Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study.

INTRODUCTION: The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS: Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS: Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS: Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.

Acute and protracted cocaine abstinence in an outpatient population: a prospective study of mood, sleep and withdrawal symptoms.

This study addresses unresolved questions about cocaine withdrawal by prospectively assessing monitored cocaine abstinence over 28 days in a sample of 24 male and female cocaine-dependent outpatients. Based on results from urine drug screens and self-reported substance use, it is likely that these patients were abstinent from cocaine during the assessment period. Abstinence-related symptoms were monitored at 2, 5, 10, 14, 21, and 28 days following last cocaine use. For patients who were known to relapse, assessments began again after the last day of cocaine use. Consistent with findings from inpatient studies of cocaine abstinence, linear improvements in negative affect, low cocaine craving, and increases in cognitive skills were reported over the 28 days. Also consistent with inpatient studies of cocaine withdrawal, a phasic withdrawal syndrome was not observed in this outpatient sample. Unlike inpatient studies, no disturbances in sleep were reported.

Forensic perioperative nursing. Advocates for justice.

Facts and evidence have been negated or lost by the inexperience of health care professionals who are not cognizant of the legal requirements concerning potential criminal cases. In the perioperative setting, policy and procedure should provide guidelines for potential criminal cases based on the key concepts and principles of forensic science. Potential forensic cases and traumatic injuries are not limited to major health care centres. All hospitals should have policies and procedures which outline: traumatic injuries/death, staff responsibilities, details of collecting evidence, documentation, chain of custody. The procedure should also include care of victims, suspected perpetrators as well as family/persons accompanying patient.

A statistical view of FMRFamide neuropeptide diversity.

FMRFamide-like peptide (FLP) amino acid sequences have been collected and statistically analyzed. FLP amino acid composition as a function of position in the peptide is graphically presented for several major phyla. Results of total amino acid composition and frequencies of pairs of FLP amino acids have been computed and compared with corresponding values from the entire GenBank protein sequence database. The data for pairwise distributions of amino acids should help in future structure-function studies of FLPs. To aid in future peptide discovery, a computer program and search protocol was developed to identify FLPs from the GenBank protein database without the use of keywords.

Isolation of Salmonella organisms from the mesenteric lymph nodes of horses at necropsy.

OBJECTIVES: To determine the prevalence of Salmonella infections in horses at necropsy. DESIGN: Cross-sectional prevalence survey. ANIMALS: 102 horses. PROCEDURE: Mesenteric lymph nodes were collected from horses that were necropsied. Horses had died or were euthanatized because of severe disease or at the request of the owner. Twenty-eight of the horses were racehorses euthantized following acute catastrophic injuries on the racetrack. Mesenteric lymph nodes were submitted for Salmonella culture via direct plating of tissue specimens on MacConkey agar and by use of 4 enrichment culture techniques that used tetrathionate and selenite enrichment broth and brilliant green and Salmonella-Shigella selective plating media. RESULTS: Salmonella typhimurium was isolated from the mesenteric lymph nodes of 2 foals (2/102, 1.96% of the horses). Salmonella organisms were not isolated from the mesenteric lymph nodes of adult horses. CONCLUSIONS AND CLINICAL RELEVANCE: Prevalence of Salmonella infections in horses of our study (1.96%) suggests that the results of cross-sectional surveys, using bacteriologic culture to determine prevalence of Salmonella infection, should be interpreted with caution. Prevalence of Salmonella infections determined in a single facility may not reflect the prevalence of Salmonella-infected horses in the general population; furthermore, obtaining a Salmonella isolate from a horse does not establish that the horse is a chronic Salmonella carrier.

Does EMDR work? And if so, why?: a critical review of controlled outcome and dismantling research.

Research on Eye Movement Desensitization and Reprocessing therapy (EMDR) was reviewed to answer the questions "Does EMDR work?" and "If so, Why?" This first question was further subdivided on the basis of the control group: (a) no-treatment (or wait list control), (b) nonvalidated treatments, and (c) other validated treatments. The evidence supports the following general conclusions: First, EMDR appears to be effective in reducing at least some indices of distress relative to no-treatment in a number of anxiety conditions, including posttraumatic stress disorder, panic disorder, and public-speaking anxiety. Second, EMDR appears at least as effective or more effective than several nonvalidated treatments (e.g., relaxation, active listening) for posttraumatic stress reactions. Third, despite statements implying the contrary, no previously published study has directly compared EMDR with an independently validated treatment for posttraumatic stress disorder (e.g., therapist-directed flooding). In the treatment of simple phobia, participant modeling has been found to be more effective than EMDR. Fourth, our review of dismantling studies reveals there is no convincing evidence that eye movements significantly contribute to treatment outcome. Recommendations regarding further research directions are provided.

The contributions of eye movements to the efficacy of brief exposure treatment for reducing fear of public speaking.

