Understanding young adult Muslim and Christian attitudes toward queer identity: A Canadian and UK comparison.

This article utilises data from two parallel mixed-methods projects to examine attitudes to queer identity among heterosexual Muslim and Christian young adults aged between 18 and 25 in Canada and the UK. Drawing on questionnaires, interviews and video diaries, our analysis revealed the enormous complexity regarding how participants made sense of their, largely contextually mediated, attitudes. A qualitative approach enabled us to carefully consider how these attitudes are forged, formulated and embodied, offering greater nuance and detail compared with attitudinal approaches focused solely on quantitative data. Responses by these young Muslim and Christian participants explore the fluidity and movement in the attitudes expressed, further emphasising complexity.

Chronic opioid exposure differentially modulates oxycodone self-administration in male and female rats.

Withdrawal from opioid painkillers can produce short-lived physical symptoms and protracted psychological symptoms including anxiety and depressive-like states that often lead to opioid misuse and opioid use disorder (OUD). Studies testing the hypothesis that opioid withdrawal potentiates the reinforcing effects of opioid self-administration (SA) are largely inconclusive and have focused on males. Although some clinical evidence indicates that women are more likely than men to misuse opioids to self-medicate, preclinical studies in both sexes are lacking. Based on clinical reports, we hypothesized that withdrawal from escalating-dose morphine injections that approximates a prescription painkiller regimen would lead to increased oxycodone SA to a greater extent in female compared to male rats. After escalating-dose morphine (5-30 mg/kg or vehicle, twice/day for 12 days), rats underwent a 2-week abstinence period during which withdrawal signs were measured. The impact of this treatment was assessed on oxycodone SA acquisition, maintenance, dose response, and progressive ratio responding, with additional analyses to compare sexes. We found that both sexes expressed somatic withdrawal, whereas only males demonstrated hyperalgesia in the warm water tail flick assay. During SA acquisition, males with prior morphine exposure took significantly more oxycodone than females. Finally, females with prior morphine exposure demonstrated the lowest motivation to SA oxycodone in the progressive ratio test. Contrary to our initial hypothesis, our findings suggest that prior opioid exposure increases vulnerability to initiate misuse more in males and decreases the reinforcing efficacy of oxycodone in females.

Outcomes in Dialysis-Dependent Indigenous and Non-Indigenous Patients Undergoing Cardiac Surgery at Townsville University Hospital.

PURPOSE: Dialysis-dependent patients have a high risk of cardiovascular death but also a high risk for perioperative mortality in cardiac surgery. Our study examined surgical complications and mortality in Indigenous and non-Indigenous dialysis-dependent patients undergoing cardiac surgery at a single centre. METHODOLOGY: The retrospective study reviewed 72 consecutive dialysis-dependent patients who underwent cardiac surgery between 2008 and 2018. Data was prospectively collected, and follow-up was obtained from physicians and general practitioners. Multivariable analysis was performed to determine predictors of mortality. RESULTS: The median age of Indigenous Australian patients was 60 years, compared with 65 years for non-Indigenous patients. Indigenous Australian patients had a significantly higher rate of return to theatre (43% versus 17%). The predominant reason for return to theatre for the whole cohort was postoperative bleeding (n=16, 22%). The overall early mortality rate was 10%. There were 35 late deaths (49%) and overall survival at 5 years was 40.92±6.8% (95% CI: 28-54%). History of arrhythmia (p=0.019) was a significant risk factor for mortality, whilst patients who underwent isolated coronary artery bypass grafting (p=0.004), and those who received internal mammary artery grafts (p=0.021) had a reduced hazard ratio for mortality. The median follow-up time was 29 months (IQR 10-52 mo). CONCLUSION: Dialysis-dependent Indigenous Australian patients present younger for cardiac surgery, with a higher prevalence of co-morbid diabetes and more extensive coronary artery disease. There was no statistically significant difference in early or late mortality between Indigenous and non-Indigenous patients. However, there was a higher rate of return to theatre amongst the Indigenous Australian cohort.

Behavioral Pharmacology of Novel Kappa Opioid Receptor Antagonists in Rats.

