Lockdowns, Bioethics, and the Public: Policy-Making in a Liberal Democracy.

Commentaries on the ethics of Covid lockdowns nearly all focus on offering substantive guidance to policy-makers. Lockdowns, however, raise many ethical questions that admit of a range of reasonable answers. In such cases, policy-making in a liberal democracy ought to be sensitive to which reasonable views the public actually holds-a topic existing bioethical work on lockdowns has not explored in detail. In this essay, I identify several important questions connected to the kind of influence the public ought to have on lockdown decision-making, including how policy-makers ought to handle misinformed or morally suspect viewpoints, and how policy-makers ought to respond to minority viewpoints. I argue that questions like this, concerning the appropriate influence of the public on decision-making, will be central to the field of bioethics as it increasingly focuses on policy and population-level issues and therefore ought to be priorities for future work.

Effects of high-intensity interval training on functional performance and maximal oxygen uptake in comparison with moderate intensity continuous training in cancer patients: a systematic review and meta-analysis.

INTRODUCTION: High-intensity interval training (HIIT) is an appropriate training modality to improve endurance and therefore contributes to physical performance. This review investigates the effect of HIIT on functional performance in cancer patients. We reviewed the relative peak oxygen uptake (relV̇O2PEAK) and meta-analytical compared HIIT with moderate intensity continuous training (MICT). Furthermore, we took various training parameters under consideration. METHODS: A systematic literature search was conducted in Scopus, PubMed, and Cochrane Library databases. For the review, we included randomized controlled trials containing HIIT with cancer patients. From this, we filtered interventions with additional MICT for the meta-analysis. Outcomes of interest were various functional performance assessments and V̇O2MAX. RESULTS: The research yielded 584 records which fit the inclusion criteria, of which 31 studies with n=1555 patients (57.4±8.6 years) could be included in the overall review and 8 studies in the meta-analysis (n=268, 59.11±5.11 years) regarding relV̇O2PEAK. Different functional outcomes were found, of which walking distance (+8.63±6.91% meters in 6-min walk test) and mobility (+2.7cm in sit and reach test) improved significantly due to HIIT. In terms of relV̇O2PEAK, the performance of cancer patients was improved by HIIT (10.68±6.48%) and MICT (7.4±4.29%). HIIT can be favored to increase relV̇O2PEAK (SMD 0.37; 95% CI 0.09-0.65; I2=0%; p=0.009). Effect sizes for relV̇O2PEAK improvements correlate moderately with total training volume (Spearman's ρ=0.49; p=0.03), whereas percentage increases do not (Spearman's ρ=0.24; p=0.14). CONCLUSION: Functional and physical outcomes were positively altered by different HIIT protocols and forms of implementation, whereas a tendency toward more effectiveness of HIIT vs. MICT was found for relV̇O2PEAK. Future studies should include functional parameters more often, to finally allow a comparison between both training protocols in this regard.

Trust and service engagement among people who inject drugs after release from prison.

BACKGROUND: Compounding histories of injecting drug use and incarceration can marginalise people engaging with services, making it difficult for them to address their health and social welfare needs, particularly when they navigate community re-entry service supports. Drawing on Hall and colleagues' five components of trust, this paper seeks to understand how trust in service providers fosters (or inhibits) effective service engagement from the perspective of people who inject drugs during the prison post-release period. METHODS: Between September 2018 and May 2020, qualitative in-depth interviews were completed with 48 adults (33 men, 15 women) recruited from SuperMIX (a longitudinal cohort study of people with a history of injection drug use in Victoria, Australia). Data relating to service engagement were coded against the five components of trust: competence, fidelity, honesty, global trust, and confidence. RESULTS: Reflections of post-release service engagement frequently focused on interactions with community corrections (parole) officers. Depictions of trust were consistently portrayed within the context of negative experiences and deficits, whereby trusting provider relationships and interactions were rarely described. Most participants recounted a stark absence of fidelity (that is, "pursuing a [client's] best interests"), with some participants detailing circumstances in which their vulnerability was purposefully, almost strategically, exploited. These encounters nearly always had the consequence of impeding the participant's positive progression in the post-release integration period. CONCLUSION: There is an urgent need to prioritise the client in health and social service delivery in the post-release transition-to-community period and recognise the importance of trust in delivering effective services to people whose life histories make them highly vulnerable to marginalisation.

