Co-designed weight management intervention for women recovering from oestrogen-receptor positive breast cancer.

BACKGROUND: Weight gain is commonly observed during and after breast cancer treatment and is associated with poorer survival outcomes, particularly in women with oestrogen receptor-positive (ER +) disease. The aim of this study was to co-design (with patients) a programme of tailored, personalised support (intervention), including high-quality support materials, to help female breast cancer patients (BCPs) with ER + disease to develop the skills and confidence needed for sustainable weight loss.  METHODS: ER + BCPs were recruited from two UK National Health Service (NHS) Trusts. The selection criteria included (i) recent experience of breast cancer treatment (within 36 months of completing primary treatment); (ii) participation in a recent focus group study investigating weight management perceptions and experiences; (iii) willingness to share experiences and contribute to discussions on the support structures needed for sustainable dietary and physical activity behaviour change. Co-design workshops included presentations and interactive activities and were facilitated by an experienced co-design researcher (HH), assisted by other members of the research team (KP, SW and JS). RESULTS: Two groups of BCPs from the North of England (N = 4) and South Yorkshire (N = 5) participated in a two-stage co-design process. The stage 1 and stage 2 co-design workshops were held two weeks apart and took place between Jan-March 2019, with each workshop being approximately 2 h in duration. Guided by the Behaviour Change Wheel, a theoretically-informed weight management intervention was developed on the basis of co-designed strategies to overcome physical and emotional barriers to dietary and physical activity behaviour change. BCPs were instrumental in designing all key features of the intervention, in terms of Capability (e.g., evidence-based information, peer-support and shared experiences), Opportunity (e.g., flexible approach to weight management based on core principles) and Motivation (e.g., appropriate use of goal-setting and high-quality resources, including motivational factsheets) for behaviour change. CONCLUSION: This co-design approach enabled the development of a theoretically-informed intervention with a content, structure and delivery model that has the potential to address the weight management challenges faced by BCPs diagnosed with ER + disease. Future research is required to evaluate the effectiveness of the intervention for eliciting clinically-important and sustainable weight loss in this population.

Local Exhaust Ventilation to Control Dental Aerosols and Droplets.

Dental procedures produce aerosols that may remain suspended and travel significant distances from the source. Dental aerosols and droplets contain oral microbes, and there is potential for infectious disease transmission and major disruption to dental services during infectious disease outbreaks. One method to control hazardous aerosols often used in industry is local exhaust ventilation (LEV). The aim of this study was to investigate the effect of LEV on aerosols and droplets produced during dental procedures. Experiments were conducted on dental mannequins in an 825.4-m3 open-plan clinic and a 49.3-m3 single surgery. Ten-minute crown preparations were performed with an air-turbine handpiece in the open-plan clinic and 10-min full-mouth ultrasonic scaling in the single surgery. Fluorescein was added to instrument irrigation reservoirs as a tracer. In both settings, optical particle counters (OPCs) were used to measure aerosol particles between 0.3 and 10.0 µm, and liquid cyclone air samplers were used to capture aerosolized fluorescein tracer. In addition, in the open-plan setting, fluorescein tracer was captured by passive settling onto filter papers in the environment. Tracer was quantified fluorometrically. An LEV device with high-efficiency particulate air filtration and a flow rate of 5,000 L/min was used. LEV reduced aerosol production from the air-turbine handpiece by 90% within 0.5 m, and this was 99% for the ultrasonic scaler. OPC particle counts were substantially reduced for both procedures and air-turbine settled droplet detection reduced by 95% within 0.5 m. The effect of LEV was substantially greater than suction alone for the air-turbine and was similar to the effect of suction for the ultrasonic scaler. LEV reduces aerosol and droplet contamination from dental procedures by at least 90% in the breathing zone of the operator, and it is therefore a valuable tool to reduce the dispersion of dental aerosols.

A RAC-GEF network critical for early intestinal tumourigenesis.

