Vaporized nicotine use among patients in HIV care who smoke tobacco: perceived health effects and effectiveness as a smoking cessation tool.

Evidence suggests adverse health effects from vaporized nicotine (VN) use, such as electronic "e" cigarettes, and limited efficacy to aid tobacco cessation. People with HIV (PWH) smoke tobacco at higher rates than the general population, with greater morbidity, highlighting the necessity of effective tobacco cessation tools. PWH may be more vulnerable to adverse effects of VN. Using semi-structured 1:1 interviews, we examined health beliefs regarding VN, patterns of use, and perceived effectiveness for tobacco cessation among PWH in HIV care at three geographically diverse U.S. sites. PWH (n = 24) had limited understanding of VN product content or health effects, presuming VN less harmful than tobacco cigarettes (TC). VN failed to adequately replicate the psychoactive effects or desired ritual of smoking TC. Concurrent TC use, and continuous VN use throughout the day, was common. Satiety using VN was elusive, and consumption quantity was difficult to track. VN had limited desirability and durability as a TC cessation tool among the interviewed PWH.

CELPI: trial protocol for a randomised controlled trial of a Carer End of Life Planning Intervention in people dying with dementia.

BACKGROUND: Dementia is a leading cause of death in developed nations. Despite an often distressing and symptom laden end of life, there are systematic barriers to accessing palliative care in older people dying of dementia. Evidence exists that 70% of people living with severe dementia attend an emergency department (ED) in their last year of life. The aim of this trial is to test whether a Carer End of Life Planning Intervention (CELPI), co-designed by consumers, clinicians and content specialists, improves access to end of life care for older people with severe dementia, using an ED visit as a catalyst for recognising unmet needs and specialist palliative care referral where indicated. METHODS: A randomised controlled trial (RCT) enrolling at six EDs across three states in Australia will be conducted, enrolling four hundred and forty dyads comprising a person with severe dementia aged ≥ 65 years, and their primary carer. Participants will be randomly allocated to CELPI or the control group. CELPI incorporates a structured carer needs assessment and referral to specialist palliative care services where indicated by patient symptom burden and needs assessment. The primary outcome measure is death of the person with dementia in the carer-nominated preferred location. Secondary outcomes include carer reported quality of life of the person dying of dementia, hospital bed day occupancy in the last 12 months of life, and carer stress. An economic evaluation from the perspective of a health funder will be conducted. DISCUSSION: CELPI seeks to support carers and provide optimal end of life care for the person dying of dementia. This trial will provide high level evidence as to the clinical and cost effectiveness of this intervention. TRIAL REGISTRATION: ACTRN12622000611729 registered 22/04/2022.

A philosophical history of programmatic assessment: tracing shifting configurations.

Programmatic assessment is now well entrenched in medical education, allowing us to reflect on when it first emerged and how it evolved into the form we know today. Drawing upon the intellectual tradition of historical epistemology, we provide a philosophically-oriented historiographical study of programmatic assessment. Our goal is to trace its relatively short historical trajectory by describing shifting configurations in its scene of inquiry-focusing on questions, practices, and philosophical presuppositions. We identify three historical phases: emergence, evolution and entrenchment. For each, we describe the configurations of the scene; examine underlying philosophical presuppositions driving changes; and detail upshots in assessment practice. We find that programmatic assessment emerged in response to positivist 'turmoil' prior to 2005, driven by utility considerations and implicit pragmatist undertones. Once introduced, it evolved with notions of diversity and learning being underscored, and a constructivist ontology developing at its core. More recently, programmatic assessment has become entrenched as its own sub-discipline. Rich narratives have been emphasised, but philosophical underpinnings have been blurred. We hope to shed new light on current assessment practices in the medical education community by interrogating the history of programmatic assessment from this philosophical vantage point. Making philosophical presuppositions explicit highlights the perspectival nature of aspects of programmatic assessment, and suggest reasons for perceived benefits as well as potential tensions, contradictions and vulnerabilities in the approach today. We conclude by offering some reflections on important points to emerge from our historical study, and suggest 'what next' for programmatic assessment in light of this endeavour.

Pourfour du Petit (1664-1741).

François Pourfour du Petit was a Parisian experimental neuro-anatomist, and ophthalmologist, who investigated his extensive wartime experiences of brain and spinal injuries and verified his conclusions by animal experiments. His results showed with great originality that brain injuries caused weakness or paralysis of the opposite limbs. He also clarified the anatomy of the spinal cord and decussation of the pyramidal tracts, and demonstrated the anatomy and clinical significance of the cervical sympathetic chain.

