Contextualized understandings of dairy farmers' perspectives on antimicrobial use and regulation in Alberta, Canada.

Antimicrobial resistance (AMR) has been largely attributed to antimicrobial use (AMU). To achieve judicious AMU, much research and many policies focus on knowledge translation and behavioral change mechanisms. To address knowledge gaps in contextual drivers of decisions made by dairy farmers concerning AMU, we conducted ethnographic fieldwork to investigate one community's understanding of AMU, AMR, and associated regulations in the dairy industry in Alberta, Canada. This included participation in on-farm activities and observations of relevant interactions on dairy farms in central Alberta for 4 mo. Interviews were conducted with 25 dairy farmers. The interviews were analyzed using thematic analysis and yielded several key findings. Many dairy farmers in this sample: (1) value their autonomy and hope to maintain agency regarding AMU; (2) have shared cultural and immigrant identities which may inform their perspectives of future AMU regulation as it relates to their farming autonomy; (3) feel that certain AMU policies implemented in other contexts would be impractical in Alberta and would constrain their freedom to make what they perceive to be the best animal welfare decisions; (4) believe that their knowledge and experience are undervalued by consumers and policy makers; (5) are concerned that the public does not have a complex understanding of dairy farming and, consequently, worry that AMU policy will be based on misguided consumer concerns; and (6) are variably skeptical of a link between AMU in dairy cattle and AMR in humans due to their strict adherence to milk safety protocols that is driven by their genuine care for the integrity of the product. A better understanding of the sociocultural and political-economic infrastructure that supports such perceptions is warranted and should inform efforts to improve AMU stewardship and future policies regarding AMU.

ECM-transmitted shear stress induces apoptotic cell extrusion in early breast gland development.

Epithelial cells of human breast glands are exposed to various mechanical ECM stresses that regulate tissue development and homeostasis. Mechanoadaptation of breast gland tissue to ECM-transmitted shear stress remained poorly investigated due to the lack of valid experimental approaches. Therefore, we created a magnetic shear strain device that enabled, for the first time, to analyze the instant shear strain response of human breast gland cells. MCF10A-derived breast acini with basement membranes (BM) of defined maturation state and basoapical polarization were used to resemble breast gland morphogenesis in vitro. The novel biophysical tool was used to apply cyclic shear strain with defined amplitudes (≤15%, 0.2 Hz) over 22 h on living spheroids embedded in an ultrasoft matrix (<60 Pa). We demonstrated that breast spheroids gain resistance to shear strain, which increased with BM maturation and basoapical polarization. Most intriguingly, poorly developed spheroids were prone to cyclic strain-induced extrusion of apoptotic cells from the spheroid body. In contrast, matured spheroids were insensitive to this mechanoresponse-indicating changing mechanosensing or mechanotransduction mechanisms during breast tissue morphogenesis. Together, we introduced a versatile tool to study cyclic shear stress responses of 3D cell culture models. It can be used to strain, in principle, all kinds of cell clusters, even those that grow only in ultrasoft hydrogels. We believe that this approach opens new doors to gain new insights into dynamic shear strain-induced mechanobiological regulation circuits between cells and their ECM.

Intrinsic cell rheology drives junction maturation.

A fundamental property of higher eukaryotes that underpins their evolutionary success is stable cell-cell cohesion. Yet, how intrinsic cell rheology and stiffness contributes to junction stabilization and maturation is poorly understood. We demonstrate that localized modulation of cell rheology governs the transition of a slack, undulated cell-cell contact (weak adhesion) to a mature, straight junction (optimal adhesion). Cell pairs confined on different geometries have heterogeneous elasticity maps and control their own intrinsic rheology co-ordinately. More compliant cell pairs grown on circles have slack contacts, while stiffer triangular cell pairs favour straight junctions with flanking contractile thin bundles. Counter-intuitively, straighter cell-cell contacts have reduced receptor density and less dynamic junctional actin, suggesting an unusual adaptive mechano-response to stabilize cell-cell adhesion. Our modelling informs that slack junctions arise from failure of circular cell pairs to increase their own intrinsic stiffness and resist the pressures from the neighbouring cell. The inability to form a straight junction can be reversed by increasing mechanical stress artificially on stiffer substrates. Our data inform on the minimal intrinsic rheology to generate a mature junction and provide a springboard towards understanding elements governing tissue-level mechanics.

