Multinational comparison study of aircraft pilot healthcare avoidance behaviour.

BACKGROUND: US and Canadian pilots are required to meet medical standards to secure their active flying status, but a subgroup exhibit healthcare avoidance behaviour due to fear of loss of that status. This phenomenon has the potential to impact pilot health, aeromedical screening and aviation safety. No international comparison study of pilot healthcare avoidance currently exists between US and Canadian pilots. AIMS: To compare the rate and subtypes of healthcare avoidance behaviour secondary to fear for loss of flying status between US and Canadian pilots. METHODS: A comparison analysis of data collected during two independent, non-probabilistic, cross-sectional internet surveys including any individual certified to perform flying duties in the USA (US survey) or Canada (Canadian survey). RESULTS: There were 4320 US pilots and 1415 Canadian pilots who completed informed consent and 3765 US pilots and 1405 Canadian pilots were included in the results. There were 56% of US pilots who reported a history of healthcare avoidance behaviour compared to 55% of Canadian pilots (P = 0.578). A multivariable logistic regression that included age, pilot type and gender showed that US pilots were slightly more likely than Canadian pilots to report this behaviour (odds ratio 1.22, 95% confidence interval 1.06-1.4). CONCLUSIONS: Healthcare avoidance behaviour due to fear of loss of flying status has a relatively high prevalence in both US and Canadian pilot populations.

"It's so tough for us now" - COVID-19 has negatively impacted religious practices relating to death among minority ethnic groups.

OBJECTIVE: The aim of the study was to investigate the impact of the COVID-19 pandemic and prevention measures on religious practices after death, by ethnic grouping, in an opportunistic/convenience sample of UK adults. METHODS: We distributed a questionnaire online and in hard copy between May 1 and June 18, 2020, via social media, post and face-to-face contact in Leicester, a multi-ethnic city in the UK. RESULTS: From 980 adults providing consent, 665 completed some or all survey items and provided ethnicity data. More than double the proportion of Black and South Asian individuals reported religious practices relating to death, burials or funerals being affected by COVID-19 than White groups. Of the 151 participants reporting practices being impacted, a greater proportion of ethnic minority groups reported restricted access/alteration to eight death-related practices (e.g., funeral attendance) compared with White groups (significantly different for all practices, P < 0.05). CONCLUSION: The initial phase of the COVID-19 pandemic in the UK has negatively impacted on the ability to conduct religious practices after death in all ethnic groups, but the impact appears greater in ethnic minority populations than in White groups. There is a need for further qualitative research on the impact of the COVID-19 pandemic on death and burial practices of minority ethnic groups.

Self-reported visual dysfunction in Parkinson disease: the Survey of Health, Ageing and Retirement in Europe.

BACKGROUND AND PURPOSE: Visual dysfunction is a non-motor symptom of Parkinson disease (PD), but its prevalence is unknown as population-based data on the epidemiology of visual symptoms in PD are lacking. The objective was to determine the prevalence of visual dysfunction in PD. METHODS: This was a cross-sectional analysis of data from adults ≥50 years old in the Survey of Health, Ageing and Retirement in Europe (SHARE), a multinational population-based health survey of adults living in one of 27 European countries and Israel. PD diagnosis was self-reported. Impairment in overall, distance or near eyesight was defined as a score of 4 or 5 on a 1-5 scale. Adjusted logistic regression was used to determine the association between PD and self-reported vision. RESULTS: There were 115 240 age-eligible participants in the SHARE study (mean age 64.3 years, 54% female), of whom 1438 (1.25%) reported a diagnosis of PD. In adjusted logistic regression models, PD was associated with increased odds of impaired overall [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.91-3.72], distance (OR 2.55, 95% CI 2.04-3.19) and near (OR 2.07, 95% CI 1.69-2.55) eyesight. Individuals with PD were also less likely to report having an eye examination within the previous 2 years (OR 0.59, 95% CI 0.38-0.92), but this did not remain statistically significant after adjusting for confounders (OR 0.76, 95% CI 0.47-1.24). CONCLUSIONS: Visual dysfunction is significantly more common in PD than in the general adult population. Visual symptoms are a potentially under-recognized and under-treated source of reduced quality of life in PD patients that require further attention and study.

