Vector competence of Australian Aedes aegypti and Aedes albopictus for an epidemic strain of Zika virus.

BACKGROUND: Recent epidemics of Zika virus (ZIKV) in the Pacific and the Americas have highlighted its potential as an emerging pathogen of global importance. Both Aedes (Ae.) aegypti and Ae. albopictus are known to transmit ZIKV but variable vector competence has been observed between mosquito populations from different geographical regions and different virus strains. Since Australia remains at risk of ZIKV introduction, we evaluated the vector competence of local Ae. aegypti and Ae. albopictus for a Brazilian epidemic ZIKV strain. In addition, we evaluated the impact of daily temperature fluctuations around a mean of 28°C on ZIKV transmission and extrinsic incubation period. METHODOLOGY/PRINCIPAL FINDINGS: Mosquitoes were orally challenged with a Brazilian ZIKV strain (8.8 log CCID50/ml) and maintained at either 28°C constant or fluctuating temperature conditions. At 3, 7 and 14 days post-infection (dpi), ZIKV RNA copies were quantified in mosquito bodies, as well as wings and legs, using qRT-PCR, while virus antigen in saliva (a proxy for transmission) was detected using a cell culture ELISA. Despite high body and disseminated infection rates in both vectors, the transmission rates of ZIKV in saliva of Ae. aegypti (50-60%) were significantly higher than in Ae. albopictus (10%) at 14 dpi. Both species supported a high viral load in bodies, with no significant differences between constant and fluctuating temperature conditions. However, a significant difference in viral load in wings and legs between species was observed, with higher titres in Ae. aegypti maintained at constant temperature conditions. For ZIKV transmission to occur in Ae. aegypti, a disseminated virus load threshold of 7.59 log10 copies had to be reached. CONCLUSIONS/SIGNIFICANCE: Australian Ae. aegypti are better able to transmit a Brazilian ZIKV strain than Ae. albopictus. The results are in agreement with the global consensus that Ae. aegypti is the major vector of ZIKV.

How performance analysis of elite long jumping can inform representative training design through identification of key constraints on competitive behaviours.

Analysing performance in competitive environments enables identification of key constraints which shape behaviours, supporting designs of more representative training and learning environments. In this study, competitive performance of 244 elite level jumpers (male and female) was analysed to identify the impact of candidate individual, environmental and task constraints on performance outcomes. Findings suggested that key constraints shaping behaviours in long jumping were related to: individuals (e.g. particularly intended performance goals of athletes and their impact on future jump performance); performance environments (e.g. strength and direction of wind) and tasks (e.g. requirement for front foot to be behind foul line at take-off board to avoid a foul jump). Results revealed the interconnectedness of competitive performance, highlighting that each jump should not be viewed as a behaviour in isolation, but rather as part of a complex system of connected performance events which contribute to achievement of competitive outcomes. These findings highlight the potential nature of the contribution of performance analysis in competitive performance contexts. They suggest how practitioners could design better training tasks, based on key ecological constraints of competition, to provide athletes with opportunities to explore and exploit functional intentions and movement solutions high in contextual specificity.

Nurse practitioner led pain management the day after caesarean section: A randomised controlled trial and follow-up study.