RAC1 activity is critical for intestinal homeostasis, and is required for hyperproliferation driven by loss of the tumour suppressor gene Apc in the murine intestine. To avoid the impact of direct targeting upon homeostasis, we reasoned that indirect targeting of RAC1 via RAC-GEFs might be effective. Transcriptional profiling of Apc deficient intestinal tissue identified Vav3 and Tiam1 as key targets. Deletion of these indicated that while TIAM1 deficiency could suppress Apc-driven hyperproliferation, it had no impact upon tumourigenesis, while VAV3 deficiency had no effect. Intriguingly, deletion of either gene resulted in upregulation of Vav2, with subsequent targeting of all three (Vav2-/- Vav3-/- Tiam1-/-), profoundly suppressing hyperproliferation, tumourigenesis and RAC1 activity, without impacting normal homeostasis. Critically, the observed RAC-GEF dependency was negated by oncogenic KRAS mutation. Together, these data demonstrate that while targeting RAC-GEF molecules may have therapeutic impact at early stages, this benefit may be lost in late stage disease.

Evaluation of Parameterized Convective Transport of Trace Gases in Simulation of Storms Observed During the DC3 Field Campaign.

Deep convective transport of surface moisture and pollution from the planetary boundary layer to the upper troposphere and lower stratosphere affects the radiation budget and climate. This study uses cloud-parameterized Weather Research and Forecasting model coupled with Chemistry simulations to analyze the subgrid deep convective transport of CO at 12- and 36-km horizontal resolution in supercell and mesoscale convective systems observed during the 2012 Deep Convective Clouds and Chemistry field campaign and compares the simulation results with aircraft measurements and cloud-resolved simulations. The best Weather Research and Forecasting simulation of these storms was obtained with the use of the Grell-Freitas convective scheme. The default Weather Research and Forecasting model coupled with Chemistry subgrid convective transport scheme was replaced with a scheme to compute convective transport within the Grell-Freitas subgrid cumulus parameterization, which resulted in improved transport simulations. We examined the CO tendencies due to subgrid- and grid-scale convective transport. Results showed that the subgrid convective transport started earlier than the grid-scale convective transport. The subgrid-scale convective transport reached its maximum during the hour prior to the formation of the grid-scale constant-altitude detrainment layer. After that, both the subgrid- and grid-scale convective transport began to decrease. The subgrid-scale convective transport played a more significant role in the supercell case than the mesoscale convective system case. Subgrid contribution reached ~90% at the beginning of the storm and decreased to ~30% (17%) for the 36-km (12-km) domain 4 hr later.

Fullerol-sensitized production of reactive oxygen species in aqueous solution.

The relative production rate of reactive oxygen in aqueous solution sensitized by fullerol (a polyhydroxylated, water-soluble form of the fullerene C60) was measured and compared to known reactive oxygen sensitizers using an oxygen consumption method. The solutions were irradiated by polychromatic visible and ultraviolet light. Reactive oxygen species were generated under both visible and ultraviolet light sources. The greatest rates of oxygen consumption were observed at acidic pH. We show for the first time evidence of both singlet oxygen and superoxide production by fullerol under both UV and polychromatic light sources.

Thyrotoxic hypokalaemic paralysis in a pregnant Afro-Caribbean woman. A case report and review of the literature.

This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis.

Thyrotoxic hypokalaemic paralysis in a pregnant Afro-Caribbean woman. A case report and review of the literature

This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis

Hepatocyte growth factor and macrophage-stimulating protein are upregulated during excisional wound repair in rats.