The use of psychological methodologies in cardiovascular disease interventions promoting a Mediterranean style diet: A systematic review.

AIMS: To evaluate theory-based psychological approaches that have been effective in promoting behavior change in interventions promoting a Mediterranean style diet (MD) for the reduction of cardiovascular disease (CVD) risk. DATA SYNTHESIS: A systematic review of primary research articles using PRISMA recommendations was conducted. References were retrieved using keyword searches from MEDLINE via PUBMED and included studies targeted participants at high risk for CVD. Two hundred and ninety one studies were reviewed; however, only six met the inclusionary criteria. Three articles describe the same intervention; therefore, only four were included. Included studies incorporated social cognitive theory, social learning theory, goal-system theory, social ecological theory, selfdetermination theory, and the transtheoretical model of behavior change. Overall, studies were nutrition interventions in clinical settings with participants at high risk for or with CVD. CONCLUSIONS: Results from use of the social cognitive theory and self-determination theory in increasing MD adherence for the reduction of CVD risk and events are encouraging. However, we encourage future long-term interventions focusing on dietary behavior change to provide not only an in-depth description of the psychological methodologies used but also how these methodologies were implemented in order ascertain the most effective theory for promoting dietary behavior change towards patterns of a MD.

Exploring knowledge, attitudes and experience of genitourinary symptoms in women with early breast cancer on adjuvant endocrine therapy.

Clinical trials of adjuvant endocrine therapy in women with early breast cancer have consistently reported that genitourinary symptoms are common. However, little is known about women's experiences of genitourinary symptoms, their views about the symptoms and how they impact on their lives. The aim of this study was to explore knowledge, attitudes and experiences of genitourinary symptoms among women receiving adjuvant endocrine therapy for early breast cancer. Thirty-two semi-structured interviews were conducted and subjected to a rigorous qualitative analysis. Genitourinary symptoms were commonly reported to negatively impact on personal, social and physical activities, were often attributed to anxiety and stress and were a source of embarrassment. Women also commented on the limited information available or provided regarding the potential genitourinary adverse effects of adjuvant endocrine therapy. There was a general lack of awareness that their symptoms could be associated with or exacerbated by adjuvant endocrine therapy. Women indicated a preference to receive information and advice about potential management options from either their general practitioner or specialist. These findings underscore the importance of improving communication and increasing awareness among both clinicians and patients about the potential impact of adjuvant endocrine therapy on genitourinary symptoms.

Human Disease/Clinical Medical Sciences in Dentistry: Current state and future directions of undergraduate teaching in the UK and Ireland.

In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well-placed to shape the HD/CMSD development for the future.

Oral Medicine for undergraduate dental students in the United Kingdom and Ireland-A curriculum.

INTRODUCTION: Oral Medicine focuses on care for patients with chronic, recurrent and medically related disorders of the orofacial region that are distinct from diseases of the periodontal and tooth tissues, with an emphasis on non-surgical management. At present, there are no shared outcomes for Oral Medicine to define the standards to be achieved before new graduates become registered dentists engaged with ongoing professional development. CURRICULUM: We present a consensus undergraduate curriculum in Oral Medicine agreed by representatives from 18 Dental Schools in the United Kingdom and Republic of Ireland. The scope of Oral Medicine practice includes conditions involving the oral mucosa, salivary glands, neurological system or musculoskeletal tissues that are not directly attributable to dental (tooth and periodontium) pathology. Account is taken of the priorities for practice and learning opportunities needed to support development of relevance to independent clinical practice. The outcomes triangulate with the requirements set out by the respective regulatory bodies in the UK and Republic of Ireland prior to first registration and are consistent with the framework for European undergraduate dental education and greater harmonisation of dental education. CONCLUSIONS: This curriculum will act as a foundation for an increasingly shared approach between centres with respect to the outcomes to be achieved in Oral Medicine. The curriculum may also be of interest to others, such as those responsible for the training of dental hygienists and dental therapists. It provides a platform for future collective developments with the overarching goal of raising the quality of patient care.

Sociodemographic, psychosocial and clinical factors associated with uptake of genetic counselling for hereditary cancer: a systematic review.