BACKGROUND: Pain on the day after caesarean section is often treated with controlled-release oxycodone to supplement the decline in analgesia from intrathecal opioids. Evidence suggests that caesarean birth is a biopsychosocial experience where a comprehensive approach is needed that promotes control and participation in pain management. OBJECTIVES: This study compared immediate-release oxycodone integrated with supportive educational strategies to controlled-release oxycodone. A follow-up phase aimed to explore pain over three months. DESIGN: This study was a two-group parallel randomised controlled trial. SETTING: A metropolitan hospital in Australia with a birthing suite, operating rooms, and a postnatal unit. PARTICIPANTS: English-speaking women scheduled for elective caesarean section were mailed trial information. Exclusion criteria included contraindications to intrathecal analgesia, herpes simplex infection, a history of chronic pain, opioid tolerance, or substance abuse. A total of 131 participants were recruited and randomised out of 298 eligible participants. METHODS: Group allocation was undertaken using sequentially numbered opaque sealed envelopes. The nurse practitioner intervention commenced on the day after surgery with immediate-release oxycodone alongside supportive strategies. The control group received scheduled doses of controlled-release oxycodone. All participants could request additional oxycodone or tramadol. Primary outcomes were pain intensity and secondary outcomes included patient global impression of change, pain interference, opioid consumption, and maternal perception of control. A follow-up phase evaluated pain outcomes over three months. RESULTS: The final sample size was 122, with 61 participants in each group. Pain intensity scores were analysed by linear mixed regression models. There were no statistical differences over 24h between the control and intervention groups at rest (p=0.40, 95% CI - 4.8mm, 11.9mm) or on sitting or moving (p=0.561, 95% CI -15.2mm, 8.3mm). Patient global impression of change was significant over three hours (p=0.014, OR=2.5, 95% CI 1.2, 5.3). The intervention group reported less pain interference while consuming less oxycodone (p<0.05). There was no difference between groups in terms of perceived control over pain management (p=0.273, 95% CI -16.2mm, 4.6mm). The follow-up analysis graded 5.9% of participants as experiencing severe pain interference. Chronic pain following caesarean was associated with postnatal depression (p<0.001). CONCLUSIONS: The research showed that a nurse practitioner intervention can improve pain management following caesarean section. The results underscore the influence of biological, psychological, and social factors on acute pain. Hence, this study reinforces the need for a biopsychosocial approach to acute pain management following caesarean delivery.

Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-Blinded, Randomized Controlled Trial.

BACKGROUND: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of preoperative warming versus usual care among women receiving intrathecal morphine, which is thought to exacerbate perioperative heat loss. METHODS: A prospective, single-blinded, randomized controlled trial compared 20 minutes of forced air warming (plus intravenous fluid warming) versus no active preoperative warming (plus intravenous fluid warming) in 50 healthy American Society of Anesthesiologists graded II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery. The primary outcome of maternal temperature change was assessed via aural canal and bladder temperature measurements at regular intervals. Secondary outcomes included maternal thermal comfort, shivering, mean arterial pressure, agreement between aural temperature, and neonatal outcomes (axillary temperature at birth, Apgar scores, breastfeeding, and skin-to-skin contact). The intention-to-treat population was analyzed with descriptive statistics, general linear model analysis, linear mixed-model analysis, χ test of independence, Mann-Whitney, and Bland-Altman analysis. Full ethical approval was obtained, and the study was registered on the Australia and New Zealand Clinical Trials Registry (Trial No: 367160, registered at http://www.ANZCTR.org.au/). RESULTS: Intention-to-treat analysis (n = 50) revealed no significant difference in aural temperature change from baseline to the end of the procedure between groups: F (1, 47) = 1.2, P = .28. There were no other statistically significant differences between groups in any of the secondary outcomes. CONCLUSIONS: A short period of preoperative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine. A combination of preoperative and intraoperative warming modalities may be required for this population.

Morphology and morphometry of the caudate lobe of the liver in two populations.

The caudate lobe of the liver has portal blood supply and hepatic vein drainage independent of the remainder of the liver and may be differentially affected in liver pathologies. Ultrasonographic measurement of the caudate lobe can be used to generate hepatic indices that may indicate cirrhosis. This study investigated the relationship of metrics of the caudate lobe and other morphological features of human livers from a northwest Indian Punjabi population (n = 50) and a UK Caucasian population (n = 25), which may affect the calculation of hepatic indices. The width of the right lobe of the liver was significantly smaller, while the anteroposterior diameter of the caudate lobe and both Harbin's Index and the Hess Index scores were significantly larger in NWI livers than in UKC livers. The Hess Index score, in particular, is much larger in the NWI population (265 %, p < 0.005). Two caudate lobe features were significantly different between the two populations-the shape of the caudate lobe and the development of the caudate process. This study shows significant population differences exist in several metrics and morphological features of the liver. These differences may affect the calculation of hepatic indices, resulting in a greater percentage of false positives of cirrhosis in the NWI population. Population-specific data are required to correctly determine normal ranges.

Development and Validation of a Technique for Casting Anatomical Features and Toolmarks.

Time may elapse between examination of marks inflicted on the body and comparison with a potential weapon. Two-dimensional photographs may be inadequate for effective comparison of a three-dimensional mark with a putative instrument. Taking a cast and producing a positive image results in a lasting three-dimensional record. This project aimed to develop and demonstrate the accuracy of an easy technique for production of long-lasting positive images (using plaster of Paris and dental alginate). Casts of facial features of embalmed cadavers were used to produce a positive image of the face (death mask). Measurements of distances between facial anatomical landmarks were compared with measurements of distances between the same landmarks on the death masks to assess accuracy of reproduction. There were no significant differences between cadaver and death mask in 6 of 9 measurements, indicating this technique has high accuracy with less mobile facial features, but produces deformation of pliable features.

