Zika virus infection in the returning traveller: what every neurologist should know

Zika virus has been associated with a wide range of neurological complications. Neurologists in areas without current active transmission of the virus may be confronted with Zika-associated neurological disease, as a large number of returning travellers with Zika virus infection have been reported and the virus continues to spread to previously unaffected regions. This review provides an overview of Zika virus-associated neurological disease and aims to support neurologists who may encounter patients returning from endemic areas

Strategi Pengembangan Agroindustri Keripik Pisang (Studi Kasus pada Seorang Pengusaha Keripik Pisang di Desa Hegarmanah Kecamatan Cidolog Kabupaten Ciamis)

Penelitian ini bertujuan untuk mengetahui besarnya biaya, penerimaan dan pendapatan, faktor internal dan eksternal yang berpengaruh terhadap pengembangan agroindustri keripik pisang, alternatif strategi yang dapat diterapkan dalam pengembangan agroindustri keripik pisang di Desa Hegarmanah Kecamatan Cidolog Kabupaten Ciamis. Jenis penelitian yang digunakan dalam penelitian ini adalah metode studi kasus. Data yangdikumpulkan meliputi data primer dan data sekunder. Penarikan responden dalam penelitian ini dilakukan purposive sampling yaitu penetuan sampel dengan pertimbangan tertentu yang dipandang dapat memberikan data secara maksimal, maka responden yang diambil satu orang pengusaha keripik pisang dan sebagai responden pendukung yaitu satu orang Pemerintah Desa Hegarmanah dan satu orang dari Dinas Pertanian.Hasil penelitian menunjukan bahwa:1) Besarnya biaya total yang dikeluarkan oleh pengusaha keripik pisang dalam satu kali proses produksi sebesar Rp 1.369.385,67, penerimaannya sebesar Rp 2.500.000,00 dan pendapatannya sebesar Rp 1.130.614,33.2) Faktor internal dan eksternal yang berpengaruh pada pengembangan agroindustri keripik pisang di Desa Hegarmanah Kecamatan Cidolog Kabupaten Ciamis terdiri dari kekuatan, kelemahan dan peluang, ancaman. Faktor-faktor yang menjadi kekuatan yaitu tersedianya cukup jumlah tenaga kerja, produksi mudah dilakukan, produk keripik pisang yang tahan lama, harga produkyang terjangkau. Sedangkan faktor-faktor yang menjadi kelemahan yaitu keterbatasan permodalan, kualitas SDM yang masih kurang, pengemasan produk masih sederhana, dan promosi masih kurang. Faktor-faktor yang menjadi peluang yaitu tidak ada pesaing produk sejenis disatu daerah, pangsa pasar yang masih luas, permintaan semakin meningkat, cuaca tidak mempengaruhi produksi. Faktor-faktor yang menjadi ancaman yaitu kelangkaan bahanbaku, fluktuasi harga bahan baku, kurang adanya peran dari pemerintah, dan kenaikan harga sarana produksi.3) Alternatif strategi yang dapat diterapkan dalam pengembangan agroindustri keripik pisang di Desa Hegarmanah Kecamatan Cidolog Kabupaten Ciamis yaitu mempertahankan kualitas produksi dan pengembangan pasar, mempertahankan kontinyuitas produksi untuk memenuhi permintaan, optimalisasi kualitas SDM untuk memenuhi permintaan produk, diversifikasi produk untuk memenuhi pangsa pasar, pengelolaan tenaga kerja dan ketersediaan bahan baku,keseragaman harga jual dengan peran serta pengawasan pemerintah, penganekaragaman pengemasan untuk memaksimalkan produksi dan menjalin kerja sama dengan pihak terkait dalam menyikapi permodalan

Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study

<p>Abstract</p> <p>Background</p> <p>Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning, and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.</p> <p>Methods</p> <p>We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and process of care outcomes for 1,346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning, and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.</p> <p>Results</p> <p>No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results, although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.</p> <p>Conclusions</p> <p>No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.</p

Fed-batch fermentation of GM-CSF-producing glycoengineered Pichia pastoris under controlled specific growth rate

<p>Abstract</p> <p>Background</p> <p>Yeast expression systems with altered N-glycosylation are now available to produce glycoproteins with homogenous, defined N-glycans. However, data on the behaviour of these strains in high cell density cultivation are scarce.</p> <p>Results</p> <p>Here, we report on cultivations under controlled specific growth rate of a GlycoSwitch-Man5 <it>Pichia pastoris </it>strain producing Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) at high levels (hundreds of milligrams per liter). We demonstrate that homogenous Man₅GlcNAc₂N-glycosylation of the secreted proteins is achieved at all specific growth rates tested.</p> <p>Conclusions</p> <p>Together, these data illustrate that the GlycoSwitch-Man5 <it>P. pastoris </it>is a robust production strain for homogenously N-glycosylated proteins.</p