[Paget's disease of bone-a current review of clinical aspects, diagnostics and treatment]. / Morbus Paget des Knochens ­ eine aktuelle Übersicht zu Klinik, Diagnostik und Therapie.

Paget's disease is a monostotic or polyostotic progressive skeletal disease with a genetic predisposition. The affected bone areas show osseous swelling and often grotesque deformation, chronic pain and fractures. Many cases are asymptomatic for a long time resulting in a late diagnosis. The pathogenesis is still unknown. In addition to a genetic predisposition, viral factors are also discussed. Laboratory tests and imaging are used for diagnosis. The effective principle of medicinal bisphosphonate treatment is to inhibit osteoclastic bone resorption and should be initiated early to prevent secondary complications. This article presents the current knowledge about this rare osteological disease.

Beam characterization and feasibility study for a small animal irradiation platform at clinical proton therapy facilities.

A deeper understanding of biological mechanisms to promote more efficient treatment strategies in proton therapy demands advances in preclinical radiation research. However this is often limited by insufficient availability of adequate infrastructures for precision image guided small animal proton irradiation. The project SIRMIO aims at filling this gap by developing a portable image-guided research platform for small animal irradiation, to be used at clinical facilities and allowing for a precision similar to a clinical treatment, when scaled down to the small animal size. This work investigates the achievable dosimetric properties of different lowest energy clinical proton therapy beams, manipulated by a dedicated portable beamline including active focusing after initial beam energy degradation and collimation. By measuring the lateral beam size in air close to the beam nozzle exit and the laterally integrated depth dose in water, an analytical beam model based on the beam parameters of the clinical beam at the Rinecker Proton Therapy Center was created for the lowest available clinical beam energy. The same approach was then applied to estimate the lowest energy beam model of different proton therapy facilities, Paul Scherrer Institute, Centre Antoine Lacassagne, Trento Proton Therapy Centre and the Danish Centre for Particle Therapy, based on their available beam commissioning data. This comparison indicated similar beam properties for all investigated sites, with emittance values of a few tens of mm·mrad. Finally, starting from these beam models, we simulated propagation through a novel beamline designed to manipulate the beam energy and size for precise small animal irradiation, and evaluated the resulting dosimetric properties in water. For all investigated initial clinical beams, similar dosimetric results suitable for small animal irradiation were found. This work supports the feasibility of the proposed SIRMIO beamline, promising suitable beam characteristics to allow for precise preclinical irradiation at clinical treatment facilities.

[Management and Outcome of Surgery in Patients with Severe Pulmonary Hypertension--A Single-Center Experience]. / Management und postoperatives Überleben bei chirurgischen Eingriffen an Patienten mit schwerer pulmonaler Hypertonie--etrospektive Analyse eines Zentrums.

BACKGROUND: Patients with pulmonary hypertension (PH) are at high risk when undergoing surgery. Up to one-third of patients suffer complications; recent studies report a mortality rate of 1 to 7%. Frequent events are deterioration of right heart function and infectious or bleeding complications. METHODS: Data of patients (age ≥ 18) with precapillary PH who need to undergo elective surgery between January 2006 and March 2015 were included in this retrospective analysis. All patients who were planned for surgery underwent the same procedure. First, patients were evaluated in the PH center. Thereafter, PH-relevant data were discussed with the surgeon/anesthesiologist team for risk-adapted planning of anesthesia and intervention. The present analysis comprises patient characteristics and information about surgery and post-interventional course. RESULTS: This study analyzes 31 surgical procedures carried out in PH patients (male: n = 8; PH-group I: n = 23, group III: n = 3, group IV: n = 5, mean age: 59.5 ± 15.3 years). Patients were characterized by compromised hemodynamics and exercise capacity: pulmonary vascular resistance: 805.4 ± 328.5 dyn*s*cm(-5), mean pulmonary arterial pressure: 46.3 ± 9.3 mmHg, 6-minute walking distance: 350.3 ± 123.3 m.The majority of interventions were performed under general anesthesia (n = 24). In 25 cases, the intraoperative monitoring was complemented with right heart catheterization.Eight interventions were associated with complications, three of which were serious. One patient died postoperatively owing to sepsis and right heart failure. CONCLUSION: A careful and structured planning of surgical interventions in patients with PH and the choice of surgical procedure and anesthesia adapted to the conditions of PH might help avoid complications. Further multicentric studies are needed.