Evidence suggests that a significant proportion of individuals referred to cancer genetic counselling (GC) do not attend, and thus may not be engaged in adequate cancer risk management. We aimed to review the literature to better understand barriers to accessing GC and how they may be overcome. We conducted a systematic literature search for articles examining factors influencing cancer GC uptake as well as motivators and barriers to GC attendance. Factors were categorised as sociodemographic, psychosocial or clinical. The literature search identified 1413 citations, 35 of which met the inclusion criteria. GC uptake ranged from 19% to 88%. With the exceptions of education level, socioeconomic status, cancer-specific distress, personal cancer diagnosis and actual and perceived risk of cancer, support was lacking for most sociodemographic, clinical and psychosocial factors as predictors of GC uptake. Cost and logistical barriers, emotional concerns, family concerns and low perceived personal relevance were reported as important considerations for those declining GC. We conclude that there is poor understanding of GC and a lack of decision support among those referred to GC. Research into ways of providing education and support to referred individuals will be important as the scope and availability of GC and genetic testing broaden.

Copper(I) Complexes of N-(2-{[(2E)-2-(4-Nitrobenzylidenyl)Hydrazinyl]Carbonyl}Phenyl)Benzamide and Triphenylphosphine: Synthesis, Characterization and Luminescence Properties.

Copper(I) complexes of the formula [Cu(L)(PPh3)2]X (1-4) (X = Cl(1), ClO4(2), BF4(3) and PF6(4)) [where L = N-(2-{[(2E)-2-(4-nitrobenzylidenyl)hydrazinyl]carbonyl}phenyl)benzamide; PPh3 = triphenylphosphine] have been prepared by the condensation of N-[2-(hydrazinocarbonyl)phenyl]benzamide with 4-nitrobenzaldehyde followed by the reaction with CuCl, [Cu(MeCN)4]ClO4, [Cu(MeCN)4]BF4 and [Cu(MeCN)4]PF6 in presence of triphenylphosphine as a coligand. Complexes 1-4 were then characterized by elemental analyses, FTIR, UV-visible and 1H NMR spectroscopy. Mononuclear copper(I) complexes 1-4 were formed with L in its keto form by involvement of azomethine nitrogen and the carbonyl oxygen along with two PPh3 groups. A single crystal X-ray diffraction study of the representative complex [(Cu(L)(PPh3)2]CIO4 (2) reveals a distorted tetrahedral geometry around Cu(I). Crystal data of (2): space group = C2/c, a = 42.8596 (9) Å, b = 14.6207 (3) Å, c = 36.4643 (7) Å, V = 20,653.7 (7) Å3, Z = 16. Complexes 1-4 exhibit quasireversible redox behaviour corresponding to a Cu(I)/Cu(II) couple. All complexes show blue-green emission as a result of fluorescence from an intra-ligand charge transition (ILCT), ligand to ligand charge transfer transition (LLCT) or mixture of both. Significant increase in size of the counter anion shows marked effect on quantum efficiency and lifetime of the complexes in solution.

Do the Elderly Get the Message? A Comparative Study of Stories Produced Verbally and as a Text Message.

When young adults re-tell a story, they naturally produce more concise but sufficiently informative narratives. The repeated narratives of elderly adults, on the other hand, tend towards prolixity. In the present study, participants were explicitly instructed to re-tell a story in a more succinct (but informative format) to investigate whether they were able to produce informative narratives in a compressed format. 30 younger adults ([Formula: see text]) and 30 older adults ([Formula: see text]) constructed a verbal narrative from a series of cartoon frames depicting a story about a cowboy and his horse. Participants then re-told this narrative as a text message. The second narrative produced by the older adult sample did on average contain fewer words, but at the expense of informative content and discourse cohesion. The tendency of older adults to produce longer narratives with re-telling is not merely reflective of a strategic choice but rather reflects a genuine macrolinguistic deficit.

Central venous obstruction in the thorax.

Central venous stenosis and occlusion can occur secondary to a spectrum of conditions ranging from aggressive malignancy to benign extrinsic anatomical compression in otherwise healthy individuals. Irrespective of aetiology, significant morbidity in the acute setting and long term can occur unless prompt accurate diagnosis and appropriate management is initiated, the radiologist being central to both. The present review will provide radiologists with a thorough illustration and explanation of the range of central venous conditions in the thorax (including deep vein thrombosis, thoracic outlet syndrome, haemodialysis, and malignancy related causes), the salient imaging findings and interventional management using case examples from the authors' practice.

