Using focus groups to inform a peer health navigator service for people who are transgender and gender diverse in Saskatchewan, Canada.

BACKGROUND: This study investigated healthcare access and quality for people who are transgender and gender-diverse (PTGD) in Saskatchewan (SK), Canada, to inform a larger project that was piloting two peer health navigators for PTGD. METHODS: Two online focus groups were held. Nineteen participants were recruited to represent a broad range in age, gender and location in SK. Transcripts of the focus groups were analyzed using a thematic approach. RESULTS: The core theme that was identified was participants' desire for culturally safe healthcare. This core theme had two component themes: (1) systemic healthcare factors and (2) individual healthcare provider (HCP) factors. The healthcare system primarily acted as a barrier to culturally safe healthcare. HCPs could be either barriers or facilitators of culturally safe care; however, negative experiences outweighed positive ones. CONCLUSIONS: PTGD in SK face discrimination, with delays and barriers to care at all levels of the healthcare system. Peer health navigators can address some of these discrepancies; however, greater support is required for PTGD to be able to access culturally safe healthcare. PATIENT OR PUBLIC CONTRIBUTION: People with lived experience/PTGD were involved in all stages of this project. They were included on the team as community researchers and co-developed the research project, conducted the focus groups, participated in the analyses and are co-authors. As well, both navigators and all the participants in the focus groups were also PTGD.

Association between P-selectin levels and left atrial blood stasis in patients with nonvalvular atrial fibrillation.

BACKGROUND: P-selectin - a biomarker of platelet and endothelial cell activation is elevated in patients with non-valvular atrial fibrillation (NVAF). However, the association between sP-selectin level and thromboembolic complications in NVAF patients remains controversial. We tested the hypothesis that plasma soluble P-selectin (sPSL) level correlates with the measures of left atrial blood stasis in NVAF. METHODS: Plasma sPSL concentration was measured using solid-phase ELISA in 103 NVAF patients (age 63 ±â€¯14 years; 26% women) and 48 normal sinus rhythm controls (NSR; age 64 ±â€¯14 years; 41% women) who were not on aspirin. Within the group of NVAF cases, 27 had no spontaneous echocardiographic contrast (SEC) detected by transesophageal echocardiography, 31had mild SEC, 15 moderate, 20 severe, and 10 patients had left atrial appendage thrombus (LAAT). RESULTS: The median soluble sPSL level was higher in NVAF cases compared to NSR controls [(interquartile range) 26 (20-32) ng/mL vs 22 (15-29) ng/mL, p = 0.0045]. Only NVAF patients with CHA2DS2-VASc score ≥ 1 had higher sPSL level compared to NSR controls. Patients with severe SEC had significantly higher sPSL levels [32 (24-38) ng/mL] compared to all other NVAF patients (p = 0.0042) and to NSR controls (p < 0.0001). Also NVAF patients with LAAT had higher sPSL level compared to NSR controls. CONCLUSIONS: There is a direct correlation between p-selectin level and severe blood stasis in the left atrium. Only NVAF patients with CHA2DS2-VASc score ≥ 1 or with LAAT had higher sPSL level compared to NSR controls.

Environmental flows and water quality objectives for the River Murray.

