Alcohol Use and HIV Prevention Among Personnel in the Belize Defence Force.

To evaluate the effect of a peer-based risk reduction project on alcohol use and sexual behavior within Belize Defence Force personnel. We used a quasi-experimental, mixed quantitative and qualitative methods design to evaluate project outcomes. Two serial cross-sectional surveys were conducted [baseline (n = 126) and 6-month follow-up (n = 128)] using computer assisted self-interview. Semistructured interviews were collected from 12 peer counselors 3 months after the beginning of the project. The proportion of respondents screening positive for alcohol dependence decreased significantly from 80 % at preintervention to 66 % at postintervention (p = 0.045), and the percentage of respondents reporting that they normally drink alcohol before work decreased from 11 to 3 % (p = 0.013). Alcohol abuse and dependency scores correlated positively with the overall number of sexual partners in both male and female respondents. There was a slight decrease in the percentage of female respondents' reporting inconsistent condom use for vaginal sex (baseline 100 %, follow-up 83 %, p = 0.088), but there was no appreciable change reported in condom use among male respondents. Qualitative findings suggest that techniques to reduce the quantity of alcohol consumed were a salient focus of peer counselors, and administrative barriers can readily mitigate implementation of such interventions. In this evaluation of a risk reduction program with the BDF, we found evidence of a reduction in types of alcohol use from baseline to follow-up. Alcohol-related risk reductions carry implications for reducing sexual risk behavior in military personnel. Future research with stronger experimental design strategies may better elucidate how substance use reduction is linked with sexual risk reduction in military personnel.

Contraceptive continuation in Hispanic women.

OBJECTIVE: The purpose of this study was to examine the effect of Hispanic ethnicity on the continuation and satisfaction of reversible contraceptive methods. STUDY DESIGN: We analyzed 12 months of data that were collected from 7913 participants in the Contraceptive CHOICE Project. Kaplan-Meier survival curves were used to estimate continuation, and Cox proportional hazard models were used to estimate the risk of discontinuation. RESULTS: Hispanic women were more likely to choose a long-acting reversible contraceptive (LARC) method compared with non-Hispanic black and non-Hispanic white women (80%, 73%, and 75%, respectively; P < .05). The 12-month continuation rates were higher for LARC methods than combined hormonal methods for all race/ethnicity (Hispanic women, 87% vs 40%; non-Hispanic black women, 85% vs 46%; non-Hispanic white women, 87% vs 56%). There was no statistical difference in discontinuation of LARC methods at 12 months. Eighty percent of LARC users reported high satisfaction levels at 12 months, regardless of race/ethnicity. CONCLUSION: Hispanic women in the Contraceptive CHOICE Project experienced high continuation and satisfaction for LARC methods, similar to women of other ethnicities.

[Diabetic nephropathy: current diagnostics and treatment]. / Diabetische Nephropathie: Aktuelle Diagnostik und Therapie.

Diabetic kidney disease is a leading cause of renal failure in Germany. Albuminuria is an early diagnostic indicator of renal damage in diabetes and, aside from renal failure, a major risk factor of cardiovascular disease. An early diagnosis of diabetic kidney disease is of great importance to reduce associated cardiovascular mortality; glycemic control should aim for HbA1c levels of < 7 %. Guidelines on blood pressure differ, but it should generally be reduced to < 140/90 mmHg; stricter limits should be applied if albuminuria is present. ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARB) should be preferred for blood pressure control. A combination of ACE-Is and ARBs or a renin-inhibitor therapy does not improve cardiovascular outcome, instead it increases the rate of adverse events, e.g., hyperkalemia or renal failure. Lipid control, usually with statins, should be started at an early phase of renal failure. Vitamin D receptor activation and uric acid reduction might play a future role in the treatment of diabetic kidney disease. Pharmacological modification of inflammatory signaling appears to be promising but is not yet of clinical relevance.

Lessons learned from microsatellite development for nonmodel organisms using 454 pyrosequencing.

Microsatellites, also known as simple sequence repeats (SSRs), are among the most commonly used marker types in evolutionary and ecological studies. Next Generation Sequencing techniques such as 454 pyrosequencing allow the rapid development of microsatellite markers in nonmodel organisms. 454 pyrosequencing is a straightforward approach to develop a high number of microsatellite markers. Therefore, developing microsatellites using 454 pyrosequencing has become the method of choice for marker development. Here, we describe a user friendly way of microsatellite development from 454 pyrosequencing data and analyse data sets of 17 nonmodel species (plants, fungi, invertebrates, birds and a mammal) for microsatellite repeats and flanking regions suitable for primer development. We then compare the numbers of successfully lab-tested microsatellite markers for the various species and furthermore describe diverse challenges that might arise in different study species, for example, large genome size or nonpure extraction of genomic DNA. Successful primer identification was feasible for all species. We found that in species for which large repeat numbers are uncommon, such as fungi, polymorphic markers can nevertheless be developed from 454 pyrosequencing reads containing small repeat numbers (five to six repeats). Furthermore, the development of microsatellite markers for species with large genomes was also with Next Generation Sequencing techniques more cost and time-consuming than for species with smaller genomes. In this study, we showed that depending on the species, a different amount of 454 pyrosequencing data might be required for successful identification of a sufficient number of microsatellite markers for ecological genetic studies.