Rebuilding northern foodsheds, sustainable food systems, community well-being, and food security.

BACKGROUND: Multiple climatic, environmental and socio-economic pressures have accumulated to the point where they interfere with the ability of remote rural Alaska Native communities to achieve food security with locally harvestable food resources. The harvest of wild foods has been the historical norm, but most Alaska Native villages are transitioning to a cash economy, with increasing reliance on industrially produced, store-bought foods, and with less reliable access to and reliance on wild, country foods. While commercially available market foods provide one measure of food security, the availability and quality of market foods are subject to the vagaries and vulnerabilities of the global food system; access is dependent on one's ability to pay, is limited to what is available on the shelves of small rural stores, and, store-bought foods do not fulfill the important roles that traditional country foods play in rural communities and cultures. Country food access is also constrained by rising prices of fuel and equipment, a federal and state regulatory framework that sometimes hinders rather than helps rural subsistence users who need to access traditional food resources, a regulatory framework that is often not responsive to changes in climate, weather and seasonality, and a shifting knowledge base in younger generations about how to effectively harvest, process and store wild foods. OBJECTIVE: The general objective is to provide a framework for understanding the social, cultural, ecological and political dimensions of rural Alaska Native food security, and to provide information on the current trends in rural Alaska Native food systems. DESIGN: This research is based on our long-term ethnographic, subsistence and food systems work in coastal and interior Alaska. This includes research about the land mammal harvest, the Yukon River and coastal fisheries, community and village gardens, small livestock production and red meat systems that are scaled appropriately to village size and capacity, and food-system intervention strategies designed to rebuild local and rural foodsheds and to restore individual and community health. RESULTS: The contemporary cultural, economic and nutrition transition has severe consequences for the health of people and for the viability of rural communities, and in ways that are not well tracked by the conventional food security methodologies and frameworks. This article expands the discussion of food security and is premised on a holistic model that integrates the social, cultural, ecological, psychological and biomedical aspects of individual and community health. CONCLUSION: We propose a new direction for food-system design that prioritizes the management of place-based food portfolios above the more conventional management of individual resources, one with a commitment to as much local and regional food production and/or harvest for local and regional consumption as is possible, and to community self-reliance and health for rural Alaska Natives.

Environmental and clinical epidemiology of Aspergillus terreus: data from a prospective surveillance study.

Aspergillus terreus may be resistant to amphotericin B and is associated with significant morbidity and mortality in immunocompromised patients. Local incidence is influenced by the density of airborne Aspergillus spp. spores which may in turn depend on meteorological factors. Once-weekly environmental samples were collected prospectively inside and outside the University Hospital of Cologne, Germany (UHC) and haematological patients were screened for nasal Aspergillus spp. colonisation and monitored for invasive fungal disease (IFD). RAPD (rapid amplification of polymorphic DNA)-polymerase chain reaction (PCR) and amphotericin B susceptibility testing were performed on all A. terreus isolates. A total of 4919 colony-forming units (cfu) were isolated (2212 indoors, 2707 outdoors). Further identification revealed A. fumigatus (73.5%), A. niger (4.3%), A. flavus (1.7%), A. terreus (0.2%) and non-Aspergillus fungi (20.3%). RAPD-PCR did not reveal clonal relationships between the A. terreus isolates. All A. terreus isolates displayed complete resistance to amphotericin. The B. Aspergillus spp. conidia exposure was lowest in June and highest in November inside and outside UHC. Conidia load correlated with the season and the relative humidity, with increasing spore counts during dry periods. One out of 855 nasal swabs was positive for A. niger. The patient did not develop IFD. A. terreus is unlikely to be a relevant pathogen at the UHC. Results from RAPD-PCR suggested a wide epidemiological variety of strains rather than a common source of contamination. Nasal swab surveillance cultures for early detection of Aspergillus spp. colonisation were not useful in identifying patients who may develop IFD. The risk of IFD at the UHC may increase in autumn and during dry periods.

Mercury interferes with endogenous antioxidant levels in Yukon River subsistence-fed sled dogs.

