Opening and closure of intraventricular neuroendoscopic procedures in infants under 1 year of age: institutional technique, case series and review of the literature.

PURPOSE: Intraventricular neuroendoscopic techniques, particularly third ventriculostomy, are employed increasingly in the management of infantile hydrocephalus. However, surgical access to the ventricular cavities is associated with a risk of post-operative cerebrospinal fluid (CSF) leak. Here, we describe a structured, multi-layered approach to wound opening and closure which aims to maximise the natural tissue barriers against CSF leakage. We present a series of patients undergoing this technique and subsequently review the literature regarding opening and closure techniques in paediatric intraventricular neuroendoscopic procedures. METHODS: We performed a retrospective case series analysis of patients under 1 year of age who underwent intraventricular neuroendoscopic procedures in a single institution over a 5-year period. Patients were identified from an institutional operative database, and operation notes and clinical records were subsequently reviewed. RESULTS: 28 patients fulfilled the inclusion criteria for this study. The mean age at operation was 9 weeks. 27 patients underwent endoscopic third ventriculostomy whilst 1 underwent endoscopic septostomy, and all patients underwent our structured, multi-layered opening and closure technique. Follow-up ranged from 4 months to 5 years. There were no cases of post-operative CSF leak, infection or wound breakdown. 12 patients remained shunt-free at the last follow-up, with the remaining 16 requiring shunt insertion for progressive hydrocephalus at a mean of 24 days post-operatively. CONCLUSION: Various methods aiming to prevent post-operative CSF leak have been reported in the literature. We propose that our institutional technique may be of benefit in minimising this risk in infants undergoing endoscopic third ventriculostomy and similar intraventricular neuroendoscopic procedures.

Effects of multiple mutualists on plants and their associated arthropod communities.

Although most studies of mutualisms focus on a single partner at a time, host species often associate with multiple mutualist partners simultaneously. Because of potential interactions between mutualists, only studying a single type of mutualism could lead to a biased perspective of mutualism benefit and how mutualisms may scale-up to affect communities. The legume Chamaecrista fasciculata engages in a resource mutualism with nitrogen-fixing rhizobia and also forms symbiotic interactions with ants by providing nectar in exchange for defense against herbivores. Although they provide very different benefits to the plant, both mutualists receive carbon resources from the plant. As a result, these two mutualists are likely to interact, potentially competing for carbon resources or mutually benefitting each other via their positive effects on plant hosts. In a full-factorial field experiment, we explored how rhizobia and ants influence one another, C. fasciculata fitness, and the associated arthropod community. Ants reduced plant allocation to rhizobia, but ants also increased rhizobia contamination of uninoculated plants, suggesting that ants may disperse rhizobia. In turn, rhizobia increased ant abundances, with ants preferentially tending plants with rhizobia. Chamaecrista fasciculata received substantial fitness benefits from rhizobia; in contrast, associating with ants reduced fitness. Additionally, the mutualists interacted to influence the abundance of other arthropods found on the plants. Rhizobia increased arthropod abundances, likely because more nitrogen-rich leaf tissue was more attractive to arthropod herbivores, but ants negated these increases. As these results illustrate, multiple mutualists may interact, influencing each other's abundance and the abundance of other community members.

Quantifying nonadditive selection caused by indirect ecological effects.

In natural biological communities, species interact with many other species. Multiple species interactions can lead to indirect ecological effects that have important fitness consequences and can cause nonadditive patterns of natural selection. Given that indirect ecological effects are common in nature, nonadditive selection may also be quite common. As a result, quantifying nonadditive selection resulting from indirect ecological effects may be critical for understanding adaptation in natural communities composed of many interacting species. We describe how to quantify the relative strength of nonadditive selection resulting from indirect ecological effects compared to the strength of pairwise selection. We develop a clear method for testing for nonadditive selection caused by indirect ecological effects and consider how it might affect adaptation in multispecies communities. We use two case studies to illustrate how our method can be applied to empirical data sets. Our results suggest that nonadditive selection caused by indirect ecological effects may be common in nature. Our hope is that trait-based approaches, combined with multifactorial experiments, will result in more estimates of nonadditive selection that reveal the relative importance of indirect ecological effects for evolution in a community context.

