Screening for familial hypercholesterolaemia in primary care: Time for general practice to play its part

Fifty per cent of first-degree relatives of index cases with familial hypercholesterolemia (FH) inherit the disorder. Despite cascade screening being the most cost-effective method for detecting new cases, only a minority of individuals with FH are currently identified. Primary care is a key target area to increase identification of new index cases and initiate cascade screening, thereby finding close relatives of all probands. Increasing public and health professional awareness about FH is essential. In the United Kingdom and in Australia, most of the population are reviewed by a General Practitioner (GP) at least once over a three-year period, offering opportunities to check for FH as part of routine clinical consultations. Such opportunistic approaches can be supplemented by systematically searching electronic health records with information technology tools that identify high risk patients. GPs can help investigate and implement results of this data retrieval. Current evidence suggests that early detection of FH and cascade testing meet most of the criteria for a worthwhile screening program. Among heterozygous patients the long latent period before the expected onset of coronary artery disease provides an opportunity for initiating effective drug and lifestyle changes. The greatest challenge for primary care is to implement an efficacious model of care that incorporates sustainable identification and management pathways

Does haste make waste? The human factors of overtaking land design

The aim of this research was to improve overtaking safety and efficiency through improvements in road signage, markings, geometry and speed control associated with the placement and layout of passing lanes. The approach of the research was to explore the effects of several types of overtaking lane treatments in the safety and controlled environment of a state-of-the-art driving simulator. It was found that under the most benign conditions there were no differential effects of the three treatments. With poorer visibility or more taxing road geometry, the drivers relied more heavily on the road markings and signage and the effects of the treatments become more pronounced. The sensitivity to the more "challenging" situations was borne out by the greater speed differential between merge area sections at these sites

Rock‐Matrix Porosity and Permeability of the Hydrothermally Altered, Upper Oceanic Crust, Oman Ophiolite

Porosity and permeability are key controls on hydrothermal circulation and alteration in magmatically heated upper oceanic crust. However, the hydraulic properties of basalts altered above 200°C are largely unknown, leaving their role in high-temperature systems unclear. Here, we assess rock-matrix porosities and permeabilities of pervasively altered MORB-like basalts from outcrops in the sheeted dikes and axial lavas of the Semail ophiolite, Oman. The samples represent regional spilite alteration (chlorite–albite–quartz ± actinolite; 150–440°C) and localized epidosite alteration (epidote–quartz; 255–435°C). Porosity and permeability of spilitized rocks vary as follows: interpillow hyaloclastites (14–27 vol.%, 10−17–10−15 m2) > pillow cores (4–12 vol.%; ∼10−19–6 × 10−18 m2) > pillow rims (4–11 vol.%; ∼10−19–2 × 10−18 m2) > massive sheet flows (1–9 vol.%; ∼10−19 m2) ≥ dikes (1–5 vol.%; ∼10−19 m2). Pillow values fall within the ranges of existing data on fresh and low-temperature altered basalts in in situ crust. However, hyaloclastite permeabilities are 1–4 orders of magnitude higher and are clearly preferred flow paths. Epidosites have elevated porosity and permeability irrespective of rock morphology (18–26 vol.%; ∼10−16–10−14 m2). Pillow stacks have upscaled (∼104 m3) matrix porosities and permeabilities of ∼9 vol.% and ∼10−17–10−16 m2 when spilitized and 16 vol.% and up to ∼10−14 m2 when epidotized. Upscaled permeabilities of spilites meet minimum requirements for observed heat and fluid discharge from high-temperature seafloor systems even without fracture networks, and reflect strong flow through the rock-matrix

Investigating the Efficacy of Emotional Freedom Technique on Perceived Stress in Athletic Training Students

In volume 4, Issue 1 of the JSMAHS you will find Professional Research Abstracts, as well as Bachelor Student Research Abstracts and Case Reports. Thank you for viewing this 4th Annual OATA Special Editio

