of a diffuse astrocytoma: a case report.

Diffusely infiltrating astrocytomas often present diagnostic difficulties. We herein correlate the radiologic and postmortem findings of a diffuse astrocytoma and conclude that recognition of abnormal bilateral and fairly symmetric enlargement and increased density of normal structures in CT scans may lead to an antemortem diagnosis of the tumor.

Effects of 2 mg and 4 mg atropine sulfate on the performance of U.S. Army helicopter pilots.

Atropine autoinjectors are issued to aviators for use in the event of organophosphate poisoning on the battlefield. This investigation assessed the effects of unchallenged 2 mg and 4 mg doses on flight performance, vision, tracking, cognitive performance, and electroencephalograms of 12 Army aviators. Effects were seen most often with the 4 mg dose in terms of aircraft control problems, vision disturbances, impaired tracking, reduced cortical activation, and decreased cognitive skill. These problems indicate helicopter tactical flight is dangerous after an unchallenged 4 mg dose. Other types of flight should also be avoided for at least 12 h after atropine.

Chemical evolution via beta decay: a case study in strontium-90.

Using (90)Sr as a representative isotope, we present a framework for understanding beta decay within the solid state. We quantify three key physical and chemical principles, namely momentum-induced recoil during the decay event, defect creation due to physical displacement, and chemical evolution over time. A fourth effect, that of electronic excitation, is also discussed, but this is difficult to quantify and is strongly material dependent. The analysis is presented for the specific cases of SrTiO(3) and SrH(2). By comparing the recoil energy with available threshold displacement data we show that in many beta-decay situations defects such as Frenkel pairs will not be created during decay as the energy transfer is too low. This observation leads to the concept of chemical evolution over time, which we quantify using density functional theory. Using a combination of Bader analysis, phonon calculations and cohesive energy calculations, we show that beta decay leads to counter-intuitive behavior that has implications for nuclear waste storage and novel materials design.

Atypical apocrine metaplasia in sclerosing lesions of the breast: a study of 51 patients.

Sclerosing breast lesions with cytologically atypical apocrine metaplasia present a difficult diagnostic problem. The clinical significance of these lesions has not been established although, historically, apocrine metaplasia and sclerosing adenosis have been regarded as totally benign. To further assess these lesions, we studied 51 patients with atypical apocrine metaplasia in sclerosing lesions of the breast, obtaining an average follow-up of 35 mo (12 to 76 mo). For convenience, these have been grouped together as atypical apocrine sclerosing lesions (AASL). The average age at diagnosis was 58 yr. The lesions tended to be small (67% less than 1.0 cm) and usually were detected by mammography (78%). Four patients had an ipsilateral mastectomy following a biopsy of AASL that was interpreted as carcinoma or "precancerous" by the referring pathologist. Two patients had nonapocrine intraductal and infiltrating duct carcinoma in previous contralateral mastectomy specimens. None of the 47 women with an intact breast developed breast carcinoma during the follow-up period. Immediate treatment with surgery and/or radiation is not indicated. The long-term clinical implication of these lesions is yet to be determined; therefore, continued clinical observation of AASL patients is advisable.

The effect of treatment of hyper- and hypothyroidism on urinary excretion of cyclic adenosine 3',5'-monophosphate.

The urinary excretion of cyclic adenosine 3',5'-monophosphate (cyclic AMP) was examined in patients with hyperthyroidism and primary hypothyroidism, before treatment and at least six months later on return to euthyroid status. Urinary cyclic AMP excretion was significantly greater in the hyperthyroid group than in the hypothyroid group both in the basal state (P less than 0.01) and the ambulant state (P less than 0.001). In ambulant hyperthyroid patients absolute urinary cyclic AMP excretion (mumol/24 h) was significantly greater (P less than 0.05) prior to treatment than on return to euthyroid status. In the hypothyroid group no significant change occurred after treatment with 1-thyroxine (P greater than 0.05). The mechanism of changes in urinary cyclic AMP excretion in thyroid disease are discussed.

A modified extrathoracic approach to the treatment of dysphagia lusoria.

The management of patients with esophageal compression by an anomalous right subclavian artery (dysphagia lusoria) has been controversial. A classic approach involves left thoracotomy, with resection of the aberrant subclavian artery from its origin to the right border of the esophagus. To prevent possible ischemic complications, most surgeons favor revascularization of the distal subclavian artery. Thoracotomy has been the traditional approach for division or reimplantation of the aberrant right subclavian artery. We describe a modification (right supraclavicular incision) of an extrathoracic approach, which was first described by Orvald in 1972, to simplify simultaneous correction of dysphagia lusoria and revascularization of the right upper extremity.