Clinical practice models in nursing education: implication for students' mobility.

BACKGROUND: In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. AIMS: The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. METHODS: A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. RESULTS: Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. CONCLUSIONS: A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience.

Mutualistic rhizobia reduce plant diversity and alter community composition.

Mutualistic interactions can be just as important to community dynamics as antagonistic species interactions like competition and predation. Because of their large effects on both abiotic and biotic environmental variables, resource mutualisms, in particular, have the potential to influence plant communities. Moreover, the effects of resource mutualists such as nitrogen-fixing rhizobia on diversity and community composition may be more pronounced in nutrient-limited environments. I experimentally manipulated the presence of rhizobia across a nitrogen gradient in early assembling mesocosm communities with identical starting species composition to test how the classic mutualism between nitrogen-fixing rhizobia and their legume host influence diversity and community composition. After harvest, I assessed changes in α-diversity, community composition, ß-diversity, and ecosystem properties such as inorganic nitrogen availability and productivity as a result of rhizobia and nitrogen availability. The presence of rhizobia decreased plant community diversity, increased community convergence (reduced ß-diversity), altered plant community composition, and increased total community productivity. These community-level effects resulted from rhizobia increasing the competitive dominance of their legume host Chamaecrista fasciculata. Moreover, different non-leguminous species responded both negatively and positively to the presence of rhizobia, indicating that rhizobia are driving both inhibitory and potentially facilitative effects in communities. These findings expand our understanding of plant communities by incorporating the effects of positive symbiotic interactions on plant diversity and composition. In particular, rhizobia that specialize on dominant plants may serve as keystone mutualists in terrestrial plant communities, reducing diversity by more than 40%.

The relationship between magical thinking, inferential confusion and obsessive-compulsive symptoms.

Inferential confusion is an under-researched faulty reasoning process in obsessive-compulsive disorder (OCD). Based on an overreliance on imagined possibilities, it shares similarities with the extensively researched construct of thought-action fusion (TAF). While TAF has been proposed as a specific subset of the broader construct of magical thinking, the relationship between inferential confusion and magical thinking is unexplored. The present study investigated this relationship, and hypothesised that magical thinking would partially mediate the relationship between inferential confusion and obsessive-compulsive symptoms. A non-clinical sample of 201 participants (M = 34.94, SD = 15.88) were recruited via convenience sampling. Regression analyses found the hypothesised mediating relationship was supported, as magical thinking did partially mediate the relationship between inferential confusion and OC symptoms. Interestingly, inferential confusion had the stronger relationship with OC symptoms in comparison to the other predictor variables. Results suggest that inferential confusion can both directly and indirectly (via magical thinking) impact on OC symptoms. Future studies with clinical samples should further investigate these constructs to determine whether similar patterns emerge, as this may eventually inform which cognitive errors to target in treatment of OCD.

Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity.

BACKGROUND: Individuals with coeliac disease (CD) and those with noncoeliac gluten sensitivity (GS) have reported difficulty following a gluten-free diet (GFD); however, few studies have explored the link between the food label, gluten-free (GF) claims and the difficulty associated with following a GFD. METHODS: The present study surveyed adults with CD (n = 1,583) and adults with GS (n = 797) about their reported difficulty following a GFD, including assessing the role of food labels and GF claims, as well as other factors known to contribute to this difficulty. A two-sample t-test and chi-squared tests for equality of means or proportions were used for the descriptive data and ordinal logistic regression (OLR) was used to model associations. RESULTS: On average, individuals with GS reported slightly more difficulty following the GFD than did participants with CD. According to the OLR results, reading the food label often was significantly associated with less reported difficulty following a GFD, whereas consuming packaged processed foods and looking for GF claims more often were significantly associated with more reported difficulty for both respondent groups. CONCLUSIONS: Individuals with GS may rely more heavily on the GF claim for information about a product's gluten content. Individuals with CD, on the other hand, may be more experienced food label readers and may rely more on the ingredient list for finding GF foods. More studies are needed aiming to understand the role of the food label in facilitating consumers' ability to follow a GFD.