BACKGROUND: New treatments for stress-related disorders including depression, anxiety, and substance use disorder are greatly needed. Kappa opioid receptors are expressed in the central nervous system, including areas implicated in analgesia and affective state. Although kappa opioid receptor agonists share the antinociceptive effects of mu opioid receptor agonists, they also tend to produce negative affective states. In contrast, selective kappa opioid receptor antagonists have antidepressant- and anxiolytic-like effects, stimulating interest in their therapeutic potential. The prototypical kappa opioid receptor antagonists (e.g., norBNI, JDTic) have an exceptionally long duration of action that complicates their use in humans, particularly in tests to establish safety. This study was designed to test dose- and time-course effects of novel kappa opioid receptor antagonists with the goal of identifying short-acting lead compounds for future medication development. METHODS: We screened 2 novel, highly selective kappa opioid receptor antagonists (CYM-52220 and CYM-52288) with oral efficacy in the warm water tail flick assay in rats to determine initial dose and time course effects. For comparison, we tested existing kappa opioid receptor antagonists JDTic and LY-2456302 (also known as CERC-501 or JNJ-67953964). RESULTS: In the tail flick assay, the rank order of duration of action for the antagonists was LY-2456302 < CYM-52288 < CYM-52220 << JDTic. Furthermore, LY-2456302 blocked the depressive (anhedonia-producing) effects of the kappa opioid receptor agonist U50,488 in the intracranial self-stimulation paradigm, albeit at a higher dose than that needed for analgesic blockade in the tail flick assay. CONCLUSIONS: These results suggest that structurally diverse kappa opioid receptor antagonists can have short-acting effects and that LY-2456302 reduces anhedonia as measured in the intracranial self-stimulation test.

Left Atrial Appendage Exclusion Using the AtriClip Device: A Case Series.

BACKGROUND: Atrial fibrillation (AF) affects 1.5-2% of the population and is associated with a five-fold increased lifetime risk of stroke [1]. The left atrial appendage (LAA) is the source of embolic strokes in up to 90% of patients with non-valvular AF with clots in the left atrium [2]. METHODS: We reviewed the clinical notes and echocardiographic findings of 20 patients who underwent open cardiac surgery in which concurrent AtriClip (Atricure Inc, Westchester, OH, USA) device insertion was attempted at our institution from July 2013 to February 2015. This was to examine the safety and efficacy of LAA exclusion with clip devices during open cardiac surgery. Indications for LAA exclusion included a history or suspicion of atrial arrhythmia, left ventricular dilatation, or a history of transient ischaemic attacks. RESULTS: All 20 of the 20 participants had successful placement of the clip device (100% success rate). There were no adverse events related to the device and no perioperative mortality. There were three late deaths due to chronic obstructive pulmonary disease (COPD), leukaemia, and refractory congestive cardiac failure. No late device related complications were found on follow-up imaging in the remaining patients. CONCLUSIONS: The results of our study demonstrate the LAA exclusion during open cardiac surgery with the AtriClip device is safe, has a 100% success rate, and appears to be stable over time.

Acrodermatitis Dysmetabolica in a Child with Cystic Fibrosis.

Acrodermatitis dysmetabolica is an umbrella term encompassing the other metabolic causes of an erosive periorificial and acral dermatitis that mimics acrodermatitis enteropathica. Causes include acquired zinc, amino acid, biotin, and fatty acid deficiencies. We present the case of an exclusively breastfed, 2-month-old boy with known cystic fibrosis admitted with failure to thrive and erosive dermatitis. A diagnosis of acrodermatitis dysmetabolica was made when investigations revealed a normal zinc level but low amino acid levels.

Atopic dermatitis in children.

BACKGROUND: Atopic dermatitis is a frequent reason for presentation to general practice. A large number of children are affected by this condition and its treatment can cause significant anxiety for parents. The role of the general practitioner (GP) is to provide advice and allay concerns regarding conventional and alternative treatments. OBJECTIVE: The aim of this article is to provide an overview of atopic dermatitis management in children in the general practice setting. This article also reviews when it is necessary to refer to specialists, the evidence for management and the link to allergies. DISCUSSION: Prescribing topical steroids to young children with atopic dermatitis involves a thorough understanding of this condition. Achieving treatment compliance partly involves providing adequate explanation to parents in order to reduce their concerns regarding the long-term side effects of topical corticosteroids. Making GPs confident and knowledgeable about atopic dermatitis will make the interaction between the practitioner, families and children more rewarding.

Mycophenolic acid in dermatology a century after its discovery.

