Diagnosis and Treatment of Gonorrhea

The various methods for diagnosis of gonorrhea are reviewed. Gram-stained smear of urethral exudate in the mate is appropriate, but for the female emphasis is placed on the use of culture on Thayer-Martin medium. Currently effective modalities of treatment are detailed, pointing out that higher doses of antibiotics are generally required for females with pelvic inflammatory disease than for males with acute gonococcal urethritis. The necessity for follow-up is also discussed

Pleural Effusion in Michigan Caused by Coccidioides Immitis After Travel to an Endemic Area

Primary coccidioidal disease is rarely diagnosed in the midwest in the nonimmunocompromised host. Since coast-to-coast travel is common today, many patients may become exposed to Coccidioides immitis while traveling in endemic areas. We present a case of acute coccidioidal pleural effusion in a Michigan woman who had recently visited northeastern Arizona. Her travel history was the single most important factor in the eventual diagnosis of coccidioidal pleural effusion

Developing Effective Cancer Pain Education Programs

Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of diverse populations and those with limited health literacy skills; (3) describe the resource needs and costs of developing a program; and (4) highlight innovative approaches to cancer pain education. We conclude with recommendations for future research and the next generation of educational interventions

A critical examination of the role of marine snow and zooplankton faecal pellets in removing ocean surface microplastic

Numerical simulations and emissions estimates of plastic in and to the ocean consistently over-predict the surface inventory, particularly in the case of microplastic (MP), i.e. fragments less than 5 mm in length. Sequestration in the sediments has been both predicted and, to a limited extent, observed. It has been hypothesized that biology may be exporting a significant fraction of surface MP by way of marine snow aggregation and zooplankton faecal pellets. We apply previously published data on MP concentrations in the surface ocean to an earth system model of intermediate complexity to produce a first estimate of the potential global sequestration of MP by marine aggregates, including faecal pellets. We find a MP seafloor export potential of between 7.3E3-4.2E5 metric tons per year, or about 0.06-8.8% of estimated total annual plastic ocean pollution rates. We find that presently, aggregates alone would have the potential to remove most existing surface ocean MP to the seafloor within less than 2 years if pollution ceases. However, the observed accumulation of MP in the surface ocean, despite this high potential rate of removal, suggests that detrital export is an ineffective pathway for permanent MP removal. We theorize a prominent role of MP biological fouling and de-fouling in the rapid recycling of aggregate-associated MP in the upper ocean. We also present an estimate of how the potential detrital MP sink might change into the future, as climate change (and projected increasing MP pollution) alters the marine habitat. The polar regions, and the Arctic in particular, are projected to experience increasing removal rates as export production increases faster than MP pollution. Northern hemisphere subtropical gyres are projected to experience slowing removal rates as stratification and warming decrease export production, and MP pollution increases. However, significant uncertainty accompanies these results

Functioning and disability in multiple sclerosis from the patient perspective

Multiple sclerosis (MS) has a great impact on functioning and disability. The perspective of those who experience the health problem has to be taken into account to obtain an in-depth understanding of functioning and disability. The objective was to describe the areas of functioning and disability and relevant contextual factors in MS from the patient perspective. A qualitative study using focus group methodology was performed. The sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for data analysis. Identified concepts were linked to International Classification of Functioning, Disability and Health (ICF) categories according to established linking rules. Six focus groups with a total of 27 participants were performed. In total, 1327 concepts were identified and linked to 106 ICF categories of the ICF components Body Functions, Activities and Participation and Environmental Factors. This qualitative study reports on the impact of MS on functioning and disability from the patient perspective. The participants in this study provided information about all physical aspects and areas of daily life affected by the disease, as well as the environmental factors influencing their lives

Producing the docile body: analysing Local Area Under-performance Inspection (LAUI)

Sir Michael Wilshaw, the head of the Office for Standards in Education (OfSTED), declared a 'new wave' of Local Area Under-performance Inspections (LAUI) of schools 'denying children the standard of education they deserve'. This paper examines how the threat of LAUI played out over three mathematics lessons taught by a teacher in her first year in the profession. A Foucauldian approach is mobilised with regard to disciplinary power and 'docile bodies'. The paper argues that, in the case in point, LAUI was a tool mediating performative conditions and, ultimately, the docile body. The paper will be of concern to policy sociologists, teachers, school leaders, and those interested in school inspection

