High resolution oesophageal manometry in the investigation of respiratory symptoms

Background: It has been suggested that gastro-oesophageal reflux and aspiration are common precipitants in respiratory diseases such as asthma, COPD, and interstitial lung disease. Several studies have indicated reduced oesophageal motility as a factor in aspiration and poorly controlled gastro-oesophageal reflux causing respiratory symptoms, however, none have provided evidence that the motility profile of this group of patients differ from GORD sufferers exhibiting more typical symptoms. Recent studies have also highlighted the importance of the gastro-oesophageal pressure gradient (GOPG) in the prevalence of reflux.Method: High Resolution Oesophageal Manometry (HRM) was performed in 121 patients, 61 of whom presented primarily with unexplained respiratory symptom (Group A). An age and sex matched control group was chosen from patients presenting with dyspepsia (Group B). The HRM findings of 61 patients (38 female), mean age 56, range (18-81) with respiratory symptoms were compared with the those of 60 suspected gastrooesophageal reflux disease (GORD) patients (39 female), mean age 57, range (19-81). Respiratory patients complained predominantly of chronic cough (50), or breathlessness (11).Results: Mean LOS and UOS resting pressures were similar between the two groups. There was a significant difference in the number of intact peristaltic swallows with a larger number of intact swallows in Group B (58% vs 43%, P=0.03) than in Group A. Intraoesophageal pressure was significantly lower during inspiration in group A (-11.5mmHg vs -8.7, p=0.001). Consequently, a significantly higher GOPG was found in group A (46mmHg vs 33mmHg, p<0.01).Conclusion: Using HRM, we have demonstrated a higher prevalence of oesophageal dysmotility in patients with unexplained respiratory symptoms than those with typical manifestations of GORD - a group in which reduced oesophageal motility is already widely documented. As well as this, we have shown that those with unexplained respiratory symptoms exhibit higher inspiratory GOPGs. Theoretically, our findings support the hypothesis that oesophageal dysmotility and an increased inspiratory GOPG could encourage both acid and non-acid aspiration and thus provoke respiratory symptoms such as cough and breathlessness

Perspectives from community-based doulas and mothers: Neighborhood context and pregnancy

Objectives: Limited research explores the potential pathways by which neighborhoods influence pregnancy or how community members conceptualize and interpret how neighborhood contexts and living environments influence pregnancy and birth. Study Design: We applied participatory Concept Mapping and a series of focused discussions with community-based doulas and mothers. Methods: We collaborated with a community-based doula program to investigate how mothers and community doulas perceived the neighborhood to influence reproductive health. We conducted a series of focused discussions including ‘Brainstorming’ to uncover key themes related to how neighborhood context influenced pregnancy, ‘Sorting and Rating’ of key themes in association with pregnancy and birth outcomes, and further discussion to uncover potential relationships. Data from the ‘Sorting and Rating’ activities were entered into Concept Systems software to generate concept maps of the themes and ideas discussed. Results: The women identified 79 key themes/items related to the neighborhood context that they thought were important for pregnancy and birth. Participants ranked most of the neighborhood factors as moderate or high in importance in influencing pregnancy health and birth. These 79 items were further aggregated to develop 9 clusters related to various themes such as ‘Access/Potential Barriers to Adequate Care,’ ‘The Environment and Infrastructure,’ ‘Neighborhood History, Demographics and Dynamics,’ ‘Community, Relationships, and Autonomy.’ The group further discussed how neighborhood contexts have a particularly influence on individual behaviors such as physical activity; and how key infrastructure issues such as transportation may impede or facilitate access to resources important for health. Conclusion: This study provides additional insight into how neighborhoods may influence pregnancy and birth and how multiple neighborhood factors may act synergistically to influence health. Concept mapping and community perspectives reinforce the importance of participant and community input in developing future research and interventions

A Networked Approach for Curricula Implementation in Support of Inclusive Education Reform

The Maritime Province Department of Education (MPDOE; a pseudonym) has long struggled to address issues of systemic racism that have significantly impacted the academic success and well-being of Indigenous and African Canadian students. When the MPDOE embarked upon its recent inclusive education reform journey, it did so through a series of studies that resulted in a comprehensive reform initiative to address the learning needs of historically marginalized and racialized students. The main thrust of the reform goals focused on curricula to support culturally responsive approaches to learning and the reconfiguring of governance to a more responsive, networked model. Though there is consensus regarding the need for network governance to advance the reform goal of curricula implementation, the legacy of past practices and problematic relationships among the MPDOE, school regions, and historically marginalized communities must be addressed to move forward with this change. The Organizational Improvement Plan (OIP) explores a solution to this problem of practice (PoP) that proposes a focus on social justice-oriented networked leadership models and intergroup and social learning processes for the development of a network team capable of actioning the curricula implementation reform goal. Explored through a reconceptualized critical paradigm that centres Indigenous and African Canadian perspectives, the development of critical consciousness for network team members to action change further undergirds the solution. As a change facilitator and leader at the MPDOE, the support for the development of a network team tasked with planning curricula implementation will be explored through inclusive, distributed, and systems leadership approaches to guide a reimagining of workplace culture and learning at the MPDOE