Seasonal morphometry of the vomeronasal organ in the marsupial mouse, Antechinus subtropicus.

The vomeronasal system consists of a peripheral organ and the connected central neuronal networks. The central connections are sexually dimorphic in rodents, and in some species, parameters of the vomeronasal organ (VNO) vary with sex, hormonal exposure, body size and seasonality. The VNO of the dasyurid marsupial mouse, Antechinus subtropicus is presumed to be functional. The unusual life history (male semelparity) is marked by distinct seasonality with differences in hormonal environments both between males and females, and in males at different time points. Body size parameters (e.g., length, weight) display sexual dimorphism and, in males, a pronounced weight gain before breeding is followed by a rapid decline during the single, short reproductive season. VNO morphometry was investigated in male and female A. subtropicus to identify possible life cycle associated activity. The overall length of the VNO is positively correlated with the size of the animal. The amount of sensory epithelium exhibits a negative correlation, decreasing with increasing size of the animal. The effects of sex and breeding condition are not obvious, although they do suggest that sensory vomeronasal epithelium mass declines in the breeding period. The VNO may be more important in A. subtropicus before breeding when it may participate in synchronising reproduction and in the development of the male stress response. J. Morphol. 277:1517-1530, 2016. © 2016 Wiley Periodicals, Inc.

Review article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review.

Risk stratification tools for patients presenting to rural EDs with undifferentiated chest pain enable early definitive treatment in high-risk patients. This systematic review compares the most commonly used risk stratification tools used to predict the risk of major adverse cardiac event (MACE) for patients presenting to rural EDs with chest pain. A comprehensive search of MEDLINE and Embase for studies published between January 2011 and January 2015 was undertaken. Study quality was assessed using QUADAS-2 criteria and the PRISMA guidelines.Eleven studies using eight risk stratification tools met the inclusion criteria. The percentage of MACE in the patients stratified as suitable for discharge, and the percentage of patients whose scores would have recommended admission that did not experience a MACE event were used as comparisons. Using the findings of a survey of emergency physicians that found a 1% MACE rate acceptable in discharged patients, the EDACS-ADP was considered the best performer. EDACS-ADP had one of the lowest rates of MACE in those discharged (3/1148, 0.3%) and discharged one of the highest percentage of patients (44.5%). Only the GRACE tool discharged more patients (69% - all patients with scores <100) but had a MACE rate of 0.3% in discharged patients. The HFA/CSANZ guidelines achieved zero cases of MACE but discharged only 1.3% of patients.EDACS-ADP can potentially increase diagnostic efficiency of patients presenting at ED with chest pain. Further assessment of tool in a rural context is recommended.

Assessment of anatomical knowledge by practical examinations: The effect of question design on student performance.

The objective structural practical examination (OSPE) is a timed examination that assesses topographical and/or applied knowledge of anatomy with the use of cadaveric resources and medical images. This study investigated whether elements of question design (provision of clinical context, type of visual resources used, gender context, and difficulty) of an anatomy question affected students' performance and also whether there was any effect of basic demography or participation in various voluntary activities. Study participants were second-year medical students (n = 150), 83 of whom consented to fill in a questionnaire collecting demographics, revision preferences, and assessment preferences. The examination scores were matched with students' responses collected on the questionnaire and all data analyzed by multiple linear regression. Difficulty of the question was the only design element found to be significantly associated with the number of students that answered correctly (P = 0.001); clinical context, visual resources used and gender of the question were not significant. When individual students' marks were analyzed along with the questionnaire data, only the students' interest in participating in department's demonstrator program was a significant predictor of a high individual score, gender of the students showed a strong trend toward significance, with female students scoring on average higher than male students. The two part OSPE questions were dissociated and analyzed using binary logistic regression to determine whether a correct answer to Part 1 (identification of a tagged or pinned anatomical structures on a specimen or medical image) was predictive of a correct answer to Part 2 (assessment of the relevant functional, applied, or clinical knowledge), but no association was found. Anat Sci Educ 9: 446-452. © 2016 American Association of Anatomists.