Mutualisms in a warming world: How increased temperatures affect the outcomes of multi-mutualist interactions.

In nature, plant species simultaneously interact with many different mutualistic partners. These mutualists may influence one another through direct interference or indirectly by competing for shared reward resources or through alteration of plant traits. Together, these mutualists also may combine to affect plant hosts in ways that may not be predictable based on pairwise interactions. Given that the outcome of mutualistic interactions often depends on environmental conditions, multi-mutualist effects on one another, and their plant hosts may be affected by global changes. Here, we grew focal plants under simulated global warming conditions and manipulated the presence of partner mutualists to test how warming affects the outcome of interactions between focal plants and their partners (nitrogen-fixing rhizobia, ant defenders, and pollinators) and interactions among these partner mutualists. We find that warming alters the fitness benefits plants receive from rhizobium resource mutualists but not ant mutualists and that warming altered plant investment in all mutualists. We also find that mutualist partners interact, often by altering the availability of plant-produced rewards that facilitate interactions with other partners. Our work illustrates that global changes may affect some but not all mutualisms, often asymmetrically (e.g., affecting investment in the mutualist partner but not plant host benefits) and also highlights the ubiquity of interactions between the multiple mutualists associating with a shared host.

Light-activated porphyrin-based formulations to inactivate bacterial spores.

AIM: The objective of this study was to develop porphyrin-based formulations to inactivate Bacillus spores. We probed the effect of porphyrins alone and in combination with germinants against both Bacillus cereus and Bacillus anthracis spores in the presence of light. METHODS AND RESULTS: We tested the effect of two different porphyrins, amine-modified protoporphyrin IX (PPIX) and meso-tetra (N-methyl-4-pyridyl) porphine tetra tosylate (TMP). Treatment with the porphyrins alone did not significantly influence spore viability. However, when spores were pretreated with a solution containing the germinants, l-alanine and inosine, the spore viability dropped by as much as 4.5 logs in the presence of light. The extent of inactivation depended on the germination conditions and the type of porphyrin used, with TMP being more effective. CONCLUSION: Porphyrins can be used effectively in combination with germinants to inactivate Bacillus spores. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this study provide evidence that porphyrins can be used to inactivate Bacillus spores in the presence of germinants and light irradiation. This finding may be general and may be extended to spores of other pathogens.

Exploring the perceptions and acceptability of an integrated lifestyle database for public health research and service commissioning: a qualitative study.

AIM: Public health lifestyle databases at local authority level are currently poorly aligned across the UK. The integration of lifestyle databases at a regional level could provide a rich resource to support research and help inform public health leads and service commissioners in improving service delivery, facilitating decision-making and developing key public health policies. Prior to its implementation, the acceptability of an integrated lifestyle database should be explored. The aim of this study was to consult with public health stakeholders to explore the acceptability of developing and implementing a regional integrated lifestyle database across four key areas of public health: smoking cessation, diet, physical activity and alcohol consumption. METHOD: Qualitative interviews were conducted with public health stakeholders recruited from across the East Midlands region of England. All interviews were conducted using video conferencing software and recorded, transcribed, and analysed using the Framework approach. Sixteen public health stakeholders were purposively identified and invited to participate in interviews. RESULTS: Stakeholders viewed the integrated database as having potential to support research, service development and commissioning decisions. Barriers such as providers' reluctance to reveal their business strategies to rival organisations, cost of setting up and running the proposed database, complex information-sharing and governance were identified. CONCLUSION: An integrated lifestyle database has the potential to support research and service commissioning regionally. However, several barriers were identified that must be addressed prior to the development and implementation of an integrated database.

Longitudinal health surveillance in a cohort of Gulf War veterans 18 years after first exposure to depleted uranium.