Mycophenolic acid was first discovered in 1913 and first used clinically in the 1970s as an immunosuppressant to prevent organ transplantation rejection. It was later used in the treatment of psoriasis. However due to its side-effect profile and fears over its carcinogenic potential it was abandoned. From the late 1990s a prodrug, mycophenolate mofetil (MMF), was developed and more recently, enteric-coated mycophenolate sodium (EC-MPS), both of which have gained increasing use in the field of dermatology for a variety of skin conditions. This review discusses the pharmacology, mechanisms of action, side-effects and current clinical applications in dermatology of MMF and EC-MPS.

On the use of hydroxyl radical kinetics to assess the number-average molecular weight of dissolved organic matter.

Dissolved organic matter (DOM) is involved in numerous environmental processes, and its molecular size is important in many of these processes, such as DOM bioavailability, DOM sorptive capacity, and the formation of disinfection byproducts during water treatment. The size and size distribution of the molecules composing DOM remains an open question. In this contribution, an indirect method to assess the average size of DOM is described, which is based on the reaction of hydroxyl radical (HO(•)) quenching by DOM. HO(•) is often assumed to be relatively unselective, reacting with nearly all organic molecules with similar rate constants. Literature values for HO(•) reaction with organic molecules were surveyed to assess the unselectivity of DOM and to determine a representative quenching rate constant (k(rep) = 5.6 × 10(9) M(-1) s(-1)). This value was used to assess the average molecular weight of various humic and fulvic acid isolates as model DOM, using literature HO(•) quenching constants, kC,DOM. The results obtained by this method were compared with previous estimates of average molecular weight. The average molecular weight (Mn) values obtained with this approach are lower than the Mn measured by other techniques such as size exclusion chromatography (SEC), vapor pressure osmometry (VPO), and flow field fractionation (FFF). This suggests that DOM is an especially good quencher for HO(•), reacting at rates close to the diffusion-control limit. It was further observed that humic acids generally react faster than fulvic acids. The high reactivity of humic acids toward HO(•) is in line with the antioxidant properties of DOM. The benefit of this method is that it provides a firm upper bound on the average molecular weight of DOM, based on the kinetic limits of the HO(•) reaction. The results indicate low average molecular weight values, which is most consistent with the recent understanding of DOM. A possible DOM size distribution is discussed to reconcile the small nature of DOM with the large-molecule behavior observed in other studies.

Photooxidation-induced changes in optical, electrochemical, and photochemical properties of humic substances.

Two aquatic fulvic acids and one soil humic acid were irradiated to examine the resulting changes in the redox and photochemical properties of the humic substances (HS), the relationship between these changes, and their relationship to changes in the optical properties. For all HS, irradiation caused photooxidation, as shown by decreasing electron donating capacities. Photooxidation was accompanied by decreases in specific UV absorbance and increases in the E2/E3 ratio (254 nm absorbance divided by that at 365 nm). In contrast, photooxidation had little effect on the samples' electron accepting capacities. The coupled changes in optical and redox properties for the different HS suggest that phenols are an important determinant of aquatic HS optical properties and that quinones may play a more important role in soil HS. Apparent quantum yields of H2O2, ·OH, and triplet HS decreased with photooxidation, thus demonstrating selective destruction of HS photosensitizing chromophores. In contrast, singlet oxygen ((1)O2) quantum yields increased, which is ascribed to either decreased (1)O2 quenching within the HS microenvironment or the presence of a pool of photostable sensitizers. The photochemical properties show clear trends with SUVA and E2/E3, but the trends differ substantially between aquatic and soil HS. Importantly, photooxidation produces a relationship between the (1)O2 quantum yield and E2/E3 that differs distinctly from that observed with untreated HS. This finding suggests that there may be watershed-specific correlations between HS chemical and optical properties that reflect the dominant processes controlling the HS character.

Women, Addictions, Mental Health, Dishonesty, and Crime Stigma: Solutions to Reduce the Social Harms of Stigma.

British drug policies could underserve women with treatment needs, and this paper provides evidence that communication through the words and actions of professionals across drug and alcohol services, health and mental health, social work and the criminal justice sector can leave women feeling stigmatised and failed. Women live with the stigma of 'the lying addict'; however, documents and courtroom statements provided by professionals can misrepresent women's experiences, which exacerbates social harm. Data are drawn from feminist participatory action research, where female lived experience experts worked alongside academics to implement a qualitative study using interviews and focus groups with women using treatment services (n = 28) and an online world café with professionals working with these women (n = 9) and further professionals providing support at lived experience data collection events (n = 5). This data set is cross-referenced with one-to-one and small-group interviews with professionals in the field (n = 17) conducted by a third-sector partner. Findings establish that stigma negatively impacts the identification of treatment needs and access to timely and appropriate service delivery. Social harms to women with addictions could be significantly reduced with timely, authentic, honest, gender-informed and trauma-informed practices for girls and women using drugs and alcohol to self-medicate from traumatic experiences.