Constructing a 'target population': A critical analysis of public health discourse on substance use among gay and bisexual men, 2000-2020.

BACKGROUND: Gay and bisexual men (GBM) have higher substance use prevalences than general population samples - often attributed to stigmatisation of sexual minority identities. We examined how influential public health research on substance use among GBM interprets this behaviour and what GBM-specific identities emerge through the discourses employed. METHODS: We searched Web of Science for publications on substance use among GBM, selecting 60 of the most cited papers published during 2000-2020. We studied the language used to describe and interpret drug-using behaviour using critical discourse analysis, focusing on interpretive repertoires and subject positions. RESULTS: Three distinct discursive tendencies were identified. First, in constructing a target population, GBM who use illicit drugs are positioned as deficient, socially irresponsible, and maladapted to dealing with stigmatisation and HIV risks. Second, in shifting the focus beyond the individual, the gay community is conceptualised as offering a safe space for socialisation. Nonetheless, gay community spaces are problematised as promoting substance use among vulnerable GBM through aggravating loneliness and normalising drug use as a form of maladaptive (avoidance) coping. Third, counterdiscursive movements add nuance, context, and comparisons that relativise rather than generalise substance use and focus on pleasure and self-determination. Such discourses centre the need for interventions that disrupt homophobic socio-structures instead of individualising approaches to limit non-conformity. CONCLUSION: 'Expert' assessments of substance use among GBM perpetuate pathologising understandings of this behaviour and promote abject subject positions, contributing to perpetuations of intergroup stigma and social exclusion based on drug and sexual practices. Our findings highlight the need for deliberate and critical engagement with prior research and a conscious effort to disrupt dominant discourses on GBM's substance use.

An Ethical Framework for Presenting Scientific Results to Policy-Makers.

Scientists have the ability to influence policy in important ways through how they present their results. Surprisingly, existing codes of scientific ethics have little to say about such choices. I propose that we can arrive at a set of ethical guidelines to govern scientists' presentation of information to policymakers by looking to bioethics: roughly, just as a clinician should aim to promote informed decision-making by patients, a scientist should aim to promote informed decision-making by policymakers. Though this may sound like a natural proposal, I show it offers guidance that conflicts with standard scientific practices. I conclude by considering one cost of the proposal: that it would prevent scientists from acting as advocates in a way that is currently common in certain fields. I accept that the proposal would restrict scientists' political advocacy rights, but argue that the benefits of adopting it-promoting democratic governance-justify the restriction.

SARS-CoV-2 Related Ischemic Colitis in an Adolescent With Trisomy 21: Diagnostic Pitfalls and Considerations.

Millions of patients seek medical attention for diarrhea, vomiting, nausea, and abdominal pain. In the current environment, it is important to recognize that these symptoms may be the only manifestation or may precede more serious systemic complications of COVID-19. Herein, we describe the first case of ischemic colitis (IC) in a young adult who presented with diarrhea and highlight the laboratory pitfalls for patients with COVID-19 presenting with gastrointestinal (GI) symptoms.

Competence, challenges and attitudes of bedside nurses caring for patients with left ventricular assist devices.

OBJECTIVES: We aimed to describe the bedside registered nurses perceived competence, attitudes, and challenges surrounding the management of patients with left ventricular assist devices (LVAD) in the intensive care unit (ICU) and stepdown unit (SDU). RESEARCH METHODOLOGY/DESIGN: An exploratory research was employed using a survey. SETTING: Bedside participants were recruited via an electronic recruitment flyer circulated in online professional and social networking sites. MAIN OUTCOME MEASURES: Items consisted of a numeric rating scale, measuring competence and attitudes related to the management of patients with left ventricular assist devices. The one open-ended question asked the participants to write responses regarding challenges in left ventricular assist device care. Data were analysed using quantitative and qualitative analytics software. RESULTS: A total of 36 intensive care unit and 35 stepdown unit bedside nurse (n = 71) from six regions of the United States responded. Overall mean scores for competency and attitude domains were ≥ 7.0. Intensive care nurses scored higher in competence and attitude when compared to stepdown unit nurses care of short-term left ventricular assist devices. Competence and attitude were positively associated with years of experience. Five themes related to challenges in care were identified. CONCLUSION: Overall, bedside nurses had satisfactory competence and attitudes surrounding the care of hospitalised left ventricular assist device patients.