Limiting liability with positioning to minimize negative health effects of cellular phone towers.

The use of cellular phones is now ubiquitous through most of the adult global population and is increasingly common among even young children in many countries (e.g. Finland, where the market for smart phones is nearly saturated). The basic operation of cellular phone networks demands widespread human exposure to radio-frequency radiation (RFR) with cellular phone base stations providing cellular coverage in most areas. As the data needs of the population increase from the major shift in the source of Internet use from personal computers to smart phones, this coverage is widely predicted to increase. Thus, both the density of base stations and their power output is expected to increase the global human RFR exposure. Although direct causation of negative human health effects from RFR from cellular phone base stations has not been finalized, there is already enough medical and scientific evidence to warrant long-term liability concerns for companies deploying cellular phone towers. In order to protect cell phone tower firms from the ramifications of the failed paths of other industries that have caused unintended human harm (e.g. tobacco) this Current Issue summarizes the peer-reviewed literature on the effects of RFR from cellular phone base stations. Specifically the impacts of siting base stations are closely examined and recommendations are made for companies that deploy them to minimize their potential future liability.

Multivariate Air Pollution Prediction Modeling with partial Missingness.

Missing observations from air pollution monitoring networks have posed a longstanding problem for health investigators of air pollution. Growing interest in mixtures of air pollutants has further complicated this problem, as many new challenges have arisen that require development of novel methods. The objective of this study is to develop a methodology for multivariate prediction of air pollution. We focus specifically on tackling different forms of missing data, such as: spatial (sparse sites), outcome (pollutants not measured at some sites), and temporal (varieties of interrupted time series). To address these challenges, we develop a novel multivariate fusion framework, which leverages the observed inter-pollutant correlation structure to reduce error in the simultaneous prediction of multiple air pollutants. Our joint fusion model employs predictions from the Environmental Protection Agency's Community Multiscale Air Quality (CMAQ) model along with spatio-temporal error terms. We have implemented our models on both simulated data and a case study in South Carolina for 8 pollutants over a 28-day period in June 2006. We found that our model, which uses a multivariate correlated error in a Bayesian framework, showed promising predictive accuracy particularly for gaseous pollutants.

Early contribution of Alexandria medical school to the anatomy, physiology and pathology of the nervous system.

Alexandria's famous medical school was established about 300 BC. It was the seat of learning for many Greco-Roman physicians. The physiologist Erasistratus, the anatomist Herophilus - named the Father of Anatomy were outstanding pioneers. Their work and discoveries of the nervous system, its structure and function, are described. In the 2nd century AD they were succeeded by Rufus of Ephesus - the medical link between Hippocrates and Galen, - and Aretaeus a leading anatomist and physician in this period.

The "split brain" and Roger Wolcott Sperry (1913-1994).

The concepts of cerebral localization were established in the early 19th century. From these arose the idea that the dominant (usually left) hemisphere mainly subserved functions of cognition and language. The "relatively retarded right hemisphere" by contrast was mute, agraphic, apraxic, and lacking generally in higher cognitive function. This essay sketches the import of the work of Sperry and colleagues on patients subjected to callosal section eg., "split brain". They showed that the minor hemisphere possessed considerable capacity for cognitive understanding and language. His Nobel prize-winning "Split-Brain Experiments"confirmed the role of the corpus callosum in interhemispheric transfer of information.

Factors associated with universal infant free school meal take up and refusal in a multicultural urban community.

BACKGROUND: Universal infant free school meals (UIFSM) were introduced in September 2014 and are available to all key stage 1 (4-7 years) children attending state-maintained infant and primary schools in England. The present study aimed to investigate the school-based factors, child and family socio-demographic characteristics, and parental beliefs associated with UIFSM take up in an urban community. METHODS: A cross-sectional questionnaire survey was completed in October to November 2015, amongst parents whose children attended eligible schools in Leicester, England. A questionnaire about school meals was also completed by each school. RESULTS: Parents reported their child did not take (non-UIFSM, n = 159) or took (UIFSM, n = 517) a UIFSM on most days. The non-UIFSM group were more likely to be White-British, have a higher socio-economic status, have English as a first language, and involve their child in the decision over whether or not to take UIFSM, compared to the UIFSM group. Cluster analysis revealed that non-UIFSM parents were either concerned over quality of meals and what/how much their child ate, concerned only by what/how much their child ate or whether their child did not like the food provided. Two subsets of parents in the UIFSM group were either very positive about UIFSM or appeared to take meals because they were free. Schools used a variety of measures to increase and maintain UIFSM take up. CONCLUSIONS: Parents like to have control over what their child eats at school and children need to enjoy their school meals. Using a range of interventions to target subsets of parents may help local authorities, schools and caterers to increase UIFSM take up.