Joint Inversion of GNSS and GRACE for Terrestrial Water Storage Change in California.

Global Navigation Satellite System (GNSS) vertical displacements measuring the elastic response of Earth's crust to changes in hydrologic mass have been used to produce terrestrial water storage change (∆TWS) estimates for studying both annual ∆TWS as well as multi-year trends. However, these estimates require a high observation station density and minimal contamination by nonhydrologic deformation sources. The Gravity Recovery and Climate Experiment (GRACE) is another satellite-based measurement system that can be used to measure regional TWS fluctuations. The satellites provide highly accurate ∆TWS estimates with global coverage but have a low spatial resolution of ∼400 km. Here, we put forward the mathematical framework for a joint inversion of GNSS vertical displacement time series with GRACE ∆TWS to produce more accurate spatiotemporal maps of ∆TWS, accounting for the observation errors, data gaps, and nonhydrologic signals. We aim to utilize the regional sensitivity to ∆TWS provided by GRACE mascon solutions with higher spatial resolution provided by GNSS observations. Our approach utilizes a continuous wavelet transform to decompose signals into their building blocks and separately invert for long-term and short-term mass variations. This allows us to preserve trends, annual, interannual, and multi-year changes in TWS that were previously challenging to capture by satellite-based measurement systems or hydrological models, alone. We focus our study in California, USA, which has a dense GNSS network and where recurrent, intense droughts put pressure on freshwater supplies. We highlight the advantages of our joint inversion results for a tectonically active study region by comparing them against inversion results that use only GNSS vertical deformation as well as with maps of ∆TWS from hydrological models and other GRACE solutions. We find that our joint inversion framework results in a solution that is regionally consistent with the GRACE ∆TWS solutions at different temporal scales but has an increased spatial resolution that allows us to differentiate between regions of high and low mass change better than using GRACE alone.

Enhanced self-renewal of human pluripotent stem cells by simulated microgravity.

A systematic study on the biological effects of simulated microgravity (sµg) on human pluripotent stem cells (hPSC) is still lacking. Here, we used a fast-rotating 2-D clinostat to investigate the sµg effect on proliferation, self-renewal, and cell cycle regulation of hPSCs. We observed significant upregulation of protein translation of pluripotent transcription factors in hPSC cultured in sµg compared to cells cultured in 1g conditions. In addition to a significant increase in expression of telomere elongation genes. Differentiation experiments showed that hPSC cultured in sµg condition were less susceptible to differentiation compared to cells in 1g conditions. These results suggest that sµg enhances hPSC self-renewal. Our study revealed that sµg enhanced the cell proliferation of hPSCs by regulating the expression of cell cycle-associated kinases. RNA-seq analysis indicated that in sµg condition the expression of differentiation and development pathways are downregulated, while multiple components of the ubiquitin proteasome system are upregulated, contributing to an enhanced self-renewal of hPSCs. These effects of sµg were not replicated in human fibroblasts. Taken together, our results highlight pathways and mechanisms in hPSCs vulnerable to microgravity that imposes significant impacts on human health and performance, physiology, and cellular and molecular processes.

Rupture prone aneurysm of the inferior mesenteric artery complicated by mid aortic syndrome with occluded celiac and superior mesenteric arteries.

We present the case of a 45-year-old male patient with a large aneurysm of the inferior mesenteric artery complicated by mid aortic syndrome with occlusion of the celiac trunk and superior mesenteric artery. The vascular pathology was detected by CT imaging after presentation and hospitalization with symptoms of acute cholecystitis. After resolve of the acute symptoms, the aneurysm was resected and the proximal inferior mesenteric artery interponated with a reversed saphenous vein bypass graft. Besides presenting this case we review the literature concerning the rare descriptions of inferior mesenteric artery aneurysms.

Animal board invited review: Animal agriculture and alternative meats - learning from past science communication failures.