Stakeholder Perspectives on Research, Policy and Practice Priorities to Increase Human Milk Feeding Rates in the United Kingdom.

BACKGROUND: Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support. RESEARCH AIM: The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part. METHODS: The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months. RESULTS: Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support. CONCLUSION: World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development.

Dark formation of hydroxyl radical in Arctic soil and surface waters.

Hydroxyl radical (•OH) is a highly reactive and unselective oxidant in atmospheric and aquatic systems. Current understanding limits the role of DOM-produced •OH as an oxidant in carbon cycling mainly to sunlit environments where •OH is produced photochemically, but a recent laboratory study proposed a sunlight-independent pathway in which •OH forms during oxidation of reduced aquatic dissolved organic matter (DOM) and iron. Here we demonstrate this non-photochemical pathway for •OH formation in natural aquatic environments. Across a gradient from dry upland to wet lowland habitats, •OH formation rates increase with increasing concentrations of DOM and reduced iron, with highest •OH formation predicted at oxic-anoxic boundaries in soil and surface waters. Comparison of measured vs expected electron release from reduced moieties suggests that both DOM and iron contribute to •OH formation. At landscape scales, abiotic DOM oxidation by this dark •OH pathway may be as important to carbon cycling as bacterial oxidation of DOM in arctic surface waters.

Simultaneous bilingual language acquisition: The role of parental input on receptive vocabulary development.

Parents often turn to educators and healthcare professionals for advice on how to best support their child's language development. These professionals frequently suggest implementing the 'one-parent-one-language' approach to ensure consistent exposure to both languages. The goal of this study was to understand how language exposure influences the receptive vocabulary development of simultaneous bilingual children. To this end, we targeted nine German-French children growing up in bilingual families. Their exposure to each language within and outside the home was measured, as were their receptive vocabulary abilities in German and French. The results indicate that children are receiving imbalanced exposure to each language. This imbalance is leading to a slowed development of the receptive vocabulary in the minority language, while the majority language is keeping pace with monolingual peers. The one-parent-one-language approach does not appear to support the development of both of the child's languages in the context described in the present study. Bilingual families may need to consider other options for supporting the bilingual language development of their children. As professionals, we need to provide parents with advice that is based on available data and that is flexible with regards to the current and future needs of the child and his family.

Chiropractic management of a U.S. Veteran with myofascial pain and concurrent distal bimelic amyotrophy (Hirayama disease): a case report.

Background: Distal bimelic amyotrophy (DBMA) also known as Hirayama disease, is a rare, self-limiting motor neuron disease manifesting as atrophy of C7-T1 innervated muscles. We present a case report describing the chiropractic management of neck and thoracic pain in a patient with known DBMA. Case presentation: A 30 year-old black male U.S. veteran with DBMA presented with myofascial pain of the neck, shoulder, and back. A trial of chiropractic care was undertaken involving spinal manipulation of the thoracic spine and cervicothoracic region, manual and instrument-assisted soft tissue mobilization, and home exercise prescription. The patient reported modest improvement in pain intensity and did not experience any adverse events. Summary: This case presents the first documentation of chiropractic services in musculoskeletal pain management of a patient with concurrent DBMA. At this time there is no guidance in the existing body of literature for the safety and effectiveness of manual therapy in this population.

Contexte: La myélopathie cervicale basse, également connue sous le nom de maladie d'Hirayama, est une maladie rare et spontanément résolutive du motoneurone qui se manifeste par une atrophie des muscles innervés C7-T1. Nous présentons un rapport de cas décrivant la prise en charge chiropratique de douleurs cervicales et thoraciques chez un patient atteint d'une maladie d'Hirayama connue. Présentation du cas: Un vétéran américain noir de 30 ans, atteint de myélopathie cervicale basse, s'est présenté avec des douleurs myofasciales au cou, aux épaules et au dos. Un essai de soins chiropratiques a été entrepris comprenant des manipulations vertébrales de la colonne thoracique et de la région cervicothoracique, des mobilisations manuelles et instrumentales des tissus mous, et la prescription d'exercices à domicile. Le patient a fait état d'une amélioration modeste de l'intensité de la douleur et n'a pas ressenti d'effets indésirables. Résumé: Ce cas présente la première documentation des services chiropratiques dans la gestion de la douleur musculo-squelettique d'un patient souffrant d'une myélopathie cervicale basse. À l'heure actuelle, il n'existe pas d'orientation dans la littérature existante sur la sécurité et l'efficacité de la thérapie manuelle dans cette population.

