Traumatic brain injury promotes neurogenesis at the cost of astrogliogenesis in the adult hippocampus of male mice.

Traumatic brain injury (TBI) can result in long-lasting changes in hippocampal function. The changes induced by TBI on the hippocampus contribute to cognitive deficits. The adult hippocampus harbors neural stem cells (NSCs) that generate neurons (neurogenesis), and astrocytes (astrogliogenesis). While deregulation of hippocampal NSCs and neurogenesis have been observed after TBI, it is not known how TBI may affect hippocampal astrogliogenesis. Using a controlled cortical impact model of TBI in male mice, single cell RNA sequencing and spatial transcriptomics, we assessed how TBI affected hippocampal NSCs and the neuronal and astroglial lineages derived from them. We observe an increase in NSC-derived neuronal cells and a concomitant decrease in NSC-derived astrocytic cells, together with changes in gene expression and cell dysplasia within the dentate gyrus. Here, we show that TBI modifies NSC fate to promote neurogenesis at the cost of astrogliogenesis and identify specific cell populations as possible targets to counteract TBI-induced cellular changes in the adult hippocampus.

Younger age, recent HIV diagnosis, no welfare support and no annual sexually transmissible infection screening are associated with nonuse of antiretroviral therapy among HIV-positive gay men in Australia.

OBJECTIVES: With the increasing momentum to maximize the benefits of antiretroviral therapy (ART), better understanding of opportunities and challenges in increasing ART coverage and promoting early ART initiation is urgently needed. Key sociodemographic, clinical and behavioural factors associated with Australian HIV-positive gay men's current nonuse of ART were systematically examined. METHODS: Data were based on 1911 responses from HIV-positive men who had participated in the Australian Gay Community Periodic Surveys (GCPS) between 2010 and 2012. Stratified univariate analysis and multivariate logistic regression were used. RESULTS: A majority of the participants were recruited from gay community venues and events and self-identified as gay or homosexual. On average, they were 44 years old and had been living with HIV for at least 10 years. Close to 80% (n=1555) were taking ART, with >90% further reporting an undetectable viral load at the time of the survey. From 2010 to 2012, there had been a moderate increase in ART uptake [adjusted odds ratio (AOR) 1.40; 95% confidence interval (CI) 1.20-1.65]. In addition, younger age (AOR 1.66; 95% CI 1.45-1.92), recent HIV diagnosis (AOR 1.78; 95% CI 1.59-1.98), not receiving any social welfare payments (AOR 2.20; 95% CI 1.05-2.54) and no annual screening for sexually transmissible infections (AOR 1.55; 95% CI 1.03-2.34) were independently associated with ART nonuse. CONCLUSIONS: Current ART coverage among HIV-positive gay men in Australia is reasonably high. To further increase ART coverage and promote early ART initiation in this population, better clinical care and sustained structural support are needed for HIV management throughout their life course.

HIV testing, gay community involvement and internet use: social and behavioural correlates of HIV testing among Australian men who have sex with men.

A significant minority of Australian men who have sex with men (MSM) have never been tested for HIV and many men do not test as often as recommended. Using data from 1770 HIV-negative and untested MSM collected in a national, online survey, we compared men who had never tested for HIV with those who had tested over 12 months ago and men who had tested over 12 months ago with those that had tested in the past year. Two multivariate logistic regression models were constructed. Compared with men tested over 12 months ago, untested men were younger, less educated, less likely to have unprotected anal intercourse with a regular male partner, less likely to have sought advice from a doctor, nurse or community organisation, more likely to expect HIV-negative disclosure, had fewer gay friends and spent more time using social networking websites. Compared with men who had tested over 12 months ago, men who had tested within the last year were younger, more likely to expect HIV-negative disclosure and disclose to casual partners, more likely to have sought advice from a doctor or nurse, had attended gay pools, gyms or beaches and had more gay friends and more male sex partners. Our findings suggest that the Internet and sex education in schools are important ways to promote HIV testing to untested MSM. Testing reinforcement messages delivered through gay community outreach and primary care will reach previously tested MSM.

Measured variation in boron loads reaching European sewage treatment works.