The present study was designed to isolate the effects of the eye-movement component of the Eye Movement Desensitization and Reprocessing (EMDR) procedure in the treatment of fear of public speaking. Seventy-one undergraduate psychology students who responded in a fearful manner on the Fear Survey Schedule II and on a standardized, self-report measure of public speaking anxiety (Personal Report of Confidence as a Speaker; PRCS) were randomly assigned to one of four groups in a 2x2 factorial design. The two independent variables assessed were treatment condition (imagery plus eye movements vs. imagery alone) and type of imagery (fear-relevant vs. relaxing). Dependent variables assessed were self-reported and physiological anxiety during exposure and behavioral indices of anxiety while giving a speech. Although process measures indicated exposure to fear-relevant imagery increased anxiety during the procedure, no significant differences among groups were found on any of the outcome measures, except that participants who received eye movements were less likely to give a speech posttreatment than participants who did not receive eye movements. Addition of the eye movements to the experimental procedure did not result in enhancement of fear reduction. It was concluded, consistent with the results of past research, that previously reported positive effects of the EMDR procedure may be largely due to exposure to conditioned stimuli.

Inclusion body disease in two captive Australian pythons (Morelia spilota variegata and Morelia spilota spilota).

Two captive Australian pythons, one carpet and one diamond python, presented with signs of central nervous system dysfunction. The carpet python was agitated. Its head was tilting and it was incoordinated and had convulsions. It was treated with antibiotics and anthelmintics but was eventually euthanased after failing to respond to therapy. The diamond python had flaccid paralysis of the caudal half. It was not treated and became disoriented and died. Hepatocytes from both pythons contained irregular 2 to 10 micron eosinophilic intracytoplasmic inclusion bodies. The brain of the diamond python was not available for examination. Occasional neurones in the carpet python brain contained similar inclusion bodies and other changes suggestive of viral infection. The clinical signs and histopathological findings in both pythons were consistent with boid inclusion body disease.

Targeting determinants and proposed evolutionary basis for the Sec and the Delta pH protein transport systems in chloroplast thylakoid membranes.

Transport of proteins to the thylakoid lumen is accomplished by two precursor-specific pathways, the Sec and the unique Delta pH transport systems. Pathway selection is specified by transient lumen-targeting domains (LTDs) on precursor proteins. Here, chimeric and mutant LTDs were used to identify elements responsible for targeting specificity. The results showed that: (a) minimal signal peptide motifs consisting of charged N, hydrophobic H, and cleavage C domains were both necessary and sufficient for pathway-specific targeting; (b) exclusive targeting to the Delta pH pathway requires a twin arginine in the N domain and an H domain that is incompatible with the Sec pathway; (c) exclusive targeting to the Sec pathway is achieved by an N domain that lacks the twin arginine, although the twin arginine was completely compatible with the Sec system. A dual-targeting signal peptide, constructed by combining Delta pH and Sec domains, was used to simultaneously compare the transport capability of both pathways when confronted with different passenger proteins. Whereas Sec passengers were efficiently transported by both pathways, Delta pH passengers were arrested in translocation on the Sec pathway. This finding suggests that the Delta pH mechanism evolved to accommodate transport of proteins incompatible with the thylakoid Sec machinery.

Equine papillary ependymoma.

A 17-year-old Arabian gelding with progressive neurologic signs had a velvety, reddish brain tumor protruding from the ventral midline caudal to the optic chiasma. Histologically, the tumor had a papillary formation with a single layer of elongate cells radially oriented around a central fibrovascular core. Intracytoplasmic globular inclusions were positive for glial fibrillary acidic protein and weakly positive for vimentin. Ultrastructurally, these inclusions were comprised of whorling intermediate filaments. Neoplastic cells also had cytoplasmic interdigitations and numerous zona adherens and often rested on a basal lamina. The tumor was diagnosed as a papillary ependymoma.

Ovine nasal zygomycosis caused by Conidiobolus incongruus.

About 700 sheep died on 52 farms in north-western New South Wales and south-western Queensland over a 3 mo period. Affected animals had a marked asymmetrical swelling of the face, extending from the nostril to just anterior to the eyes. They lost condition rapidly and died within 7 to 10 days. At necropsy there was a unilateral severe necrogranulomatous rhinitis with extension of inflammation into the adjacent subcutaneous tissue, nasal septum and hard palate. Metastatic lesions were present in the draining lymph nodes and in the thorax. Histological changes consisted of a granulomatous reaction with numerous eosinophilic foci of necrosis and a diffuse, heavy, mixed inflammatory cell response. Many vessels had segmental necrosis and thrombosis. Fungal hyphae were numerous, particularly within or associated with necrotic foci. Conidiobolus incongruus was isolated from nasal tissues, parotid and submandibular lymph nodes and pulmonary lesions.

Locomotor effects in sheep of alkaloids identified in Australian Tribulus terrestris.

Fresh, mature, ungrazed Tribulus terrestris plant material was subjected to a standard alkaloid extraction procedure. The extract was fractionated by thin layer chromatography (TLC) and high performance liquid chromatography (HPLC). Two major alkaloid fractions were demonstrated. These fractions were identified by means of TLC, ultraviolet spectrofluorimetry (UVS) and HPLC, as the beta-carboline indoleamines harmane and norharmane. The extractable alkaloid content was determined to be 44 mg/kg dry matter. Synthetic harmane and norharmane were administered subcutaneously to sheep at a dose rate of 54 mg/kg. Both compounds caused similar nervous effects. The main effect observed was limb paresis, which in some sheep was body side blased. The clinical signs observed in the experimental sheep were consistent with those described for naturally occurring cases of Tribulus terrestris staggers. It was proposed that harmane and norharmane accumulate in tryptamine-associated neurones of the central nervous system, during months of tribulus ingestion, and gradually interact irreversibly with a specific neuronal gene DNA sequence.