An aspartyl protease directs malaria effector proteins to the host cell.

Plasmodium falciparum causes the virulent form of malaria and disease manifestations are linked to growth inside infected erythrocytes. To survive and evade host responses the parasite remodels the erythrocyte by exporting several hundred effector proteins beyond the surrounding parasitophorous vacuole membrane. A feature of exported proteins is a pentameric motif (RxLxE/Q/D) that is a substrate for an unknown protease. Here we show that the protein responsible for cleavage of this motif is plasmepsin V (PMV), an aspartic acid protease located in the endoplasmic reticulum. PMV cleavage reveals the export signal (xE/Q/D) at the amino terminus of cargo proteins. Expression of an identical mature protein with xQ at the N terminus generated by signal peptidase was not exported, demonstrating that PMV activity is essential and linked with other key export events. Identification of the protease responsible for export into erythrocytes provides a novel target for therapeutic intervention against this devastating disease.

The density of tobacco retailers in home and school environments and relationship with adolescent smoking behaviours in Scotland.

BACKGROUND: Neighbourhood retailing of tobacco products has been implicated in affecting smoking prevalence rates. Long-term smoking usually begins in adolescence and tobacco control strategies have often focused on regulating 'child spaces', such as areas in proximity to schools. This cross-sectional study examines the association between adolescent smoking behaviour and tobacco retail outlet density around home and school environments in Scotland. METHODS: Data detailing the geographic location of every outlet registered to sell tobacco products in Scotland were acquired from the Scottish Tobacco Retailers Register and used to create a retail outlet density measure for every postcode. This measure was joined to individual responses of the Scottish Schools Adolescent Lifestyle and Substance Use Survey (n=20 446). Using logistic regression models, we explored the association between the density of retailers, around both home and school address, and smoking behaviours. RESULTS: Those living in the areas of highest density of retailers around the home environment had 53% higher odds of reporting having ever smoked (95% CI 1.27 to 1.85, p<0.001) and 47% higher odds of reporting current smoking (95% CI 1.13 to 1.91 p<0.01). Conversely, those attending schools in areas of highest retail density had lower odds of having ever smoked (OR 0.66, 95% CI 0.50 to 0.86 p<0.01) and lower odds of current smoking (OR 0.75, 95% CI 0.59 to 0.95, p<0.05). CONCLUSIONS: The density of tobacco retail outlets in residential neighbourhoods is associated with increased odds of both ever smoked and current smoking among adolescents in Scotland. Policymakers may be advised to focus on reducing the overall density of tobacco outlets, rather than concentrating on 'child spaces'.

Asymmetry in the discrimination of quantity by rats: The role of the intertrial interval.

In three experiments, rats were trained to discriminate between 20 and five (Exps. 1 and 2), or between 40 and five (Exp. 3), black squares. The squares were randomly distributed in the center of a white background and displayed on a computer screen. For one group, the patterns containing the higher quantity of squares signaled the delivery of sucrose (+), whilst patterns with the lower quantity of squares did not (-). For the second group, sucrose was signaled by the lower, but not by the higher, quantity of squares. In Experiment 1, the intertrial interval (ITI) was a white screen, and the 20+/5- discrimination was acquired more readily than the 5+/20- discrimination. For Experiment 2, the ITI was made up of 80 black squares on a white background. In this instance, the 5+/20- discrimination was acquired more successfully than the 20+/5- discrimination. In Experiment 3, two groups were trained with a 40+/5- discrimination, and two with a 5+/40- discrimination. For one group from each of these pairs, the training trials were separated by a white ITI, and the 40+/5- discrimination was acquired more readily than the 5+/40- discrimination. For the remaining two groups, the training trials were not separated by an ITI, and the two groups acquired the task at approximately the same rate. The results indicate that the cues present during the ITI play a role in the asymmetrical acquisition of magnitude discriminations based on quantity.

Young people's exposure to point-of-sale tobacco products and promotions.

OBJECTIVES: Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. STUDY DESIGN: Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. METHODS: Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. RESULTS: Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. CONCLUSIONS: POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.

Residential mobility and the association between physical environment disadvantage and general and mental health.