As part of a longitudinal surveillance program, 35 members of a larger dynamic cohort of 79 Gulf War I veterans exposed to depleted uranium (DU) during combat underwent clinical evaluation at the Baltimore Veterans Administration Medical Center. Health outcomes and biomonitoring results were obtained to assess effects of DU exposure and determine the need for additional medical intervention. Clinical evaluation included medical and exposure histories, physical examination, and laboratory studies including biomarkers of uranium (U) exposure. Urine collections were obtained for U analysis and to measure renal function parameters. Other laboratory measures included basic hematology and chemistry parameters, blood and plasma U concentrations, and markers of bone metabolism. Urine U (uU) excretion remained above normal in participants with embedded DU fragments, with urine U concentrations ranging from 0.006 to 1.88 µg U/g creatinine. Biomarkers of renal effects showed no apparent evidence of renal functional changes or cellular toxicity related to U body burden. No marked differences in markers of bone formation or bone resorption were observed; however, a statistically significant decrease in levels of serum intact parathyroid hormone and significant increases in urinary calcium and sodium excretion were seen in the high versus the low uU groups. Eighteen years after first exposure, members of this cohort with DU fragments continue to excrete elevated concentrations of uU. No significant evidence of clinically important changes was observed in kidney or bone, the two principal target organs of U. Continued surveillance is prudent, however, due to the ongoing mobilization of uranium from fragment depots.

Molecular approaches to the identification of Bulinus species in south-west Nigeria and observations on natural snail infections with schistosomes.

The current study considers the distribution of a small sample of 138 Bulinus snails, across 28 localities within eight Nigerian states. Snails were identified using a combination of molecular methods involving both DNA sequencing of a partial cytochrome oxidase subunit 1 (cox1) fragment and restriction profiles obtained from ribosomal internal transcribed spacer (its) amplicons. The results showed that the majority of Bulinus samples tested belonged to the species Bulinus truncatus while only two were Bulinus globosus. The use of RsaI restriction endonuclease to cleave the ribosomal its of Bulinus, as a method of species identification, was adopted for the majority of samples, this being a quicker and cheaper method better suited to small laboratory environments. Polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat within each of the collected Bulinus samples was employed to determine the extent and distribution of infected snails within the sample areas. Successful amplification of the Dra1 repeat demonstrated that 29.7% of snails were infected with schistosomes. Sequencing of the partial schistosome its from a small subset of snail samples suggested that some snails were either penetrated by both Schistosoma haematobium and Schistosoma bovis miracidia or hybrid miracidia formed from the two species.

[Total cystectomies for cancers locally advanced of bladder about 12 cases in the service of urology of the general hospital of Grand-Yoff]. / Cystectomies totales pour cancers localement avancés de vessie au service d'urologie de l'hôpital général de Grand-Yoff.

OBJECTIVE: The goals of the study is to evaluate the feasability of the total cystectomy for cancer infiltrating locally advanced of bladder and to evaluate perioperatitive morbidity and short-term results. PATIENTS AND METHODS: We made a retrospective study concerning 12 first patients having profited from a total cystectomy for cancer infiltrating of the bladder in our hospital over one period of 1 year. The parameters of study were: the age at the time of the diagnosis, circumstances of the diagnosis, antecedents of the patient, the histological type and stage TNM before and after intervention, the type of derivation associated, duration of the intervention, the anesthesia, complications and morbidity per- and postoperational. We carried out calculations of average and frequency for the data analysis. RESULTS: The mean age was 51 years (extreme: 32; 83). They were nine men and three women. The circumstances of diagnosis were dominated by the total hematuria and in less frequency by the bladder irritative symptoms. The antecedents of the patients were dominated by the schistosomia (five cases) and the tobacco addiction (two cases). The histological type obtained in preoperative after biopsy or trans urethral resection of bladder found, seven cases of squamous cell carcinoma, four cases of transitional cell carcinoma and one case of adenocarcinoma. Into preoperative, three patients were at the stage pT2, eight patients pT3, one pT4. Four patients had a replacement of bladder: three by a bladder in Z and a patient had Camey II. They were the three patients pT2 preoperative and a patient pT3. Two patients had a standard ureterosigmoidostomy type coffey: the patient pT4 and a patient pT3. The six other patients had Bricker. All the patients profited from a blood transfusion peroperational (two units on average). We did not record any operational mortality. The complications and morbidity are represented by the suppurations of wall (three cases), the vesicocutaneous fistula (one case), the infections urinary and the anemia which was constant. CONCLUSION: The management of bladder cancer poses a real problem in our countries because of the diagnosis at advanced stage.