The role of whitecapping in thickening the ocean surface boundary layer

Author Posting. © American Meteorological Society, 2015. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 45 (2015): 2006–2024, doi:10.1175/JPO-D-14-0234.1.The effects of wind-driven whitecapping on the evolution of the ocean surface boundary layer are examined using an idealized one-dimensional Reynolds-averaged Navier–Stokes numerical model. Whitecapping is parameterized as a flux of turbulent kinetic energy through the sea surface and through an adjustment of the turbulent length scale. Simulations begin with a two-layer configuration and use a wind that ramps to a steady stress. This study finds that the boundary layer begins to thicken sooner in simulations with whitecapping than without because whitecapping introduces energy to the base of the boundary layer sooner than shear production does. Even in the presence of whitecapping, shear production becomes important for several hours, but then inertial oscillations cause shear production and whitecapping to alternate as the dominant energy sources for mixing. Details of these results are sensitive to initial and forcing conditions, particularly to the turbulent length scale imposed by breaking waves and the transfer velocity of energy from waves to turbulence. After 1–2 days of steady wind, the boundary layer in whitecapping simulations has thickened more than the boundary layer in simulations without whitecapping by about 10%–50%, depending on the forcing and initial conditions.We thank Skidmore College for financial and infrastructure support, and Skidmore and the National Science Foundation for funding travel to meetings where early versions of this work were presented. We also thank the National Science Foundation, Oregon State University, Jonathan Nash, and Joe Jurisa for funding and hosting a workshop on River Plume Mixing in October, 2013, where ideas and context for this paper were developed.2016-02-0

Cloud-based services for electronic civil registration and vital statistics systems

This paper examines the hosting options for electronic civil registration and vital statistics (CRVS) systems, particularly the use of data centers versus cloud-based solutions. A data center is a facility that houses computer systems and associated hardware and software components, such as network and storage systems, power supplies, environment controls, and security devices. An alternative to using a data center is cloud-based hosting, which is a virtual data center hosted by a public cloud provider. The cloud is used on a pay-as-you-go basis and does not require purchasing and maintaining of hardware for data centers. It also provides more flexibility for continuous innovation in line with evolving information and communications technology

Mapping a novel positive allosteric modulator binding site in the central vestibule region of human P2X7

P2X7 receptors are important in the regulation of inflammatory responses and immune responses to intracellular pathogens such as Mycobacterium tuberculosis and Toxoplasma gondii. Enhancement of P2X7 receptor responses may be useful in pathogen clearance particularly in individuals with defective microbial killing mechanisms. Ginsenosides from Panax ginseng have been discovered to act as positive allosteric modulators of P2X7. Here we describe a novel modulator binding site identified by computational docking located in the central vestibule of P2X7 involving S60, D318, and L320 in the lower body β-sheets lining the lateral portals. Potentiation of ATP-mediated responses by ginsenosides CK and Rd caused enhanced ionic currents, Ca2+ influx and YOPRO-1 uptake in stably transfected HEK-293 cells (HEK-hP2X7) plus enhanced cell death responses. Potentiation of ATP responses by CK and Rd was markedly reduced by mutations S59A, S60A, D318L and L320A supporting the proposed allosteric modulator binding site. Furthermore, mutation of the conserved residues S60 and D318 led to alterations in P2X7 response and a higher sensitivity to ATP in the absence of modulators suggesting residues in the connecting rods play an important role in regulating P2X7 gating. Identification of this novel binding site location in the central vestibule may also be relevant for structurally similar channels

Identification and characterisation of enteroaggregative Escherichia coli subtypes associated with human disease

Enteroaggregative E. coli (EAEC) are a major cause of diarrhoea worldwide. Due to their heterogeneity and carriage in healthy individuals, identification of diagnostic virulence markers for pathogenic strains has been difficult. In this study, we have determined phenotypic and genotypic differences between EAEC strains of sequence types (STs) epidemiologically associated with asymptomatic carriage (ST31) and diarrhoeal disease (ST40). ST40 strains demonstrated significantly enhanced intestinal adherence, biofilm formation, and pro-inflammatory interleukin-8 secretion compared with ST31 isolates. This was independent of whether strains were derived from diarrhoea patients or healthy controls. Whole genome sequencing revealed differences in putative virulence genes encoding aggregative adherence fimbriae, E. coli common pilus, flagellin and EAEC heat-stable enterotoxin 1. Our results indicate that ST40 strains have a higher intrinsic potential of human pathogenesis due to a specific combination of virulence-related factors which promote host cell colonization and inflammation. These findings may contribute to the development of genotypic and/or phenotypic markers for EAEC strains of high virulence