Hepatocyte growth factor (HGF) and macrophage-stimulating protein (MSP) are structurally related molecules that stimulate epithelial cell proliferation and migration. MSP also acts directly as a chemoattractant for resident macrophages. These activities are integral to the wound repair processes of inflammation, epithelialization and tissue remodelling. To begin to examine the involvement of HGF and MSP in healing of cutaneous wounds we have mapped the temporal expression of these two molecules and their receptors, MET and RON respectively, in adult rat excisional wounds. Four 2x2-cm full-thickness excisional wounds were created on the dorsum of 18 rats, and biopsies were taken through the wounds at 3, 5, 7, 14, 21, and 28 days postwounding. These biopsies were analyzed using immunofluorescent staining and in situ hybridization (ISH). The number of cells staining positively for HGF and MET significantly increased in response to wounding. HGF staining and mRNA peaked at 7 days postwounding whereas MET was upregulated earlier, peaking after 3 days. Both HGF and MET protein were observed in fibroblasts of the dermis and in the newly forming granulation tissue. ISH studies also revealed that fibroblasts at the wound edges and within the newly forming granulation tissue also expressed HGF and c-met mRNA. Immunofluorescent staining revealed both MSP and RON within the wound, with maximum staining occurring between 7 and 21 days for both the ligand and receptor. In addition, MSP co-localized with a small subset of ED1-positive cells (monocytes). In contrast, ED2-positive cells (macrophages) did not co-localize with MSP. Thus, increased expression of HGF, MSP and their receptors MET and RON respectively was observed in response to wounding. Furthermore, MSP co-localization with a subset of monocytes may confirm a role for MSP in the activation of mature macrophages, which may be important in tissue remodelling.

Family settings and children's adjustment: differential adjustment within and across families.

BACKGROUND: Children in stepfamilies and single-parent families exhibit elevated levels of behavioural and emotional problems compared with children in intact (biological) families, but there is variation within and across these family types. AIMS: To examine the sources of variation in children's behavioural and emotional problems across diverse family settings. METHOD: Levels of behavioural and emotional problems in children from diverse stepfamilies and single-parent families were compared with children living with both biological parents. Psychosocial risks were measured at the individual child and family levels. RESULTS: Behavioural and emotional problems were elevated in children in stepmother/complex stepfamilies and single-parent families, but not in simple stepfather families, relative to 'biological' families. Psychopathology associated with family type was explained by compromised quality of the parent-child relationship, parental depression and socio-economic adversity. Sibling similarity in behavioural and emotional problems was most pronounced in high-risk family settings. CONCLUSIONS: Family type is a proxy for exposure to psychosocial risks; the extent of family-wide influence on children's development may be strongest in high-stress settings.

Ancient chronology. Astronomical orientation of the pyramids.

Spence speculates that Egypt's pyramid builders found true north by using a plumb line: when the stars Kochab and Mizar were seen on the same vertical, one was facing north. As evidence in support of this hypothesis, she points to the proposed interstar-line precession past the north celestial pole at a rate of 27' per century (cy). We argue that a mathematical error affects this result, which when corrected points more strongly to a different pair of stars. This suggests that the conventional ancient chronology, instead of being compressed, may actually have to be expanded slightly.

Siblings, parents, and partners: family relationships within a longitudinal community study. ALSPAC study team. Avon Longitudinal Study of Pregnancy and Childhood.

Links between sibling relationships, mother-partner, and parent-child relationships were studied in a longitudinal community sample of 3681 sibling pairs. Individual differences in sibling relationship quality were related to mother-partner affection and hostility assessed 4 years earlier, to contemporary parent-child negativity, and to indices of social adversity. Evidence for both direct and indirect pathways (via parent-child relations) linking mother-partner and sibling relations were found. Comparisons of prediction for non-stepfamilies and stepfather families showed similarities in patterns of association, but also differences: In stepfather families, mother-partner hostility was unrelated to parent-child negativity and sibling relationship quality. Both positivity and negativity towards young siblings decreased with the age of older siblings, and older sisters were more positive than older brothers.

Problems and competencies reported by parents of Vietnamese children in Hanoi.

OBJECTIVE: To determine the distribution of behavioral and emotional problems and competencies among a sample of Vietnamese children aged 4 through 18 years living in Hanoi. METHOD: A representative community sample of 1,526 children and adolescents was selected from 2 precincts in Hanoi. Problems and competencies were assessed with the Child Behavior Checklist (CBCL). RESULTS: Vietnamese children had lower mean raw scores than U.S. norms on the CBCL's Total, Externalizing, Internalizing, and Competence scales. Boys were reported to have more externalizing problems and girls more internalizing problems. Girls' levels of internalizing problems increased significantly with age. CONCLUSION: The lower levels of problems and competencies reported in Vietnamese children may represent differences in the prevalence of psychiatric disorders, in parental perceptions of what constitutes deviant behavior, or in parental comfort with reporting psychopathological behaviors. Further research is needed to clarify the relationship between the reported behavioral and emotional problems of Vietnamese children and the presence of psychiatric disorders. From a clinical perspective, the study's results suggest that levels of problems and competencies may vary significantly between different ethnic and cultural groups. Specific clinical cutoffs used to identify children requiring further psychiatric assessment need to be established separately for different ethnic groups.