Per capita boron loads reaching 48 sewage treatment works (STWs) in The Netherlands, Germany, Italy, and the UK have been determined from monitoring data. These have been compared with the per capita input predicted from boron in detergents, as determined from detergent product sales data. The resulting distribution of the ratios of measured boron to boron predicted from consumer usage has a 90th percentile of less than 1.5. Boron has previously been shown to be a good marker for substances contained in detergent products, as it cannot be biodegraded and is not substantially adsorbed in the sewer, and there is little or no removal during sewage treatment processes. The monitoring information on the distribution of boron loads found at the different STWs should thus be indicative of the distribution of other substances released to the environment by detergent products, as specified by the relevant industrial category (IC 5-personal/domestic) in the Technical Guidance Documents. Variation in detergent product consumption figures from 18 European countries is also low, with the country with the highest per capita detergent consumption having only 1.3 times the European average detergent use. Thus the present practice of determining a "reasonable worst case" by multiplying the average per capita consumption by a factor of four to account for geographic differences in distribution, is considered to be inappropriate. This should be replaced by a factor of less than two, which combines within country and between country variations to provide a reasonable worst case approximation of the load reaching the sewage treatment facility.

GREAT-ER: a new tool for management and risk assessment of chemicals in river basins. Contribution to GREAT-ER #10.

The GREAT-ER (Geo-referenced Regional Exposure Assessment Tool for European Rivers) project team has developed and validated an accurate aquatic chemical exposure prediction tool for use within environmental risk assessment schemes. The software system GREAT-ER 1.0 calculates the distribution of predicted environmental concentrations (PECs) of consumer chemicals in surface waters, for individual river stretches as well as for entire catchments. The system uses an ARC/INFO-ArcView (ESRI) based Geographical Information System (GIS) for data storage and visualization, combined with simple mathematical models for prediction of chemical fate. At present, the system contains information for four catchments in Yorkshire, one catchment in Italy, and two in Germany, while other river basins are being added. Great-ER 1.0 has been validated by comparing simulations with the results of an extensive monitoring campaign for two 'down-the-drain' chemicals, i.e. the detergent ingredients boron and Linear Alkylbenzene Sulphonate (LAS). GREAT-ER 1.0 is currently being expanded with models for the terrestrial (diffuse input), air and estaurine compartments.

Ecological risk assessment of endocrine disruptors.

The European Centre for Ecotoxicology and Toxicology of Chemicals proposes a tiered approach for the ecological risk assessment of endocrine disruptors, integrating exposure and hazard (effects) characterization. Exposure assessment for endocrine disruptors should direct specific tests for wildlife species, placing hazard data into a risk assessment context. Supplementing the suite of mammalian screens now under Organization for Economic Cooperation and Development (OECD) validation, high priority should be given to developing a fish screening assay for detecting endocrine activity in oviparous species. Taking into account both exposure characterization and alerts from endocrine screening, higher tier tests are also a priority for defining adverse effects. We propose that in vivo mammalian and fish assays provide a comprehensive screening battery for diverse hormonal functions (including androgen, estrogen, and thyroid hormone), whereas Amphibia should be considered at higher tiers if there are exposure concerns. Higher tier endocrine-disruptor testing should include fish development and fish reproduction tests, whereas a full life-cycle test could be subsequently used to refine aquatic risk assessments when necessary. For avian risk assessment, the new OECD Japanese quail reproduction test guideline provides a valuable basis for developing a test to detecting endocrine-mediated reproductive effects; this species could be used, where necessary, for an avian life-cycle test. For aquatic and terrestrial invertebrates, data from existing developmental and reproductive tests remain of high value for ecological risk assessment. High priority should be given to research into comparative endocrine physiology of invertebrates to support data extrapolation to this diverse fauna.

Monitoring, modelling and environmental exposure assessment of industrial chemicals in the aquatic environment.

Monitoring and laboratory data play integral roles alongside fate and exposure models in comprehensive risk assessments. The principle in the European Union Technical Guidance Documents for risk assessment is that measured data may take precedence over model results but only after they are judged to be of adequate reliability and to be representative of the particular environmental compartments to which they are applied. In practice, laboratory and field data are used to provide parameters for the models, while monitoring data are used to validate the models' predictions. Thus, comprehensive risk assessments require the integration of laboratory and monitoring data with the model predictions. However, this interplay is often overlooked. Discrepancies between the results of models and monitoring should be investigated in terms of the representativeness of both. Certainly, in the context of the EU risk assessment of existing chemicals, the specific requirements for monitoring data have not been adequately addressed. The resources required for environmental monitoring, both in terms of manpower and equipment, can be very significant. The design of monitoring programmes to optimise the use of resources and the use of models as a cost-effective alternative are increasing in importance. Generic considerations and criteria for the design of new monitoring programmes to generate representative quality data for the aquatic compartment are outlined and the criteria for the use of existing data are discussed. In particular, there is a need to improve the accessibility to data sets, to standardise the data sets, to promote communication and harmonisation of programmes and to incorporate the flexibility to change monitoring protocols to amend the chemicals under investigation in line with changing needs and priorities.