Over the past decade, there intense consideration of managing flows in the River Murray to provide environmental benefits. In 1990 the Murray-Darling Basin Ministerial Council adopted a water quality policy: To maintain and, where necessary, improve existing water quality in the rivers of the Murray-Darling Basin for all beneficial uses - agricultural, environmental, urban, industrial and recreational, and in 1994 a flow policy: To maintain and where necessary improve existing flow regimes in the waterways of the Murray-Darling Basin to protect and enhance the riverine environment. The Audit of Water Use followed in 1995, culminating in the decision of the Ministerial Council to implement an interim cap on new diversions for consumptive use (the "Cap") in a bid to halt declining river health. In March 1999 the Environmental Flows and Water Quality Objectives for the River Murray Project (the Project) was set up, primarily to establish be developed that aims to achieve a sustainable river environment and water quality, in accordance with community needs, and including an adaptive approach to management and operation of the River. It will lead to objectives for water quality and environmental flows that are feasible, appropriate, have the support of the scientific, management and stakeholder communities, and carry acceptable levels of risk. This paper describes four key aspects of the process being undertaken to determine the objectives, and design the flow options that will meet those objectives: establishment of an appropriate technical, advisory and administrative framework; establishing clear evidence for regulation impacts; undergoing assessment of environmental flow needs; and filling knowledge gaps. A review of the impacts of flow regulation on the health of the River Murray revealed evidence for decline, but the case for flow regulation as the main cause is circumstantial or uncertain. This is to be expected, because the decline of the River Murray results from many factors acting over a long period. Also, the health of the river varies along its length, from highly degraded to reasonably healthy, so it is clear that different approaches will be needed in the various river zones, with some problems requiring reach or even point scale solutions. Environmental flow needs have been determined through two major Expert Panel reports that identified the ecological priorities for the river. The next step is to translate these needs into feasible flow management actions that will provide the necessary hydrological conditions. Several investigations are underway to recommend options for flow management. Two important investigations are described in this paper: how to enhance flows to wetlands of national and international significance, and how to physically alter or change the operation of structures (including a dam, weir, lock, regulator, barrage or causeway), to provide significant environmental benefits. Early modelling suggests that the only option which has a positive environmental effect in all zones of the River is a reduction in overall water consumption.

Inhibition of glioma cell growth and tumorigenic potential by CCN3 (NOV).

AIMS: To establish whether the ectopic expression of CCN3 (NOV) in glioma cells can interfere with their tumorigenic potential and assess its potential value in molecular medicine. METHODS: Glioma cell lines were used to assess whether differences in the degree of intracellular communication induced by the expression of the gap junction protein connexin 43 (Cx43) is related to the differential expression of CCN3 (NOV). The antiproliferative activity of rat CCN3 (rCCN3; NOV) in glioma cells, has been assessed both in vitro and in vivo with glioma cell lines expressing different amounts of CCN3 (NOV). RESULTS: Upon ectopic expression of Cx43, the growth of C6 glioma cells is decreased. An increase of CCN3 (NOV) expression matches the reduced tumorigenic potential of these transfected cells. The localisation of CCN3 (NOV) is affected by the increased expression of Cx43 in the Cx-13 transfected cells, in which it is detected at areas of cell-cell contact. In a xenograft model, CCN3 (NOV) transfected glioma cells were found to induce tumours to a lesser degree than their parental counterparts, which do not express detectable amounts of CCN3 (NOV). CONCLUSIONS: Previous observations had suggested an inverse relation between CCN3 (NOV) expression in glioma cells and their tumorigenicity. These results establish a direct association between the establishment of functional gap junctional intercellular communication and the expression of rCCN3 (NOV). In addition to a negative effect on murine and human cell growth, CCN3 (NOV) has antiproliferative activity on tumour cells in vivo. Thus, the antiproliferative activity of the CCN3 (NOV) protein might involve reorganisation of cellular contacts that play a crucial role in tumorigenesis. The antiproliferative activity of CCN3 (NOV) established in this work sets the stage for the potential use of CCN proteins in molecular oncology.

The effects of remifentanil on haemodynamic stability during rigid bronchoscopy.

We examined the effect of remifentanil on the haemodynamic response to rigid bronchoscopy in 22 adult ASA 2-4 patients, randomly allocated to receive 1.0 microg.kg-1 remifentanil over 1 min followed by 0.5 microg.kg-1.min-1 (remifentanil group) or 2.0 microg.kg-1 fentanyl followed by a saline infusion (control group). Following the initial infusion, all patients received a sleep dose of propofol followed by rocuronium 0.6 mg.kg-1 and their lungs were ventilated using a Sander's injector attached to the rigid bronchoscope. Direct arterial blood pressures, heart rate and ST segment changes on the CM5 lead configuration of the electrocardiograph were measured at 1-min intervals from before induction of anaesthesia until the end of bronchoscopy. Arterial pressures and heart rate were similar in the two groups before and after induction of anaesthesia. Remifentanil attenuated the haemodynamic response to bronchoscopy (p < 0.05 for increases in arterial pressures and heart rate). Four patients in the remifentanil group had ST segment depression compared with eight patients in the control group, but this was not statistically significant.