An optimization approach for analysing nonlinear stability with transition to turbulence in fluids as an exemplar.

This article introduces and reviews recent work using a simple optimization technique for analysing the nonlinear stability of a state in a dynamical system. The technique can be used to identify the most efficient way to disturb a system such that it transits from one stable state to another. The key idea is introduced within the framework of a finite-dimensional set of ordinary differential equations (ODEs) and then illustrated for a very simple system of two ODEs which possesses bistability. Then the transition to turbulence problem in fluid mechanics is used to show how the technique can be formulated for a spatially-extended system described by a set of partial differential equations (the well-known Navier-Stokes equations). Within that context, the optimization technique bridges the gap between (linear) optimal perturbation theory and the (nonlinear) dynamical systems approach to fluid flows. The fact that the technique has now been recently shown to work in this very high dimensional setting augurs well for its utility in other physical systems.

Genesis of streamwise-localized solutions from globally periodic traveling waves in pipe flow.

The aim in the dynamical systems approach to transitional turbulence is to construct a scaffold in phase space for the dynamics using simple invariant sets (exact solutions) and their stable and unstable manifolds. In large (realistic) domains where turbulence can coexist with laminar flow, this requires identifying exact localized solutions. In wall-bounded shear flows, the first of these has recently been found in pipe flow, but questions remain as to how they are connected to the many known streamwise-periodic solutions. Here we demonstrate that the origin of the first localized solution is in a modulational symmetry-breaking Hopf bifurcation from a known global traveling wave that has twofold rotational symmetry about the pipe axis. Similar behavior is found for a global wave of threefold rotational symmetry, this time leading to two localized relative periodic orbits. The clear implication is that many global solutions should be expected to lead to more realistic localized counterparts through such bifurcations, which provides a constructive route for their generation.

Facial biometrics of peri-oral changes in Crohn's disease.

Crohn's disease is a chronic relapsing and remitting inflammatory condition which affects any part of the gastrointestinal tract. In the oro-facial region, patients can present peri-oral swellings which results in severe facial disfigurement. To date, assessing the degree of facial changes and evaluation of treatment outcomes relies on clinical observation and semi-quantitative methods. In this paper, we describe the development of a robust and reproducible measurement strategy using 3-D facial biometrics to objectively quantify the extent and progression of oro-facial Crohn's disease. Using facial laser scanning, 32 serial images from 13 Crohn's patients attending the Oral Medicine clinic were acquired during relapse, remission, and post-treatment phases. Utilising theories of coordinate metrology, the facial images were subjected to registration, regions of interest identification, and reproducible repositioning prior to obtaining volume measurements. To quantify the changes in tissue volume, scan images from consecutive appointments were compared to the baseline (first scan image). Reproducibility test was performed to ascertain the degree of uncertainty in volume measurements. 3-D facial biometric imaging is a reliable method to identify and quantify peri-oral swelling in Crohn's patients. Comparison of facial scan images at different phases of the disease revealed precisely profile and volume changes. The volume measurements were highly reproducible as adjudged from the 1% standard deviation. 3-D facial biometrics measurements in Crohn's patients with oro-facial involvement offers a quick, robust, economical and objective approach for guided therapeutic intervention and routine assessment of treatment efficacy on the clinic.

Long-term stability of the genome structure of the cyanobacterium, Dolichospermum in a deep German lake.

Dolichospermum is a cyanobacterial genus commonly associated with toxic blooms in lakes and brackish water bodies worldwide, and is a long-term resident of Lake Stechlin, northeastern Germany. In recent decades, shifts in the phosphorus loading and phytoplankton species composition have seen increased biomass of Dolichospermum during summer blooms from 1998, peaking around 2005, and declining after 2020. Cyanobacteria are known to rapidly adapt to new environments, facilitated by genome adaptation. To investigate the changes in genomic features that may have occurred in Lake Stechlin Dolichospermum during this time of increased phosphorus loading and higher biomass, whole genome sequence analysis was performed on samples of ten akinetes isolated from ten, 1 cm segments of a sediment core, representing a ∼45-year period from 1970 to 2017. Comparison of these genomes with genomes of extant isolates revealed a clade of Dolichospermum that clustered with the ADA-6 genus complex, with remarkable genome stability, without gene gain or loss events in response to recent environmental changes. The genome characteristics indicate that this species is suited to a deep-chlorophyll maximum, including additional light-harvesting and phosphorus scavenging genes. Population SNP analysis revealed two sub-populations that shifted in dominance as the lake transitioned between oligotrophic and eutrophic conditions. Overall, the results show little change within the population, despite diversity between extant populations from different geographic locations and the in-lake changes in phosphorus concentrations.