Hydroxyl radical formation upon oxidation of reduced humic acids by oxygen in the dark.

Humic acids (HAs) accept and donate electrons in many biogeochemical redox reactions at oxic/anoxic interfaces. The products of oxidation of reduced HAs by O(2) are unknown but are expected to yield reactive oxygen species, potentially including hydroxyl radical (·OH). To quantify the formation of ·OH upon oxidation of reduced HAs by O(2), three HAs were reduced electrochemically to well-defined redox states and were subsequently oxidized by O(2) in the presence of the ·OH probe terephthalate. The formation of ·OH upon oxidation increased with increasing extent of HA reduction. The yield of ·OH ranged from 42 to 160 mmol per mole of electrons donated by the reduced HA. The intermediacy of hydrogen peroxide (H(2)O(2)) in the formation of ·OH was supported by enhancement of ·OH formation upon addition of exogenous H(2)O(2) sources and by the suppression of ·OH formation upon addition of catalase as a quencher of endogenous H(2)O(2). The formation of ·OH in the dark during oxidation of reduced HA represents a previously unknown source of ·OH formation at oxic/anoxic interfaces and may affect the biogeochemical and pollutant redox dynamics at these interfaces.

Use of MRI for evaluation of retained uterine fundus mimicking a pelvic mass.

Increased use of less invasive hysterectomy techniques requires awareness of the unique potential complications they pose in patients with continued symptoms after surgery. Retained uterine fundus is rare after vaginal hysterectomy; only 2 other cases have been reported in the English literature. Magnetic resonance imaging (MRI) was not used preoperatively in either case. However, imaging evaluation, in particular with MRI because of its superior soft tissue resolution, can be helpful in suggesting the diagnosis. Herein is presented the case of a 40-year-old woman who had undergone vaginal hysterectomy several years previously, but was experiencing abdominal pain. MRI was performed, which revealed a supravesical mass. Visualization at MRI of intact round ligaments arising from the mass favored the diagnosis of retained uterine fundus and confirmed after surgical excision.

The effect of cardiopulmonary bypass on blood thiamine concentration and its association with post-operative lactate concentration.

OBJECTIVE: Cardiothoracic surgery is a large field in Australia, and evidence suggests post-cardiopulmonary bypass (CPB) hyperlactataemia is associated with higher morbidity and mortality. Low thiamine levels are a potentially common yet treatable cause of hyperlactataemia and may occur in the setting of exposure to CPB non-biological material. We hypothesized that cardiopulmonary bypass would result in decreased whole-blood thiamine levels, which may therefore result in increased whole-blood lactate levels in the post-operative period. METHODS: Adult patients undergoing non-emergent CPB were recruited in a single centre, prospective, analytic observational study at Townsville University Hospital, Australia. The primary outcome was a comparison of pre- and post-CPB thiamine diphosphate level, secondarily aiming to assess any relationship between lactate and thiamine levels. Prospective pre- and post-CPB blood samples were taken and analysed at a central reference laboratory. RESULTS: Data was available for analysis on 78 patients. There was a statistically significant increase in thiamine diphosphate level from pre-CPB: 1.36 nmol/g Hb, standard deviation (SD) 0.31, 95% confidence intervals (CI) 1.29-1.43, to post-CPB: 1.77 nmol/g Hb, SD 0.53, 95% CI 1.43-1.88, p value < 0.001. There was a non-statistically significant (p > 0.05) trend in rising whole-blood lactate levels with increasing time. Analysis of lactate levels at varying time periods found a significant difference between baseline measurements and increased levels at 13-16 h (p < 0.05). There was no significant relationship observed between whole-blood thiamine levels and post-operative lactate levels. CONCLUSION: Whole-blood thiamine levels were found to increase immediately post-CPB in those undergoing elective cardiac surgery. There was no correlation between whole-blood thiamine levels and post-operative arterial lactate levels.