Ainu Prayer Text Asahikawa Ainu\u27s prayer (published in the KAMIKAWA Ainu Kumamatsuri )

欧文抄録:p.256These texts were told by Tuakanno SUNAZAWA,Nankeainu MONNO,Hautomtei MONNO, Atsumiyashikuru ISHIYAMA, and recoded by Hideaki KURAMITSU in city MONBETSU in Hokkaido on October.25, 1953. 30 prayers texts upon Bear ceremony(iomante) in Ainu northern diaIect (Ishikari dialect). Roman transcription.1. Prayer to the fire goddess 2.Prayer to the fire goddess 3.Tapkar dance 4.Prayer to the fire goddess 5.Prayer to the fire goddess 6.Prayer to the guardian of village 7.Prayer to the guardian of village 8.Prayer to the god of forest 9.Prayer to the god of wolf 10.Prayer to the god of fox 11.Prayer to the god of owl 12.Prayer to the god of bear 13.Prayer to the god of cliff 14. Prayer to the god of altar 15.Prayer to the god of altar 16.Prayer to the god of wren 17.Prayer to the god of waesel 18.Prayer to the Siberian black bellied dipper 19.Prayer to the water goddess 20.Prayer to the god of pile 21.Prayer to the god of pile 22.Prayer to the cubs 23.Prayer to the cubs 24.Prayer to the cubs 25.Prayer to the god of heaven 26.Prayer to the god of bear 27.Prayer to the cubs 28.Prayer to the god of bear 29. Prayer to the god of bear 30.Tapkar dance 31. Tapkar dance 32.Prayer to the fire goddess 33.Prayer to the cub

Fatal lymphocytic cardiac damage in coronavirus disease 2019 (COVID-19) : autopsy reveals a ferroptosis signature

Aims Cardiovascular complications, including myocarditis, are observed in coronavirus disease 2019 (COVID-19). Major cardiac involvement is a potentially lethal feature in severe cases. We sought to describe the underlying pathophysiological mechanism in COVID-19 lethal cardiogenic shock. Methods and results We report on a 48-year-old male COVID-19 patient with cardiogenic shock; despite extracorporeal life support, dialysis, and massive pharmacological support, this rescue therapy was not successful. Severe acute respiratory syndrome coronavirus 2 RNA was detected at autopsy in the lungs and myocardium. Histopathological examination revealed diffuse alveolar damage, proliferation of type II pneumocytes, lymphocytes in the lung interstitium, and pulmonary microemboli. Moreover, patchy muscular, sometimes perivascular, interstitial mononuclear inflammatory infiltrates, dominated by lymphocytes, were seen in the cardiac tissue. The lymphocytes 'interlocked' the myocytes, resulting in myocyte degeneration and necrosis. Predominantly, T-cell lymphocytes with a CD4:CD8 ratio of 1.7 infiltrated the interstitial myocardium, reflecting true myocarditis. The myocardial tissue was examined for markers of ferroptosis, an iron-catalysed form of regulated cell death that occurs through excessive peroxidation of polyunsaturated fatty acids. Immunohistochemical staining with E06, a monoclonal antibody binding to oxidized phosphatidylcholine (reflecting lipid peroxidation during ferroptosis), was positive in morphologically degenerating and necrotic cardiomyocytes adjacent to the infiltrate of lymphocytes, near arteries, in the epicardium and myocardium. A similar ferroptosis signature was present in the myocardium of a COVID-19 subject without myocarditis. In a case of sudden death due to viral myocarditis of unknown aetiology, however, immunohistochemical staining with E06 was negative. The renal proximal tubuli stained positively for E06 and also hydroxynonenal (4-HNE), a reactive breakdown product of the lipid peroxides that execute ferroptosis. In the case of myocarditis of other aetiology, the renal tissue displayed no positivity for E06 or 4-HNE. Conclusions The findings in this case are unique as this is the first report on accumulated oxidized phospholipids (or their breakdown products) in myocardial and renal tissue in COVID-19. This highlights ferroptosis, proposed to detrimentally contribute to some forms of ischaemia-reperfusion injury, as a detrimental factor in COVID-19 cardiac damage and multiple organ failure