Nitric oxide, stress, and depression.

Stress and depression have a significant impact on modern society. Even though their symptomatology is well characterized, little is known about the molecular mechanisms underlying these disturbing disorders. While the role of neurotransmitters such as serotonin, norepinephrine (NE), dopamine (DA), corticotropin-releasing hormone (CRH), and arginine vasopressin (AVP) has been extensively studied, new evidence suggests a role for the unique neurotransmitter nitric oxide (NO). This highly diffusible and reactive molecule is synthesized by at least three enzyme subtypes of NO synthase (NOS). The commonly known neuronal NOS subtype is localized in areas of the brain related to stress and depression. The limbic-hypothalamic-pituitary-adrenal (LHPA) axis is the core of this system. These interrelated pathways have in common the production, and negative feedback, of glucocorticoids. Within these areas, NO is suggested to play a role in modulating the release of other neurotransmitters, acting as a cellular communicator in plasticity and development, and/or acting as a vasodilator in regulation of blood flow. This article summarizes some of the recent advances in the understanding of the role of NO in stress and depression.

Determination of a potential role of the CCN family of growth regulators in connexin43 transfected C6 glioma cells.

Tumour cells often exhibit erratic cell growth, as well as decreased gap junctional intercellular communication (GJIC). C6 glioma cells are characterized by low levels of gap junction mRNA and protein, and decreased amounts of GJIC when compared with astrocytes. Previous work has shown that C6 glioma cells transfected with connexin43 (C6-Cx43) exhibit decreased proliferation in vivo and in vitro, as well as genes that are differentially expressed between these cells. In this study, RNA levels of two CCN (connective tissue growth factor [CTGF], Cyr61/Cef-10, nephroblastoma overexpressed [NOV]) gene family members are shown to be upregulated in C6-Cx43 cells: Cyr61 and Nov. Cyr61 has previously been shown to increase adhesion, migration and growth in many cell types, whereas NOV has growth suppressive capacities. Cyr61 RNA expression is shown here to respond to serum in quiescent cells in an immediate early gene fashion, independent of Cx43 expression. In contrast, Nov RNA levels remain constant, reflective of transfected Cx43 expression. Furthermore, confocal microscopy indicates that NOV colocalizes with Cx43 plaques at the cell membrane. These findings provide insight into the possible role of Nov and Cyr61 in tumour cells.

Work stress among community psychiatric nurses.

This article examines the findings of a research study on the levels and sources of stress among 60 community psychiatric nurses (CPNs) from six health authorities in the midlands area. This three-way comparative study explores the stress levels experienced by CPNs working with primary clients. The hypothesis that higher levels of stress is experienced by CPNs working with the severely mentally ill is supported. The stress levels experienced did appear to vary with the type of clients catered for. Using a questionnaire designed to measure individual variables, CPNs working with the severely mentally ill reported higher caseloads, less training, lack of respect and understanding of their role by others and the need for more supervision and support. Forty per cent of CPNs were found to be stressed according to the General Health Questionnaire (GHQ 28). While there is debate about where CPNs should focus their interventions and which clients should be prioritized, it appears that working with the severely mentally ill is less attractive and more stressful to CPNs. The results and suggestions for further research are highlighted in this article.

Drainage of a pancreatic pseudocyst: an unusual complication.

A 34-year-old white woman had external drainage of a pancreatic pseudocyst. During sinography, contrast medium filled perigastric varices, causing septic shock. From this experience, we believe that although sinograms are helpful, they should be preceded by prophylactic administration of antibiotics and that contrast material should be sterile. The drainage catheter should be removed as soon as possible.

World Health Organization--basic radiographic system (WHO-BRS) unit: experimental clinical evaluation.

The basic radiographic system (BRS) is a simplified version of a standard radiographic unit designed by the World Health Organization and the Pan American Health Organization. The design of the BRS includes the requirement that it should be able to perform routine radiographic examinations with a minimum of operator training. This report describes the performance of a BRS manufactured by Siemens. The physical parameters of this BRS were very good and operation should require a minimum of training. A small number of BRS films were compared with films obtained using the standard equipment in the department. The BRS films were generally regarded as satisfactory. Radiation exposure to patients is equal to, and in some cases less than, exposures with conventional X-ray units.