Developing a nearshore geospatial framework for recovery assessment and planning

As part of the Beach Strategies project developed by the Estuary and Salmon Restoration Program (ESRP), Puget Sound Partnership, ESRP, and Coastal Geologic Services (CGS) developed a geospatial framework to integrate nearshore data for analyses. The Beach Strategies project developed a geodatabase to inform restoration and protection planning. The Nearshore Geospatial Framework was designed as a companion structure to the Beach Strategies data to facilitate consistent and scalable units of analysis across the region-wide dataset. The framework is a series of consistent polygons with variable characteristics in both aquatic and inland areas of the nearshore. The polygon structures include variable buffer widths for the aquatic and nearshore, and contributing upland areas for shoretypes and drift cells. In addition to providing analytical structure, the framework also links to existing long term monitoring spatial datasets. The Nearshore Geospatial Framework was developed to succeed the PSNERP Change Analysis framework which is not compatible with the Beach Strategies geodatabase due to updated drift cell mapping

The "Safe Student" Scholarship: Expanding Education Choice Options to Improve School Safety

School safety is an issue that policymakers have struggled to address for decades. Current federal policy provides an Unsafe School Choice Option that has been largely overlooked. States should ensure that implementation of the policy allows all students who are in unsafe environments to transfer to a safe and effective school. At the same time, state policymakers should immediately provide school choice options to children who are direct victims of school violence or bullying, and to those students in schools with a high rate of such victimization, through the introduction of "safe student" scholarships.

Care for the Uninsured: A Year of Review for La Casita de la Salud

As the academic year ends, the former directors of La Casita de la Salud share a memorable clinical experience and the impact it has made on the student volunteers. La Casita not only provides health care to the underserved, but it also shows students the impact that they may have in the life of their patients. the clinic has progressed monumentally in the past year after a committee executive board strove to better the clinic\u27s operation. This article highlights the numerous developments as well as some obstacles the clinic will have to face in the near future

A Human Torque Teno Virus Encodes a MicroRNA That Inhibits Interferon Signaling

Rodney P. Kincaid, James M. Burke, Jennifer C. Cox, Christopher S. Sullivan, The University of Texas at Austin, Molecular Genetics and Microbiology, Austin, Texas, United States of AmericaEthel-Michele de Villiers, Division for the Characterization of Tumorviruses, Deutsches Krebsforschungszentrum, Heidelberg, GermanyTorque teno viruses (TTVs) are a group of viruses with small, circular DNA genomes. Members of this family are thought to ubiquitously infect humans, although causal disease associations are currently lacking. At present, there is no understanding of how infection with this diverse group of viruses is so prevalent. Using a combined computational and synthetic approach, we predict and identify miRNA-coding regions in diverse human TTVs and provide evidence for TTV miRNA production in vivo. The TTV miRNAs are transcribed by RNA polymerase II, processed by Drosha and Dicer, and are active in RISC. A TTV mutant defective for miRNA production replicates as well as wild type virus genome; demonstrating that the TTV miRNA is dispensable for genome replication in a cell culture model. We demonstrate that a recombinant TTV genome is capable of expressing an exogenous miRNA, indicating the potential utility of TTV as a small RNA vector. Gene expression profiling of host cells identifies N-myc (and STAT) interactor (NMI) as a target of a TTV miRNA. NMI transcripts are directly regulated through a binding site in the 3′UTR. SiRNA knockdown of NMI contributes to a decreased response to interferon signaling. Consistent with this, we show that a TTV miRNA mediates a decreased response to IFN and increased cellular proliferation in the presence of IFN. Thus, we add Annelloviridae to the growing list of virus families that encode miRNAs, and suggest that miRNA-mediated immune evasion can contribute to the pervasiveness associated with some of these viruses.This work was supported by grants RO1AI077746 from the National Institutes of Health, RP110098 from the Cancer Prevention and Research Institute of Texas, a Burroughs Wellcome Investigators in Pathogenesis Award to CSS, a UT Austin Powers Graduate Fellowship to RPK, a UT Austin Institute for Cellular and Molecular Biology fellowship, and the DKFZ for EMdV. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Molecular BiosciencesMicrobiologyEmail: [email protected]