Before adopting modern corn-and-grain-based western processed diets, circumpolar people had a high fat and protein subsistence diet and exhibited a low incidence of obesity, diabetes and cardiovascular disease. Some health benefits are attributable to a subsistence diet that is rich in omega-3 fatty acids and antioxidants. Pollution, both global and local, is a threat to wild foods, as it introduces contaminants into the food system. Northern indigenous people and their sled dogs are exposed to a variety of contaminants, including mercury, that accumulate in the fish and game that they consume. The sled dogs in Alaskan villages are maintained on the same subsistence foods as their human counterparts, primarily salmon, and therefore they can be used as a food systems model for researching the impact of changes in dietary components. In this study, the antioxidant status and mercury levels were measured for village sled dogs along the Yukon River. A reference kennel, maintained on a nutritionally balanced commercial diet, was also measured for comparison. Total antioxidant status was inversely correlated with the external stressor mercury.

[Morphologic classification of Reinke's edema through optical coherence tomography]. / Morphologische Klassifikation des Reinke-Odems mittels optischer Kohärenztomografie.

OBJECTIVE: Several classification systems for Reinke's edema have been proposed in the past, which are somewhat less than morphologically ideal. The objective of the present study is to evaluate the ability of optical coherence tomography (OCT) to attain a reproducible graduation of Reinke's edema. MATERIAL AND METHODS: In a prospective study, 30 consecutive patients underwent endolaryngeal, microsurgical resection of their Reinke's edema. Graduation was performed through OCT based on morphologic criteria, where each result was compared with that of other classification systems. RESULTS: In Reinke's edema grade I according to Glanz, a feathered pattern is found, while Reinke's edema grade II demonstrates a lacunar and Reinke's edema grade III a confluent pattern. Correlation between the different classification systems was uniformly weak and not significant. CONCLUSIONS: Due to the three different recognizable patterns, OCT qualifies as an objective and reproducible aid for the graduation of Reinke's edema and gives certain insights in its pathogenesis.

[Optical coherence tomography : significance of a new method for assessing unclear laryngeal pathologies]. / Optische Kohärenztomographie : Stellenwert einer neuen Methode bei der Abklärung unklarer Kehlkopfveränderungen.

BACKGROUND: Optical coherence tomography (OCT) is a new imaging technology of as yet unknown significance in laryngology. The objective of this study was to evaluate the ability of this noninvasive method to reliably predict diagnosis and possible malignancy in laryngeal disease. PATIENTS AND METHODS: In a prospective study, a total of 225 laryngeal lesions in 201 consecutive patients were examined during elective microlaryngoscopy. Clinical assessment under the operating microscope with and without OCT was compared with conventional histopathology. RESULTS: For all cases, diagnosis gained by OCT was significantly superior to microlaryngoscopy alone. In particular, the exact grade of dysplasia could be better determined with the help of OCT, whereas statistical significance was just barely missed for the prediction of benign lesions. Additionally, OCT proved to be a very helpful method for identifying malignant tumors of the larynx. CONCLUSIONS: OCT is a simple, rapid, and reliable aid in the diagnostic investigation of unclear laryngeal pathologies, especially of laryngeal cancer and its precursor lesions.

An exploratory study of total mercury levels in archaeological caribou hair from northwest Alaska.

Over the past ten years, total mercury (THg) levels have been surveyed in Alaskan wildlife and fish as part of the Arctic Monitoring and Assessment (AMAP). Beyond these studies there is little historical data on THg levels in important subsistence species for people in Alaska. A survey of THg in caribou hair from archaeological deposits would provide data to develop temporal trends for this region of the Arctic. Caribou hair from a Western Thule settlement beneath the Alaska native village of Deering (ca. AD 1150) show variability in hair THg values, with a mean level (86 ng/g) which is in the range that is observed in modern Rangifer sp. (caribou and reindeer). Hair from House 1 had a THg mean level of 99.6 ng/g and hair from House 2 had a THg mean of 64.2 ng/g. This is the earliest reported record of mercury in caribou associated with human subsistence activities in the western North American Arctic, and is a first step toward compilation of a needed database through which to measure and evaluate exposure to mercury by people who rely heavily on caribou as a food source. We hypothesize that similarity in mercury values in archaeological samples of caribou and in contemporary samples would give an additional perspective on human exposure to mercury through caribou harvest and consumption today. Since this hypothesis will be more useful if evaluated at a regional rather than global scale, further studies will be needed at different archaeological sites across Alaska to determine the generality of this observation in relation to geographic scale.