Acute myocarditis causing fatal ventricular arrhythmia in treated polymyositis.

A patient with definite polymyositis responded clinically to prednisolone in combination with azathioprine, with improvement in muscle strength and normalization of muscle enzyme levels. After 7 weeks' treatment the patient developed chest pain and fatal ventricular arrhythmias. An autopsy showed inflammatory myocarditis, but marked improvement in the skeletal muscle histology. This case illustrates that myocarditis may be a late complication of polymyositis despite immunosuppressive therapy.

Nickel influences iron metabolism through physiologic, pharmacologic and toxicologic mechanisms in the rat.

A study involving three experiments was done to ascertain whether the beneficial effect of nickel on hematopoiesis in moderately iron-deficient rats was due to physiologic and/or pharmacologic mechanisms. Female Sprague-Dawley rats were fed nickel supplements ranging from 0 to 100 micrograms/g in iron-low (15 micrograms Fe3+/g), iron-adequate (65 micrograms Fe3+/g), or iron-luxuriant (100 micrograms Fe3+/g) diets. The basal diet contained from 2 ng (experiment 3) to 36 ng (experiment 1) of nickel/g. At 10 weeks, both nickel deficiency and toxicity (100 micrograms/g diet) tended to depress hematopoiesis and markedly altered femur and liver trace element content in marginally iron-deficient rats. The alterations included elevated copper, iron and nickel, and depressed calcium and manganese in femurs. The pharmacologic action of nickel was indicated by the finding that high dietary nickel (5, 10, 20 or 50 micrograms/g) apparently stimulated hematopoiesis in marginally iron-deprived rats to a greater extent than dietary levels of nickel (0.1, 0.5 or 1.0 microgram/g) considered adequate for nutritional needs. High dietary nickel also elevated the iron content in liver of marginally iron-adequate rats. The findings indicate that nickel influences iron metabolism at physiologic, pharmacologic and toxic levels of intake. They also indicate that many previously reported signs of nickel deprivation, including effects on hematopoiesis, may have been misinterpreted and might be manifestations of pharmacologic actions of nickel.

Changes in anatomical distribution of tumour lesions induced by platelet-active drugs.

To examine the effect of platelet-active drugs on the spread of blood-borne tumour cells, two murine tumours, sarcoma 180 (S-180) and TLX-5 lymphoma, were selected. Following intravenous (IV) injection into CBA mice the former elicited thrombocytopenia and formed discrete pulmonary tumours, whereas the latter failed to elicit thrombocytopenia and formed discrete tumours in all visceral organs examined except the lungs. S-180 cells were injected IV into mice pre-treated with RA233 (known to prevent thrombocytopenia and thrombus formation) and TLX-5 cells were injected IV into mice pre-treated with Corynebacterium parvum (known to induce thrombocytopenia and thrombus formation). RA233 pre-treatment did not change survival time or incidence of S-180 pulmonary tumours but did result in a higher incidence of extrapulmonary tumours and a lower tumour cell burden immediately after injection. Pre-treatment with C. parvum resulted in a higher TLX-5 tumour cell burden but not discrete tumours in the lungs. On the basis of known drug activities it is proposed that thrombocytopenia induced in these experiments is in part a reflection of thrombus formation in the lungs which influences the speed of passage of tumour cells through capillaries. In some cases this may lead to a changed anatomical distribution of tumour lesions.

Incidence of sulphasalazine-induced male infertility.

Sperm analysis of 21 patients taking sulphasalazine for inflammatory bowel disease revealed that 86% had abnormal semen analysis and 72% had oligospermia.

The nonarterial origin of cystic adventitial disease of the popliteal artery in two patients.

Two patients with compression of a popliteal artery caused by periarticular cystic lesions of the knee joint are described. Both gave the usual history of complete resolution of intermittent claudication for a period of months, followed by recurrence. The authors feel that this is a significant historical feature in this condition.