Using online tools at the Bovine Genome Database to manually annotate genes in the new reference genome.

With the availability of a new highly contiguous Bos taurus reference genome assembly (ARS-UCD1.2), it is the opportune time to upgrade the bovine gene set by seeking input from researchers. Furthermore, advances in graphical genome annotation tools now make it possible for researchers to leverage sequence data generated with the latest technologies to collaboratively curate genes. For many years the Bovine Genome Database (BGD) has provided tools such as the Apollo genome annotation editor to support manual bovine gene curation. The goal of this paper is to explain the reasoning behind the decisions made in the manual gene curation process while providing examples using the existing BGD tools. We will describe the sources of gene annotation evidence provided at the BGD, including RNA-seq and Iso-Seq data. We will also explain how to interpret various data visualizations when curating gene models, and will demonstrate the value of manual gene annotation. The process described here can be applied to manual gene curation for other species with similar tools. With a better understanding of manual gene annotation, researchers will be encouraged to edit gene models and contribute to the enhancement of livestock gene sets.

Correction to: Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies.

The original article [1] contains a small mistake concerning the ARTIC Team members mentioned in the Acknowledgements. The team member, Rocco Salvatore Calabrò had their name presented incorrectly. This has now been corrected in the original article.

The significance of bromide in the Brust-Schiffrin synthesis of thiol protected gold nanoparticles.

The mechanism of the two-phase Brust-Schiffrin synthesis of alkane thiol protected metal nanoparticles is known to be highly sensitive to the precursor species and reactant conditions. In this work X-ray absorption spectroscopy is used in conjunction with liquid/liquid electrochemistry to highlight the significance of Br- in the reaction mechanism. The species [AuBr4]- is shown to be a preferable precursor in the Brust-Schiffrin method as it is more resistant to the formation of Au(i) thiolate species than [AuCl4]-. Previous literature has demonstrated that avoidance of the Au(i) thiolate is critical to achieving a good yield of nanoparticles, as [Au(i)X2]- species are more readily reduced by NaBH4. We propose that the observed behavior of [AuBr4]- species described herein explains the discrepancies in reported behavior present in the literature to date. This new mechanistic understanding should enable nanoparticle synthesis with a higher yield and reduce particle size polydispersity.

Stereotyped behaviours as precursors of self-injurious behaviours: a longitudinal study with infants and toddlers at risk for developmental delay.

BACKGROUND: The notion that stereotypic behaviours may be precursors of self-injurious behaviour (SIB) has been considered in the past, but the available empirical evidence is still inconsistent and ambiguous. METHOD: In a longitudinal study, we collected data on stereotypic behaviour and SIB from 160 infants and toddlers who were at-risk for developmental delay. Interviews were conducted with parents at three time points during a one-year span using the Behaviour Problems Inventory-01 which contains subscales for SIB and stereotyped behaviour. We used growth modelling to estimate linear trends in several models. Model fit was evaluated according to a combination of fit statistics as is recommended in structural equation or latent variable modelling approaches such as latent growth modelling. RESULTS: In examining the relationship between stereotyped behaviours and SIB across time, the model that represented earlier stereotyped behaviour as predicting later SIB fit the data better than the other models. CONCLUSIONS: The findings corroborate the notion that stereotyped behaviour can be a precursor of SIB. If replicated by other studies, it makes a case for considering early intervening with stereotyped behaviour as a SIB prevention strategy.

A prolonged outbreak of Salmonella Infantis associated with pork products in central Germany, April-October 2013.