Sustainability discussions bring in multiple competing goals, and the outcomes are often conflicting depending upon which goal is being given credence. The role of livestock in supporting human well-being is especially contentious in discourses around sustainable diets. There is considerable variation in which environmental metrics are measured when describing sustainable diets, although some estimate of the greenhouse gas (GHG) emissions of different diets based on varying assumptions is commonplace. A market for animal-free and manufactured food items to substitute for animal source food (ASF) has emerged, driven by the high GHG emissions of ASF. Ingredients sourced from plants, and animal cells grown in culture are two approaches employed to produce alternative meats. These can be complemented with ingredients produced using synthetic biology. Alternative meat companies promise to reduce GHG, the land and water used for food production, and reduce or eliminate animal agriculture. Some CEOs have even claimed alternative meats will 'end world hunger'. Rarely do such self-proclamations emanate from scientists, but rather from companies in their efforts to attract venture capital investment and market share. Such declarations are reminiscent of the early days of the biotechnology industry. At that time, special interest groups employed fear-based tactics to effectively turn public opinion against the use of genetic engineering to introduce sustainability traits, like disease resistance and nutrient fortification, into global genetic improvement programs. These same groups have recently turned their sights on the 'unnaturalness' and use of synthetic biology in the production of meat alternatives, leaving agriculturists in a quandary. Much of the rationale behind alternative meats invokes a simplistic narrative, with a primary focus on GHG emissions, ignoring the nutritional attributes and dietary importance of ASF, and livelihoods that are supported by grazing ruminant production systems. Diets with low GHG emissions are often described as sustainable, even though the nutritional, social and economic pillars of sustainability are not considered. Nutritionists, geneticists, and veterinarians have been extremely successful at developing new technologies to reduce the environmental footprint of ASF. Further technological developments are going to be requisite to continuously improve the efficiency of animal source, plant source, and cultured meat production. Perhaps there is an opportunity to collectively communicate how innovations are enabling both alternative- and conventional-meat producers to more sustainably meet future demand. This could counteract the possibility that special interest groups who promulgate misinformation, fear and uncertainty, will hinder the adoption of technological innovations to the ultimate detriment of global food security.

Seasonal and Long-Term Groundwater Unloading in the Central Valley Modifies Crustal Stress.

Changes in terrestrial water content cause elastic deformation of the Earth's crust. This deformation is thought to play a role in modulating crustal stress and seismicity in regions where large water storage fluctuations occur. Groundwater is an important component of total water storage change in California, helping to drive annual water storage fluctuations and loss during periods of drought. Here we use direct estimates of groundwater volume loss during the 2007-2010 drought in California's Central Valley obtained from high resolution Interferometric Synthetic Aperture Radar-based vertical land motion data to investigate the effect of groundwater volume change on the evolution of the stress field. We show that GPS-derived elastic load models may not capture the contribution of groundwater to terrestrial water loading, resulting in an underestimation of nontectonic crustal stress change. We find that groundwater unloading during the drought causes Coulomb stress change of up to 5.5 kPa and seasonal fluctuations of up to 2.6 kPa at seismogenic depth. We find that faults near the Valley show the largest stress change and the San Andreas fault experiences only ~40 Pa of Coulomb stress change over the course of a year from groundwater storage change. Annual Coulomb stress change peaks dominantly in the fall, when the groundwater level is low; however, some faults experience peak stress in the spring when groundwater levels are higher. Additionally, we find that periods of increased stress correlate with higher than average seismic moment release but are not correlated with an increase in the number of earthquakes. This indicates groundwater loading likely contributes to nontectonic loading of faults, especially near the Valley edge, but is not a dominant factor in modulation of seismicity in California because the amplitude of stress change declines rapidly with distance from the Valley. By carefully quantifying and spatially locating groundwater fluctuations, we will improve our understanding of what drives nontectonic stress and forces that modulate seismicity in California.

Characterization of three GLOBOSA-like MADS-box genes from maize: evidence for ancient paralogy in one class of floral homeotic B-function genes of grasses.

Floral homeotic B-function genes are involved in specifying the identity of petals and stamens during flower development in higher eudicotyledonous plants. Monocotyledonous plants belonging to the grass family (Poaceae) have very similar B-function genes, except that these genes specify lodicules rather than petals. All B-function genes known so far are members of the MADS-box gene family encoding transcription factors. In some eudicot model systems such as Arabidopsis and Antirrhinum, the B-function is provided by heterodimeric protein complexes encoded by one DEF- and one GLO-like gene. In several different lineages of flowering plant species, however, more than one DEF- or GLO-like gene is found. A known example is the monocot model system rice, which contains two GLO-like genes, termed OSMADS2 and OSMADS4. Duplications of floral homeotic genes may have played a critical role in the diversification of floral homeotic functions and thus the evolution of flowers. In order to date the gene duplication event that gave rise to these two genes, we cloned cDNAs of three different GLO-like genes from maize, a distant relative of rice within the Poaceae family. Phylogeny reconstructions and chromosomal mapping indicate that one of these genes, named ZMM16, is orthologous to OSMADS2, and that the other two, ZMM18 and ZMM29, are probably orthologous to OSMADS4. The gene duplication which gave rise to OSMADS2- and OSMADS4-like genes occurred probably after the split of the lineages that resulted in extant Liliaceae and Poaceae, but before the separation of the lineages that gave rise to extant maize and rice about 50 MYA. Northern and in situ hybridization studies demonstrated that the maize genes are expressed in lodicules, stamens and carpels throughout spikelet development in male and female inflorescences. The GLO-like genes from rice have very similar patterns of mRNA accumulation. In addition, ZMM16 shows also weak expression in vegetative organs. Conservation of the expression in lodicules and stamens is in perfect agreement with a floral homeotic B-function of the GLO-like genes in grasses. The conserved expression in carpels is discussed. Moreover, circumstantial evidence for a functional diversification of GLO-like genes in grasses is provided.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