Experimental assessment of wind erosion after soil stabilization treatments at Eneabba, Western Australia.

Wind tunnel experiments on rehabilitation surfaces at Eneabba, Western Australia evaluated the techniques used by Associated Minerals Consolidated Ltd. (AMC) and Allied Eneabba Ltd. (AEL) to stabilize regions being revegetated following heavy mineral sand mining.Newly landscaped areas proved to be the most erodible, beginning to erode at 9 m sec(-1) and producing a soil flux of 10 kg m(-1) min(-1) at 18 m sec(-1) wind speeds. Sandier, more organically-rich, surfaces in the rehabilitation areas were somewhat less erodible with losses of only 2 kg m(-1) min(-1) at wind speeds of 18 m sec(-1).The mining companies use various nurse crops and top dressing mulch for surface stabilization. Rows of oats, sparse plantings of the grass cultivar "SUDAX" (Dekalb ST6) supplied by Westfarmers Ltd. and applications of Terolas, a cold, bituminous surface binding material supplied by Shell Co. of Australia Ltd., all proved successful in reducing wind erosion in this semi-arid region where more than 25% of summer days experience winds greater than 8 m sec(-1).

Factor V Leiden and pulmonary embolism in a young woman taking an oral contraceptive.

A 34-year-old woman with a history of asthma and oral contraceptive use died suddenly. Autopsy examination showed chronic pulmonary emboli with an acute pulmonary saddle embolus. An underlying congenital thrombophilic disorder was considered. Molecular studies on DNA isolated from blood using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis revealed coagulation factor V Leiden mutation. The incidence of venous thromboembolism in patients with factor V Leiden mutation and associated activated protein C (APC) resistance is discussed.

PIP: This article presents a case report of a 34-year-old woman with a known medical history of asthma and oral contraceptive use who died suddenly from a massive pulmonary embolus. This woman had no underlying malignancy, trauma, recent surgery, or other predisposing factors putting her at risk of venous thromboembolism except for her use of oral contraceptives. Upon autopsy, a large saddle embolus was found occluding the main pulmonary arteries with bilateral extension into the smaller arteries. An acute pulmonary embolus obliterating the lumen of the main pulmonary artery was found during the microscopic examination. Molecular studies of blood DNA using polymerase chain reaction and restriction fragment length polymorphism revealed a coagulation factor V Leiden mutation. Female carriers of factor V Leiden mutation who take oral contraceptives have a more than 30-fold increased risk of developing deep venous thrombosis. This case demonstrates that the woman had an underlying predisposition that was further potentiated by oral contraceptive use. The incidence of venous thromboembolism in patients with factor V Leiden mutation and associated activated protein C resistance is discussed.

System for long-term review of patients at risk of becoming hypothyroid. Further experience.

8 years' experience of a computer-assisted system for long-term follow-up of patients at risk of hypothyroidism shows that the system is reliable, efficient, and economical. Less than 0.1% of registered patients are now lost to follow-up and less than 2% of patients need to be seen by the medical staff each year. Changes have been made in registration procedures and in the methods of finding patient who fail to attend. Improvements in the laboratory screening of thyroid function have also been introduced. The need to follow-up patients already under treatment with thyroxine has been recognised and the importance of a reliable system is reaffirmed.

Endogenously expressed estrogen receptor and coactivator AIB1 interact in MCF-7 human breast cancer cells.

Coactivators are believed to mediate estrogen-induced gene responses via interaction with estrogen receptors (ER). Currently, a major challenge is to determine the importance of each coactivator in a specific cell type and promoter context in response to a particular ligand. The potential of ER to interact with a growing list of coactivators has been shown in a variety of in vitro and gene transfer assays, yet very few data have demonstrated the interaction of endogenous coactivators with ER in intact cells. We report here a ligand-specific interaction of endogenous human ER (hER) and the AIB1 coactivator in MCF-7 human breast cancer cells by using immunoprecipitation analyses. Complexes between endogenously expressed hER and AIB1 were detected in estradiol-treated cells and to a much lesser extent in cells treated with the partial agonist, monohydroxytamoxifen. We were unable to detect an hER-SRC-1 complex in our immunoprecipitations from MCF-7 cells. The in vitro-binding affinity for mouse ER interaction with AIB1 was estimated to be 40-120 nM. We conclude that AIB1 is a major coactivator for hER in MCF-7 human breast cancer cells.