Tubo-ovarian abscess after tubal ligation.

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.

PIP: This paper presents the case of a 32-year-old woman who developed a tubo-ovarian abscess 7 years following tubal ligation via minilaparotomy. Symptoms experienced included pain, which was exacerbated by walking, and mild deep dyspareunia. Abdominal and pelvic examinations revealed pain in the left iliac fossa, cervical excitation tenderness, and an ill-defined left adnexal mass. Sonographic evaluation of the pelvis showed an irregularly shaped, cystic mass (8.0 x 4.5 x 5.3 cm) with thickened internal septations and solid parts. A left tubo-ovarian multilobulated complex mass adherent to the omentum and the pelvic side was found upon laparotomy. There was pus in the Pouch of Douglas, and the uterus was 10 weeks in size with symmetrical enlargement. The previously ligated right fallopian tube and the ovary were unremarkable. Management includes left adnexectomy, omental biopsy, and 5-day course of antibiotics against Staphylococcus aureus, which was cultured from the purulent material in the Pouch of Douglas. Tubo-ovarian abscess should be considered in diagnosing patients presenting symptoms of pelvic inflammatory disease.

Children's adjustment and prosocial behaviour in step-, single-parent, and non-stepfamily settings: findings from a community study. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

The adjustment and prosocial behaviour of 4-year-old children and their older siblings growing up in step-parent or single-parent families, or with two biological parents, was investigated within a longitudinal community study, the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Mean differences in mothers' perception of adjustment were found for children in different family settings, with higher levels of problems and lower prosocial scores reported for those in single- and step-parent families than those in non-stepfamilies. Individual differences within each family setting were marked. With the exception of single parenthood, which remained a risk indicator for the 4-year-olds, the contribution of family type to differences in adjustment and prosocial behaviour largely disappeared when account was also taken of negativity in family relationships, maternal age, education level, depressive symptomatology, and history of previous live-in relationships, mothers' support networks, and the family's current financial and housing circumstances. Boys remained more at risk for adjustment difficulties than girls when this range of factors was taken into account. The limitations and implications of these findings on a community sample, a first step in a programme of research into family processes in children's adjustment, are discussed.

Genetic "clocks" and "soft" events: a twin model for pubertal development and other recalled sequences of developmental milestones, transitions, or ages at onset.

We propose and explore a twin model to examine the basis for synchrony that often characterizes different facets of normal development. In so doing we also present an approach to the analysis of "soft" events; events for which available reports of dates or ages of occurrence are unreliable or inconsistent. Discrepancies among reports are accounted for by a statistical measurement model. This combines current status error reflecting uncertain definition of onset and two mechanisms for the phenomenon of "telescoping," namely, systematic compression of the time scale and heteroscedastic random measurement error. Statistically, the model can be viewed as a mixed generalized linear model with random effects within both mean and variance functions or, alternatively, as involving multiplicative random effects. We apply the model to multiple maternal reports on menarche and onset of breast development in twin daughters. Fitted to data from the Virginia Twin Study Of Adolescent and Behavioral Development by the use of penalized/predictive quasi-likelihood, the model provided much improved estimates of the true age-at-onset distribution as compared to those from a naive analysis. Results suggested that the observed variance was made up almost entirely of genetic variance and measurement error variance due to telescoping and current status errors and that the timing of breast development and menarche are largely under the control of a common set of genes. Results also indicated that maternal recollections of the onset of breast development were both more poorly defined and subject to greater recall errors than maternal recollections of menarche.