Identification of animal species by protein radioimmunoassay of bone fragments and bloodstained stone tools.

In forensics and archaeology, it is important to distinguish human from animal remains and to identify animal species from fragmentary bones and bloodstains. We report blind tests in which a protein radioimmunoassay (pRIA) was used to identify the species of six bone fragments lacking morphological specificity and 43 bloodstained lithic tools, knapped experimentally and soaked in blood of known animal and human origin. The submitters of the bone fragments and the bloodstained tools each listed a number of possible species, from which the testers selected the best match with the pRIA results. All six bone fragments were correctly identified: three humans, a deer, a dog, and a cow. Forty-three tools were stained with blood from a wide variety of species including ungulates, carnivores, a fish, and a bird. On 40 of these 43, at least one species (or blood-free control) was identified correctly. Some of the tools were stained with blood of two different species. A mixture of sheep and musk ox blood was correctly identified; in several other mixtures, only a single species was detected. Two tools with human blood and one with human sweat were correctly reported as human. There was a single false positive (one of three controls reported as weakly bovine) and no false negatives. We conclude that the pRIA technique shows a high degree of accuracy in discriminating human from animal bone fragments and bloodstains and in identifying animal species.

A randomized controlled trial to prevent patient lift and transfer injuries of health care workers.

STUDY DESIGN: Randomized controlled trial (RCT). OBJECTIVES: To compare the effectiveness of training and equipment to reduce musculoskeletal injuries, increase comfort, and reduce physical demands on staff performing patient lifts and transfers at a large acute care hospital. SUMMARY OF BACKGROUND DATA: Back injury to nursing staff during patient handling tasks is a major issue in health care. The value of mechanical assistive devices in reducing injuries to these workers is unclear. METHODS: This three-armed RCT consisted of a "control arm," a "safe lifting" arm, and a "no strenuous lifting" arm. A medical, surgical, and rehabilitation ward were each randomly assigned to each arm. Both intervention arms received intensive training in back care, patient assessment, and handling techniques. Hence, the "safe lifting" arm used improved patient handling techniques using manual equipment, whereas the "no strenuous lifting" arm aimed to eliminate manual patient handling through use of additional mechanical and other assistive equipment. RESULTS: Frequency of manual patient handling tasks was significantly decreased on the "no strenuous lifting" arm. Self-perceived work fatigue, back and shoulder pain, safety, and frequency and intensity of physical discomfort associated with patient handling tasks were improved on both intervention arms, but staff on the mechanical equipment arm showed greater improvements. Musculoskeletal injury rates were not significantly altered. CONCLUSIONS: The "no strenuous lifting" program, which combined training with assured availability of mechanical and other assistive patient handling equipment, most effectively improved comfort with patient handling, decreased staff fatigue, and decreased physical demands. The fact that injury rates were not statistically significantly reduced may reflect the less sensitive nature of this indicator compared with the subjective indicators.

Conducting nutrition education research in junior high schools: approaches and challenges.

This article describes some of the approaches used and challenges encountered conducting nutrition education research in junior high schools. The Teens Eating for Energy and Nutrition at School (TEENS) study recruited 16 schools and over 3800 seventh graders to participate in an intervention to increase students' intakes of fruits, vegetables, and lower fat foods for the purpose of reducing their future risk of cancer. The TEENS intervention included a classroom curriculum as well as a school environment and family component. This article describes some of the issues faced in the design and implementation of the study including recruiting schools and teens, maximizing the number of students within each intervention school exposed to all components of the intervention, and implementing elements of nutrition education in a classroom setting. The methods used to meet these challenges and the success of the methods attempted are described.

Buffer zones promoting oligotrophication in golf course runoffs: fiddler crabs as estuarine health indicators.