Health care futures, Part 1. The emergence of the new health care consumer. Panel discussion.

In Part 1 of this second annual panel discussion, six experts examine the new health care consumer. The whole concept of the patient as consumer still makes people uneasy when it's applied to health care. Whether you prefer consumer, customer, purchaser, end-user, ultimate buyer, or beneficiary, one thing's for sure: Many of us are as different from the bygone patient as an HMO is from the general practitioner who made house calls. One of the reasons for many Americans' new interest, knowledge, attitudes, and expectations about health and health care is the Internet, the second topic in this discussion. In Part 2, physician executives from the three leading physician practice management companies (PPMCs) join Jeff Goldsmith, Barbara LeTourneau, and Uwe Reinhardt for a spirited exchange about this burgeoning new industry in the American health care sector. They will tackle questions such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? Can PPMCs meet Wall Street's earnings expectations and also help physicians deliver better care? When PPMCs win, who loses? And, what roles will physician executives play in PPMCs?

From task force to statute: establishing health sciences libraries in state law as a component of the health care system.

This paper describes how Montana librarians successfully incorporated health sciences libraries into the statewide health care resource management plan being developed under 1993 state law. First, a broad-based Montana Task Force for Biomedical Information was formed with funds from the National Network of Libraries of Medicine/Pacific Northwest Region and the Montana Area Health Education Center. The resulting report reviewed findings from national studies and trends to current state developments and deficiencies. The report was presented to the governor and state legislators in the context of cost-containment measures being considered in the state's health care reform bill. Now Montana law provides that "it is further the policy of the state of Montana that the health care system should ... facilitate universal access to current health sciences information," and "The management plan must include ... identification of the current supply and distribution of ... health sciences library resources and services." This experience highlights the need for health sciences librarians to develop skills in advocacy, lobbying, and networking with other components of the health care industry.

Community hospitals and the Internet: lessons from pilot connections.

Community hospitals in rural and isolated areas have had little access to the Internet. In 1992, the National Library of Medicine funded a pilot project to be conducted by the University of Washington and seven community hospitals in the northwestern United States. The goals of the project were to connect the hospitals to the Internet and study the uses made of this resource. A number of administrative, technical, financial, and organizational problems were dealt with in the attempt to establish the Internet connections and introduce this resource to these health care settings. This paper examines these issues and presents conclusions drawn from the experiences of the project team.

Drive-up prescription refill service at a large Navy medical facility.

A drive-up prescription refill service at a large naval medical facility is described. A pharmacy drive-up refill service was created to reduce customer congestion, to reduce demand for parking, and to improve customer service. The drive-up program is staffed by a full-time pharmacy technician, a full-time volunteer, and a part-time pharmacy technician who assists during lunches, breaks, and peak hours. Customers must request refills by telephone, and requests are recorded by a pharmacy answering machine. Recorded requests are transcribed, processed, and checked by a pharmacist in the main pharmacy. Refills ready for pickup are transported to the drive-up site twice daily. If a refill is missing, the customer is asked to park, fill out a missing refill form, and pick up the refill at the main pharmacy. Approximately 700 prescription refills are processed and filled daily at the drive-up service. The addition of a drive-up refill service reduced customer visits to the outpatient pharmacy department by about one third and reduced demand for parking by a projected 360-400 parking spaces per day. The error rate for missing refills is less than 0.5%. The only negative consequence of the drive-up service is less interaction between the customer and the pharmacy staff for counseling. A drive-up refill service at a large naval medical facility reduced customer congestion, reduced parking demand, and improved customer service at the outpatient pharmacy department.

Managing the mixed physician practice.

In general, utilization of health care resources translates into physician income. In both a capitated and a fee-for-service environment, the physician is reimbursed for patient care. The reimbursement structures of these two systems is quite different, however, and this difference creates a perplexing reward system for the physician. This article has two goals: To focus on the decision-making process of physicians in a mixed fee-for-service/HMO environment and the potential for cognitive dissonance in this system. To propose an approach for physician leaders in this setting to not only manage and minimize cognitive dissonance, but also strategically position their group for a successful future.