Extracellular matrix determinants and the regulation of cancer cell invasion stratagems.

During development, wound repair and disease-related processes, such as cancer, normal, or neoplastic cell types traffic through the extracellular matrix (ECM), the complex composite of collagens, elastin, glycoproteins, proteoglycans, and glycosaminoglycans that dictate tissue architecture. Current evidence suggests that tissue-invasive processes may proceed by protease-dependent or protease-independent strategies whose selection is not only governed by the characteristics of the motile cell population, but also by the structural properties of the intervening ECM. Herein, we review the mechanisms by which ECM dimensionality, elasticity, crosslinking, and pore size impact patterns of cell invasion. This summary should prove useful when designing new experimental approaches for interrogating invasion programs as well as identifying potential cellular targets for next-generation therapeutics.

Congenital anomalies of the inferior vena cava.

Congenital anomalies of the inferior vena cava (IVC) and its tributaries are increasingly recognized in asymptomatic patients due to the more frequent use of cross-sectional imaging and computed tomography (CT) in particular. IVC development is a complex process involving formation of anastomoses between three pairs of embryonic veins in the 4th to 8th week of gestation. Various permutations occur in the basic venous plan of the abdomen and pelvis resulting in variants such as isolated left IVC, double IVC, and retroaortic left renal vein. The majority of these anomalies are asymptomatic but occasionally present clinically with thromboembolic complications. However, awareness of their existence is important to avoid important diagnostic pitfalls and in preoperative surgical and interventional radiological planning.

Human health risks from mercury exposure from broken compact fluorescent lamps (CFLs).

Human health risk to infants/toddlers and adults was evaluated based on two exposure scenarios from compact fluorescent lamp (CFL) breakage; first in a room with no ventilation and no clean-up, and second in a room with adequate ventilation and clean-up. Concentration data from multiple exposure scenarios tested in a study by Stahler et al. (2008) were compared to human toxicity benchmarks to calculate hazard quotients. For the no clean-up scenario, hazard quotients were generally less than 1, suggesting an unlikely health risk. When the room was ventilated and the broken CFL was cleaned-up, mercury concentrations were generally lower. A review of release scenarios, along with duration-adjusted toxicity benchmarks, indicated that few releases produced levels of concern, but some scenarios resulted in exceedance of risk targets and require further study. Uncertainties in this screening characterization include assumptions about room size, ventilation, age of lamp, the distribution of mercury in the room, and also the choice of the toxicity benchmarks used to develop the hazard quotients.

Incidence of Parkinson disease in North America.

Parkinson disease (PD) is the second most common age-related neurodegenerative condition diagnosed in North America. We recently demonstrated, using multiple epidemiological data sources, that the prevalence of PD diagnoses was greater than previously reported and currently used for clinical, research, and policy decision-making. Prior PD incidence estimates have varied, for unclear reasons. There is a need for improved estimates of PD incidence, not only for care delivery planning and future policy but also for increasing our understanding of disease risk. The objective of this study was thus to investigate the incidence of Parkinson disease across five epidemiological cohorts in North America in a common year, 2012. The cohorts contained data on 6.7 million person-years of adults ages 45 and older, and 9.3 million person-years of adults ages 65 and older. Our estimates of age-sex-adjusted incidence of PD ranged from 108 to 212 per 100,000 among persons ages 65 and older, and from 47 to 77 per 100,00 among persons ages 45 and older. PD incidence increased with age and was higher among males. We also found persistent spatial clustering of incident PD diagnoses in the U.S. PD incidence estimates varied across our data sources, in part due to case ascertainment and diagnosis methods, but also possibly due to the influence of population factors (prevalence of genetic risk factors or protective markers) and geographic location (exposure to environmental toxins). Understanding the source of these variations will be important for health care policy, research, and care planning.