Nitrogen pollution above a threshold level induces a eutrophication process in coastal creek ecosystems and consequently impacts on the water quality. The remedy for this scenario is the introduction of methods to enhance oligotrophication by means of constructed wetlands and buffer zones. This paper discusses new data on nitrogen flux and population changes in the primary consumers in the Bradley Creek ecosystem, adjacent to the Duck Haven Golf Course in southeastern North Carolina. In 1998-99, over different seasons, density distribution of the field populations of the fiddler crab Uca minax, was monitored as an indicator of environmental health. A control site at Whiskey Creek, adjacent to the University Center for Marine Sciences, was monitored in the same period since this site is not influenced by any golf course nutrient flux. The results pointed out that threshold level for optimum population density in Spartina grandiflora salt marsh is 0.1 mg/L of nitrates. A dense crab population, adjacent to the golf course with a buffer zone, was indicative of restoration of the estuarine ecosystem. A model, involving the use of constructed wetlands for oligotrophication, is being prepared on the basis of studies conducted by the University of South Alabama for a stormwater wetland constructed adjacent to the university's golf course.

Prevention of the hemodynamic effects of iopromide-carrying liposomes in rats and pigs.

RATIONALE AND OBJECTIVES: Intravenous injection of liposomes is able to trigger allergy-like reactions that affect the cardiopulmonary system. The mechanism of these effects is still not totally clear. Because prediction of adverse reactions and the consequent exclusion of reactive patients do not seem feasible, prevention might have a considerable impact. METHODS: Two small, multilamellar liposome batches with the encapsulated contrast agent iopromide, which differed by size and buffer composition, were injected into anesthetized rats (n = 5 per group) and pigs (n = 6 per group). Blood pressure (BP), cardiac output (CO), contractility (dP/dt; in rats), total peripheral resistance (TPR; in rats), pulmonary vascular resistance (in pigs), and pulmonary arterial pressure (PAP; in pigs) were monitored. Saline, mannitol solution, the two buffers, and the contrast medium were used as controls. RESULTS: Significant changes in hemodynamic parameters were observed not only between liposomes and controls but also between the two liposome preparations. In rats, a significant decrease in BP followed by its normalization and subsequent increase, a decrease in CO followed by an increase, a decrease in TPR, and a decrease in dP/dt followed by an increase were observed. In pigs, the effects were different both in quality and in quantity (more intense) compared with those in rats. In this species, an increase in BP, a decrease in CO, an increase in TPR, and an increase in PAP were found. Pretreatment with acetylsalicylic acid was able to prevent the hemodynamic changes induced by the liposomes. CONCLUSIONS: Allergy-like side effects induced by liposome injection strongly depend on the size, electric charge, and composition of the particles. The mechanism triggered by liposome injection probably is complex and can be effectively blocked by pretreatment with acetylsalicylic acid.

Influence of the process parameters on the morphology and enzyme production of Aspergilli.

Several papers have been published dealing with various fungi to determine their morphology, enzyme production or process performance. However, no publication considered all of these aspects simultaneously. In the case of the production of xylanase by Aspergillus awamori the interrelationship of various key parameters are investigated. The influence of the reactor type (shake flasks, stirred tank and airlift tower loop reactor), the medium composition (semisynthetic and complex medium with wheat bran of different sizes, respectively as well as different concentrations of phosphate), and the specific power input (stirrer speed) on the growth, morphology, physiology, and productivity of the fungus are investigated. The results reveal a complex interrelationship which explains why the published results are contradictory. Without considering all of the relevant parameters, it is not possible to make general conclusions.

Does yogurt enriched with Bifidobacterium longum affect colonic microbiology and fecal metabolites in health subjects?

Diet-induced changes in the colonic microflora seem to play a role in colon carcinogenesis. In this study the effects of a yogurt (500 mL/d for 3 wk) enriched with Bifidobacterium longum and 5 g lactulose/L (A) on the fecal bacterial flora and various risk indexes for colon carcinogenesis were tested in 12 healthy volunteers and compared with a conventional yogurt (B). Increased excretion of bifidobacteria (P < 0.017) was found after consumption of both yogurts compared with the prestudy periods, whereas cultural counts of aerobes and anaerobes were not different. Breath-hydrogen exhalation was elevated and mouth-to-cecum transit time was accelerated in the period of yogurt A ingestion (P < 0.05) whereas no differences were found for oral-anal mean transit time, stool weight and pH, and fecal concentrations of short-chain fatty acids, bile acids, and neutral sterols. The results generally indicate great stability of the human fecal flora to this kind of dietary intervention.