BACKGROUND: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  OBJECTIVES: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  METHODS: We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  RESULTS: Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  CONCLUSIONS: Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Copeptin as a marker for arginine-vasopressin/antidiuretic hormone secretion in the diagnosis of paraneoplastic syndrome of inappropriate ADH secretion.

Direct measurement of arginine-vasopressin/antidiuretic hormone (AVP/ADH) concentrations is not included in the standard diagnostic procedures for paraneoplastic syndrome of inappropriate ADH secretion (SIADH). Here, we evaluate the potential of copeptin measurement as a surrogate marker of AVP/ADH secretion for the direct diagnosis of suspected SIADH in cancer patients. Forty-six unselected cancer patients with serum sodium concentrations permanently below 135 mmol/L were included in this study. We compared standard diagnostic criteria for SIADH to the measurement of plasma copeptin in relation to osmolality. Normative data for comparison were constructed from 24 healthy controls studied under basal conditions, experimental dehydration, and hypotonic hypervolemia as well as from 222 hospital patients with no suspicion of an altered ADH regulation. Log transformation of copeptin revealed a linear relationship to plasma osmolality in the controls (R = 0.495, p < 0.001). Compared to these normative data, copeptin levels in most cancer patients were inappropriately high for plasma osmolality and were not significantly correlated. These results, suggestive for paraneoplastic SIADH, could be confirmed by conventional diagnostic procedures for SIADH. Current strategies to diagnose SIADH are difficult to perform under outpatients conditions. Our approach allows screening from a single plasma sample for true paraneoplastic ADH oversecretion and thus rapid selection for a specific therapy with an AVP receptor antagonist.

Efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in major orthopedic surgery: findings from the ORTHO-TEP registry.

BACKGROUND: Thromboprophylaxis with rivaroxaban (R) is superior to enoxaparin in patients undergoing major orthopedic surgery (MOS). However, rivaroxaban has never been directly compared with fondaparinux (F), which also shows superior efficacy over enoxaparin. The clinical impact of switching from fondaparinux to rivaroxaban thromboprophylaxis is unclear. OBJECTIVES: To evaluate the efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in unselected patients undergoing MOS. PATIENTS/METHODS: This is a monocentric, retrospective cohort study in 5061 consecutive patients undergoing MOS at our centre, comparing rates of symptomatic VTE, bleeding and surgical complications, length of hospital stay and risk factors for VTE. RESULTS: Rates of symptomatic VTE were 5.6% (F) and 2.1% (R; P < 0.001), with rates for distal DVT being 3.9 vs. 1.1% (P < 0.001). Rates of major VTE were numerically higher with fondaparinux (1.8 vs. 1.1%), but not statistically significant. Rates of severe bleeding (bleeding leading to surgical revision or death, occurring in a critical site, or transfusion of at least two units of packed red blood cells) were statistically lower with rivaroxaban compared with fondaparinux (2.9 vs. 4.9%; P = 0.010). The mean length of hospital stay was significantly shorter in the rivaroxaban group (8.3 days, 95% CI 8.1-8.5 vs. 9.3 days, 9.1-9.5; P < 0.001). CONCLUSION: Based on an indirect comparison of two consecutive cohorts, our data suggest that thromboprophylaxis with rivaroxaban is associated with less VTE and bleeding events than fondaparinux in unselected patients undergoing MOS. Prospective comparisons are warranted to confirm our findings.

A species-specific real-time PCR assay for identification of three lichen-forming fungi, Lobaria pulmonaria, Lobaria immixta and Lobaria macaronesica.

We present a multiplex real-time PCR assay for the simultaneous identification of three morphologically similar species of lichen-forming fungi, Lobaria pulmonaria, Lobaria immixta and Lobaria macaronesica. Based on TaqMan MGB (minor groove binding) probes targeting the fungal internal transcribed spacer (ITS nrDNA) region, our assay unambiguously identifies known samples from all the three species, thus providing a powerful alternative to the more expensive DNA-sequencing techniques.