One of the largest and longest Salmonella outbreaks in Germany within the last 10 years occurred in central Germany in 2013. To identify vehicles of infection, we analysed surveillance data, conducted a case-control study and food traceback. We identified 267 cases infected with Salmonella Infantis with symptom onset between 16 April and 26 October 2013 in four neighbouring federal states. Results of our study indicated that cases were more likely to have eaten raw minced pork from local butcher's shops [odds ratio (OR) 2·5, 95% confidence interval (CI) 1·1-5·8] and have taken gastric acid-reducing or -neutralizing medication (OR 3·8, 95% CI 1·3-13) than controls. The outbreak was traced back to contaminated raw pork products found in different butcher's shops supplied by one slaughterhouse, to pigs at one farm and to an animal feed producer. Characterization of isolates of human, food, animal, feed, and environmental origin by phage-typing and pulsed-field gel electrophoresis confirmed the chain of infection. Insufficient hygiene standards in the slaughterhouse were the most probable cause of the ongoing transmission. We recommend that persons taking gastric acid suppressants should refrain from consuming raw pork products. Improving and maintaining adequate hygiene standards and process controls during slaughter is important to prevent future outbreaks.

Contribution and interaction of kinin receptors and dynorphin A in a model of trigeminal neuropathic pain in mice.

Infraorbital nerve constriction (CION) causes hypersensitivity to facial mechanical, heat and cold stimulation in rats and mice and is a reliable model to study trigeminal neuropathic pain. In this model there is evidence that mechanisms operated by kinin B1 and B2 receptors contribute to heat hyperalgesia in both rats and mice. Herein we further explored this issue and assessed the role of kinin receptors in mechanical hyperalgesia after CION. Swiss and C57Bl/6 mice that underwent CION or sham surgery or dynorphin A (1-17) administration were repeatedly submitted to application of either heat stimuli to the snout or mechanical stimuli to the forehead. Treatment of the animals on the fifth day after CION surgery with DALBK (B1 receptor antagonist) or HOE-140 (B2 receptor antagonist), both at 0.01-1µmol/kg (i.p.), effectively reduced CION-induced mechanical hyperalgesia. Knockout mice for kinin B1, B2 or B1/B2 receptors did not develop heat or mechanical hyperalgesia in response to CION. Subarachnoid dynorphin A (1-17) delivery (15nmol/5µL) also resulted in orofacial heat hyperalgesia, which was attenuated by post-treatment with DALBK (1 and 3µmol/kg, i.p.), but was not affected by HOE-140. Additionally, treatment with an anti-dynorphin A antiserum (200µg/5µL, s.a.) reduced CION-induced heat hyperalgesia for up to 2h. These results suggest that both kinin B1 and B2 receptors are relevant in orofacial sensory nociceptive changes induced by CION. Furthermore, they also indicate that dynorphin A could stimulate kinin receptors and this effect seems to contribute to the maintenance of trigeminal neuropathic pain.

Prevalence of Subclinical Coronary Artery Disease in Middle-Aged, Male Marathon Runners Detected by Cardiac CT.