Integration of subclassification strategies in randomised controlled clinical trials evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain: a systematic review

Background There is lack of evidence for specific treatment interventions for patients with non-specific chronic low back pain (NSCLBP) despite the substantial amount of randomised controlled clinical trials evaluating treatment outcome for this disorder. Hypothesis It has been hypothesised that this vacuum of evidence is caused by the lack of subclassification of the heterogeneous population of patients with chronic low back pain for outcome research.Methods A systematic review with a meta-analysis was undertaken to determine the integration of subclassification strategies with matched interventions in randomised controlled clinical trials evaluating manual therapy treatment and exercise therapy for NSCLBP. A structured search for relevant studies in Embase, Cinahl, Medline, PEDro and the Cochrane Trials Register database, followed by hand searching all relevant studies in English up to December 2008. Results Only 5 of 68 studies (7.4%) subclassified patients beyond applying general inclusion and exclusion criteria. In the few studies where classification and matched interventions have been used, our meta-analysis showed a statistical difference in favour of the classification-based intervention for reductions in pain (p=0.004) and disability (p=0.0005), both for short-term and long-term reduction in pain (p=0.001). Effect sizes ranged from moderate (0.43) for short term to minimal (0.14) for long term. Conclusion A better integration of subclassification strategies in NSCLBP outcome research is needed. We propose the development of explicit recommendations for the use of subclassification strategies and evaluation of targeted interventions in future research evaluating NSCLBP

The global biological microplastic particle sink

Every year, about four percent of the plastic waste generated worldwide ends up in the ocean. What happens to the plastic there is poorly understood, though a growing body of evidence suggests it is rapidly spreading throughout the global ocean. The mechanisms of this spread are straightforward for buoyant larger plastics that can be accurately modelled using Lagrangian particle models. But the fate of the smallest size fractions (the microplastics) are less straightforward, in part because they can aggregate in sinking marine snow and faecal pellets. This biologically-mediated pathway is suspected to be a primary surface microplastic removal mechanism, but exactly how it might work in the real ocean is unknown. We search the parameter space of a new microplastic model embedded in an earth system model to show that biological uptake can significantly shape global microplastic inventory and distributions and even account for the budgetary “missing” fraction of surface microplastic, despite being an inefficient removal mechanism. While a lack of observational data hampers our ability to choose a set of “best” model parameters, our effort represents a first tool for quantitatively assessing hypotheses for microplastic interaction with ocean biology at the global scale

Zooplankton grazing of microplastic can accelerate global loss of ocean oxygen

Global warming has driven a loss of dissolved oxygen in the ocean in recent decades. We demonstrate the potential for an additional anthropogenic driver of deoxygenation, in which zooplankton consumption of microplastic reduces the grazing on primary producers. In regions where primary production is not limited by macronutrient availability, the reduction of grazing pressure on primary producers causes export production to increase. Consequently, organic particle remineralisation in these regions increases. Employing a comprehensive Earth system model of intermediate complexity, we estimate this additional remineralisation could decrease water column oxygen inventory by as much as 10% in the North Pacific and accelerate global oxygen inventory loss by an extra 0.2–0.5% relative to 1960 values by the year 2020. Although significant uncertainty accompanies these estimates, the potential for physical pollution to have a globally significant biogeochemical signal that exacerbates the consequences of climate warming is a novel feedback not yet considered in climate research

Developing sexual competence? Exploring strategies for the provision of effective sexualities and relationships education

School-based sexualities and relationships education (SRE) offers one of the most promising means of improving young people's sexual health through developing 'sexual competence'. In the absence of evidence on whether the term holds the same meanings for young people and adults (e.g. teachers, researchers, policy-makers), the paper explores 'adult' notions of sexual competence as construed in research data and alluded to in UK Government guidance on SRE, then draws on empirical research with young people on factors that affect the contexts, motivations and outcomes of sexual encounters, and therefore have implications for sexual competence. These data from young people also challenge more traditional approaches to sexualities education in highlighting disjunctions between the content of school-based input and their reported sexual experience. The paper concludes by considering the implications of these insights for developing a shared notion of what SRE is trying to achieve and suggestions for recognition in the content and approaches to SRE.</p