Surface immobilization of hexa-histidine-tagged adeno-associated viral vectors for localized gene delivery.

Adeno-associated viral (AAV) vectors, which are undergoing broad exploration in clinical trials, have significant promise for therapeutic gene delivery because of their safety and delivery efficiency. Gene delivery technologies capable of mediating localized gene expression may further enhance the potential of AAV in a variety of therapeutic applications by reducing spread outside a target region, which may thereby reduce off-target side effects. We have genetically engineered an AAV variant capable of binding to surfaces with high affinity through a hexa-histidine metal-binding interaction. This immobilized AAV vector system mediates high-efficiency delivery to cells that contact the surface and thus may have promise for localized gene delivery, which may aid numerous applications of AAV delivery to gene therapy.

Association of medication attitudes with non-persistence and non-compliance with medication to prevent fractures.

UNLABELLED: Our objective was to assess the association of self-reported non-persistence (stopping fracture-prevention medication for more than 1 month) and self-reported non-compliance (missing doses of prescribed medication) with perceived need for fracture-prevention medication, concerns regarding long-term harm from and/or dependence upon medications, and medication-use self-efficacy (confidence in one's ability to successfully take medication in the context of their daily life). INTRODUCTION: Non-persistence (stopping medication prematurely) and non-compliance (not taking medications at the prescribed times) with oral medications to prevent osteoporotic fractures is widespread and attenuates their fracture reduction benefit. METHODS: Cross-sectional survey and medical record review of 729 patients at a large multispecialty clinic in the United States prescribed an oral bisphosphonate between January 1, 2006 and March 31, 2007. RESULTS: Low perceived necessity for fracture-prevention medication was strongly associated with non-persistence independent of other predictors, but not with non-compliance. Concerns about medications were associated with non-persistence, but not with non-compliance. Low medication-use self-efficacy was associated with non-persistence and non-compliance. CONCLUSIONS: Non-persistence and non-compliance with oral bisphosphonate medication have different, albeit overlapping, sets of predictors. Low perceived necessity of fracture-prevention medication, high concerns about long-term safety of and dependence upon medication , and low medication-use self-efficacy all predict non-persistence with oral bisphosphonates, whereas low medication-use self-efficacy strongly predicts non-compliance with oral bisphosphonate medication. Assessment of and influence of these medication attitudes among patients at high risk of fracture are likely necessary to achieve better persistence and compliance with fracture-prevention therapies.

Selective assembly of multi-component nanosprings and nanorods.

This communication proposes a new approach to create complex hierarchical nano-to-meso-scale architectures based on the use of biological connector molecules to direct the assembly of uniquely shaped multi-component nanostructures fabricated using glancing angle deposition (GLAD). Multiple sets of 50-nm-wide and 150 to 650-nm-tall Si-Cr/Au multi-stack zigzag nanosprings and nanorods are grown by GLAD on Si substrates. Nanorods, chosen for selective assembly, are detached from the substrate, suspended in an aqueous solution, and their surfaces are selectively functionalized by attaching biotin and streptavidin connector-molecules to the Au-regions. Successive mixing of different suspensions leads to the end-to-end assembly of long and short nanorods. This technique provides the path to build hybrid nano-architectures including nano-honeycombs, nanoladders, and 3D nanorod networks, comprised of controlled material combinations.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]. / Incontinence urinaire de la femme: profil épidémiologique au sud du Sahara.

UNLABELLED: The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries. MATERIAL AND METHODS: A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence. RESULTS: Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases. CONCLUSION: Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.