PURPOSE: To evaluate the prevalence of coronary artery disease (CAD) in middle-aged, male marathon runners using coronary dual source CT angiography (DSCTA). MATERIALS AND METHODS: 50 male marathon runners older than 45 years (mean age: 52.7, standard deviation: 5.9 years, range: 45 to 67 years) received DSCTA including calcium scoring (CS) in addition to standard pre-participation screening. Based on standard risk factors, the risk for coronary events was calculated using the PROCAM score. Coronary status was defined using the following system: 1. absence of CAD (CS zero, no coronary plaques) 2. mild coronary atherosclerosis (CS > 0, coronary plaques with luminal narrowing < 50 %), 3. moderate coronary atherosclerosis (CS > 0, luminal narrowing > 50 %), 4. significant CAD (CS > 0, luminal narrowing > 75 %). RESULTS: The mean PROCAM score was 1.85 % (standard deviation = 1.56, range 0.39 to 8.47 %). 26/50 marathon runners had no atherosclerosis. 1 of the remaining 24 participants had significant CAD, 3 had moderate coronary atherosclerosis and 20 had mild coronary atherosclerosis. Treadmill exercise testing was unremarkable in terms of myocardial ischemia in all participants. Age, systolic blood pressure, personal minimum time, family history of cardiovascular disease and PROCAM score were factors associated with an increased risk for coronary atherosclerosis. CONCLUSION: Coronary atherosclerosis can be detected in almost 50 % of male marathon runners aged older than 45 years. In 24 % of the participants plaques were located in the proximal coronary system. However, only a minority of these persons have obstructive CAD. As expected, treadmill exercise testing failed to detect these persons that possibly have a higher risk for coronary events. KEY POINTS: • Coronary atherosclerosis can be detected in ~50 % of male marathon runners > 45 years. • Only a minority of these persons have obstructive CAD. • Treadmill exercise testing failed to detect these persons. • Cardiac CT might help to identify athletes with elevated risk for coronary events, especially in persons with a family history of coronary artery.

Self-association of organic solutes in solution: a NEXAFS study of aqueous imidazole.

N K-edge near-edge X-ray absorption fine-structure (NEXAFS) spectra of imidazole in concentrated aqueous solutions have been acquired. The NEXAFS spectra of the solution species differ significantly from those of imidazole monomers in the gas phase and in the solid state of imidazole, demonstrating the strong sensitivity of NEXAFS to the local chemical and structural environment. In a concentration range from 0.5 to 8.2 mol L(-1) the NEXAFS spectrum of aqueous imidazole does not change strongly, confirming previous suggestions that imidazole self-associates are already present at concentrations more dilute than the range investigated here. We show that various types of electronic structure calculations (Gaussian, StoBe, CASTEP) provide a consistent and complete interpretation of all features in the gas phase and solid state spectra based on ground state electronic structure. This suggests that such computational modelling of experimental NEXAFS will permit an incisive analysis of the molecular interactions of organic solutes in solutions. It is confirmed that microhydrated clusters with a single imidazole molecule are poor models of imidazole in aqueous solution. Our analysis indicates that models including both a hydrogen-bonded network of hydrate molecules, and imidazole-imidazole interactions, are necessary to explain the electronic structure evident in the NEXAFS spectra.

Fertility after implementation of long- and short-term progesterone-based ovulation synchronization protocols for fixed-time artificial insemination in beef heifers.

Two experiments were conducted to evaluate the effect of long-term (LT; a 14-day controlled internal drug release insert [CIDR]-PGF2α [PGF]-GnRH) and short-term (ST; 5-day CO-Synch + CIDR) progesterone-based protocols on pregnancy rate to fixed-time artificial insemination (FTAI) in beef heifers. In experiment 1, Angus cross beef heifers (N = 1887) at nine locations received a body condition score and a reproductive tract score (RTS). Within the herd, heifers were randomly assigned to LT-72 and ST-56 protocol groups. Heifers in the LT-72 group received a CIDR from Days 0 to 14, followed by 25 mg of PGF 16 days later (Day 30). Heifers in the ST-56 group received a CIDR and 100 µg of gonadorelin hydrochloride (GnRH) on Day 25 followed by 25 mg of PGF at CIDR removal on Day 30 and a second dose of PGF 6 hours later (Day 30). Artificial insemination was performed at 56 hours (Day 32) after CIDR removal for the ST-56 group and at 72 hours (Day 33) after CIDR removal for the LT-72 group, and all heifers were given GnRH (100 µg, intramuscular) at the time of AI. In experiment 2, Angus cross beef heifers (N = 718) at four locations received a body condition score and an RTS. Within the herd, heifers were randomly assigned to LT-72 and ST-72 protocol groups. The protocol was similar to experiment 1 except that AI was performed at 72 hours after CIDR removal for both LT-72 and ST-72 groups. In experiment 1, no difference in AI pregnancy rates between the LT-72 and ST-56 groups was observed (54.5% [489 of 897] and 55.5% [549 of 990], respectively; P = 0.92) after accounting for the RTS. The AI pregnancy rates for heifers with RTS 3 or less, 4, and 5 were 52.6%, 53.6%, and 59.9%, respectively (P < 0.05). In experiment 2, controlling for the RTS, no difference in AI pregnancy rates was observed between the LT-72 and ST-72 groups, 56.9% (198 of 347) and 57.8% (214 of 371), respectively (P = 0.87). The AI pregnancy rates for heifers with RTS 3 or less, 4, and 5 were 49.3%, 58.4%, and 62.1%, respectively (P < 0.05). In conclusion, heifers synchronized for fixed-time AI with LT and ST protocols resulted in a similar AI pregnancy rate. Approximately, 55% of the herd was pregnant to one insemination in 33 days with the LT protocol compared with just 8 days with the ST protocol.

Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis.

PURPOSE: To analyse antibiotic use density (AD)--World Health Organization defined daily doses/1,000 patient-days--before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU). METHODS: In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed. RESULTS: AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2%. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS. CONCLUSIONS: Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period.

Muscle ultrasound in classic infantile and adult Pompe disease: a useful screening tool in adults but not in infants.

A cohort of 4 infantile and 15 adult Pompe patients has been investigated regarding correlation between strength and ultrasound of skeletal musculature. In adults, muscle ultrasound is useful to assess clinical and subclinical involvement of muscles. In this study, visible sonographic changes were found in every clinically affected muscle, using a modified Heckmatt scale. In some muscles morphologic changes preceded weakness. Regarding the anatomical pattern of involvement, our findings do not support the hypothesis of a specific pattern with a higher vulnerability of vastus intermedius than rectus femoris, which has been postulated before. A frequent sparing of triceps brachii could be confirmed. Intramuscular abnormalities occurred in a focal, a diffuse, or an intermediate pattern, with characteristics of both. In contrast to muscular dystrophies, bone echogencity was not markedly decreased in Pompe disease even in an advanced stage. In infants, muscle ultrasound showed no distinct pathology even in clinically severely affected children and should not be used as a screening method for infantile Pompe disease.

Calm temperament improves reproductive performance of beef cows.

Profitability of a beef operation is determined by the proportion of cows attaining pregnancy early in the breeding season and those that are pregnant at the end of breeding season. Many factors, including temperament, contribute to those reproductive parameters. The objective of this study was to evaluate effects of temperament on reproductive performance of beef cows. In Experiment 1, Angus and Angus-cross beef cows (n = 1546) from eight locations were assigned a body condition score (BCS; 1 = emaciated; 9 = obese) and chute exit and gait score (1 = slow exit, walk; calm temperament; 2 = jump, trot or run; excitable temperament). Cows were grouped with bulls (1 : 25 to 1 : 30; with satisfactory breeding potential and free of venereal disease) for an 85-day breeding season. Pregnancy status and stage of gestation were determined (transrectal palpation) 35 days after the end of the breeding season. Controlling for BCS (p < 0.01) and handling facility (p < 0.0001) and handling facility by temperament score interaction (p < 0.001), breeding season pregnancy rate was lower in excited versus calm cows [88.6% (798/901) vs 94.1% (607/645); p < 0.001]. Cows with an excitable temperament took 24 more days to become pregnant compared to calm cows (median days to pregnancy, 35 vs 59 days; p < 0.0001). In Experiment 2, Angus and Angus-cross beef cows (n = 1407) from 8 locations were assigned scores for body condition and chute exit and gait (as described in Experiment 1) and assigned to bulls (breeding sound and free of venereal disease; 1 : 25 to 1 : 30) for 85 days. Pregnancy status was determined by transrectal palpation at 2 and 6 months after the onset of the breeding season. Controlling for BCS (p < 0.05), pregnancy loss was higher in excited versus calm cows [5.5% (36/651) vs 3.2% (20/623), p < 0.0001]. In conclusion, beef cows with an excitable temperament had significantly lower reproductive performance than calmer cows. The modified two-point chute exit-gait scoring method was repeatable and identified cattle with an excitable temperament.