BACKGROUND: Selective migration may influence the association between physical environments and health. This analysis assessed whether residential mobility concentrates people with poor health in neighbourhoods of the UK with disadvantaged physical environments. METHODS: Data were from the British Household Panel Survey. Moves were over 1 year between adjacent survey waves, pooled over 10 pairs of waves, 1996-2006. Health outcomes were self-reported poor general health and mental health problems. Neighbourhood physical environment was defined using the Multiple Environmental Deprivation Index (MEDIx) for wards. Logistic regression analysis compared risk of poor health in MEDIx categories before and after moves. Analyses were stratified by age groups 18-29, 30-44, 45-59 and 60+ years and adjusted for age, sex, marital status, household type, housing tenure, education and social class. RESULTS: The pooled data contained 122 570 observations. 8.5% moved between survey waves but just 3.0% changed their MEDIx category. In all age groups odds ratios for poor general and mental health were not significantly increased in the most environmentally deprived neighbourhoods following moves. CONCLUSIONS: Over a 1-year time period residential moves between environments with different levels of multiple physical deprivation were rare and did not significantly raise rates of poor health in the most deprived areas.

Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention.

BACKGROUND: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the prepregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health. METHODS: The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index (BMI) >35 kg m(-2) to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors (intervention) versus a group of 89 women who chose not to attend (non-intervention). RESULTS: Mean (SD) weight gain in the intervention group [4.5 (4.6) kg] was less than in the non-intervention group [10.3 (4.4) kg] between antenatal booking and 36 weeks of gestation (< 0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced by 55%). The impact of the intervention on gestational weight gain was greater in women with BMI >40 kg m(-2) at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy. CONCLUSIONS: Intensive, personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy.

The types of food introduced during complementary feeding and risk of childhood obesity: a systematic review.

The determinants of childhood overweight and obesity are complex, but infant feeding and the early diet are important contributing factors. The complementary feeding period in particular, is a time during which children are nutritionally vulnerable, and a time where life-long eating habits may be established. We conducted a systematic review of the literature that investigated the relationship between the types of food consumed by infants during the complementary feeding period and overweight or obesity during childhood. Electronic databases were searched from inception until June 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 10 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Studies were categorised into three groups: macronutrient intake, food type/group and adherence to dietary guidelines. Some association was found between high protein intakes at 2-12 months of age and higher body mass index (BMI) or body fatness in childhood, but was not the case in all studies. Higher energy intake during complementary feeding was associated with higher BMI in childhood. Adherence to dietary guidelines during weaning was associated with a higher lean mass, but consuming specific foods or food groups made no difference to children's BMI. We concluded that high intakes of energy and protein, particularly dairy protein, in infancy could be associated with an increase in BMI and body fatness, but further research is needed to establish the nature of the relationship. Adherence to dietary guidelines during weaning is recommended.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review.

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.

The neuroanatomy of herophilus.

Herophilus (ca. 330 to ca. 260 BC) was one of Hellenistic -Alexandria's renowned scholars, a leading physician, often named the 'Father of Anatomy'. From cadaveric dissections and possibly vivisection Herophilus considered the ventricles to be the seat of the soul, intelligence and mental functions. Herophilus introduced the term rete mirabile found in ungulates but not in man, as opposed to Galen, who erroneously believed it a vital human network. A founder of the principles of observations in science, and an exponent of measurements in medicine, his accurate dissections resulted in original anatomical discoveries. He distinguished nerves that produce voluntary motion from blood vessels, and motor from sensory nerves; the nerves of the spinal cord were directly linked to the brain. He identified at least seven pairs of cranial nerves. Herophilus demonstrated the meninges, and ventricles, regarding the fourth as most important. His name is perpetuated by his accounts of the calamus scriptorius and the confluence of venous sinuses the torcular Herophili.

The neurology of aretaeus: radix pedis neurologia.

Aretaeus (Aretaios) was a physician born in Cappadocia in about the 2nd century AD, a student of medicine and physician in Alexandria. His works are found in eight books which espoused the physiological and pathological views of the Hippocratic principles derived from the pneumatists and the eclectic schools. Though he has been called the forgotten physician, it has been said that: 'after Hippocrates no single Greek author has equalled Aretaios'. In order to give an indication of his neurological legacy, this paper offers a summary of and quotations from his principal neurological contributions: migraine, vertigo, tetanus, epilepsy, melancholia, strokes and paralysis. One of his most important discoveries was the notion that the pyramidal tract decussates.