Tubo-ovarian abscess after tubal ligation

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.

Tubo-ovarian abscess after tubal ligation

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.(AU)

Family structure and depressive symptoms in men preceding and following the birth of a child. The Avon Longitudinal Study of Pregnancy and Childhood Study Team.

OBJECTIVE: The prevalence and etiology of pre- and postpartum depressive symptoms in women in a variety of family forms have been well documented, but relatively little research has been conducted on the adjustment of their male partners. The authors' goals in this study were 1) to estimate rates of depression during the pregnancy and 8 weeks following the birth of a child in a large representative community sample of fathers in different family structures and 2) to explore the role of stressful life events, social and emotional support, the quality of the partner relationship, and socioeconomic circumstances. METHOD: This study describes the relations of family setting and other correlates to men's depressive symptoms during the pregnancies (18 weeks gestation, on average) and 8 weeks after the births of children for 7,018 partners of female participants in the Avon Longitudinal Study of Pregnancy and Childhood. RESULTS: Men living in stepfamilies had-significantly higher levels of depressive symptoms before and after the birth than did men in more traditional families. The effect of stepfamily status on depression was mediated by education, life events, social support, social network, and level of aggression in the partnership. CONCLUSIONS: There are similarities in the patterns and correlates of depression after the birth of a child for men and women. These findings point to the importance of family and partnership ecology in the adjustment of men before and after the birth of a child.

Appendiceal disease in chronic pelvic pain

Pelvic pain is considered chronic when it present for more than six months. Chronic pelvic pain affects as many as 15 percent of women in the reproductive age group, leading to significant impairment of work and home activities. The causes of chronic pelvic pain can be either gynaecological or non-gynaecological. Gastrointestinal causes tend to be overlooked by gynaecologists and in particular the appendix which not often considered as a source of chronic pelvic pain. This paper presents a case series from the experience at the Peebles Hospital in the British Virgin Islands. Of 36 diagnostic laparoscopies performed between September 1992 and September 1997 for patients suffering from chronic pelvic pain there were 7 with appendiceal disease. Of the 7 appendices that were removed 4 showed histopathologic evidence of chronic disease. Pelvic inflammatory disease was the assessment in 3 patients and repeated courses of antibiotics had not resulted in clinical improvement. Four of the patients who had appendectomies have remained pain free since operation. Although appendiceal disease is not a common entity in chronic pelvic pain it is important that health care providers involved in the management of patients with chronic pain consider the appendix as a possible cause.(AU)

Insulin-like growth factor I (IGF-I) and IGF-Binding proteins in rat wound fluid.

Insulin-like growth factors (IGFs) play an important role in tissue repair, including healing of dermal and epidermal injury. In this study we have measured changes in the IGF:IGF-binding protein (IGFBP) profile of rat wound fluid (WF) collected after sc implantation of Hunt-Schilling chambers for 21 days. WF IGF-I levels 1 day after implantation were equivalent to plasma levels, then fell during the first 7 days before recovering to approximately two thirds of plasma levels by day 21. Western ligand blots of whole WF revealed a profile qualitatively similar to that found in plasma, although the intensity of the IGFBP-3 band was significantly less than that in plasma. Neutral gel chromatography of pooled day 14 WF, after in vitro incubation with [125I]IGF-I, separated the radioligand into three distinct regions of 150, 40, and 7.5 kDa. However, compared to plasma recovery of[125I]IGF-I in the 150-kDa region in WF was reduced, and that in the 40-kDa region was increased. Ligand blotting of the WF-derived neutral gel fractions revealed IGFBP-3 within the 150-kDa complex. Incubation of WF with plasma (1:1, vol/vol) resulted in a progressive decline in the intensity of the plasma IGFBP-3 band. Protease inhibitors, including EDTA, antipain, or aprotonin, inhibited this process. We have described the changes over time in WF IGF-I concentrations, characterized the IGFBP profile, and demonstrated the presence of IGFBP-3 proteolytic activity in WF. The latter may play a role in the regulation of IGF bioavailability during the repair process.