A Case of Internal Carotid Artery Thrombosis associated with Thalidomide Administration in Multiple Myeloma

Thalidomide is an effective chemotherapeutic agent used to achieve remission in multiple myeloma. However, its administration is associated with several adverse effects including venous thromboembolism, while arterial thrombosis has also, although rarely, been described in the literature. We report a case of internal carotid artery occlusion within 1 week of starting thalidomide with prophylactic low molecular weight heparin in a patient who had no other prothrombotic risk factors. It is not known why this complication occurs despite the administration of anticoagulant prophylaxis. The role of factor VIII, von Willebrand factor antigen levels and fibrinogen in multiple myeloma patients should be studied in order to determine if these factors should be targeted in future prophylactic treatment

Mental health difficulties and health related quality of life amongst late adolescents in vocational education

This study investigated vocational students’ mental health by identifying the prevalence of depression, stress, anxiety, eating disorders and associated risk and protective factors among 16- to 18-year-old students attending a vocational college in Malta. Health Related Quality of Life (HRQOL) was also investigated. A sample of 422 students completed standardised self-report mental health tools and a demographic and personal variables’ questionnaire. A total of 64.4% of students were found to be struggling with at least one of the mental health conditions assessed while 36.7% reported a suspected eating disorder. The prevalence rates of depression, anxiety and stress (moderate, severe or extremely severe) were 43.3%, 48.8% and 29.3% respectively. Students had a lower HRQOL than the reference population as indicated by European norm data. Only 13.5% of participants sought help from mental health services. Risk factors include female gender, poverty, being LGBTQ, not living with both parents, past negative school experiences, poor relationships and presence of suspected or diagnosed conditions or disabilities, amongst others. Having supportive relationships with family, peers and school personnel emerged as protective factors.peer-reviewe

Children in out-of-home care in Malta : key findings from a series of three studies commissioned by the Office of the Commissioner for Children

There is more than one reason why we should be pleased with the research that is summarily described in this publication. One such reason is that this work illustrates the principle that all efforts that are made towards bettering the situation of children should rest on a solid foundation of scientific research. In this respect, this tripartite piece of research is valid in that it replaces anecdotal evidence regarding out-of-home care for children in Malta with a well-rounded body of scientific facts. This means that the recommendations that are made in this report can be more easily understood and subscribed to when they are read in the light of the findings that are presented. Another important element about this research is that it evaluates the outcome of out-of-home care solely in terms of the well-being of the children in care. This is important in view of the need to make out-of-home care in Malta more child-centred and less service-driven and ultimately more respectful of the rights of children. This research studies the entire cohort of its target group of children and it underlines the principle enunciated in Article 2 of the United Nations Convention for the Rights of the Child, namely that the rights of children should be enjoyed by all children without discrimination, and that any disparity among children in the enjoyment of their rights is a matter of grave injustice. Finally, it is the very subject-matter that highlights so prominently the importance of this research. The right of the child to be cared for in a social environment that is conducive to its well-being is easily the most fundamental of all the rights of the child since it is through such an environment that a child can acquire the emotional and psychological stability that is necessary to the enjoyment of almost any other right. Children thus are vulnerable because their overall well-being hinges on whether such an enabling environment is available to them. Children in out-of-home care are doubly vulnerable because of the disruptions in their natural family milieu and the difficulty in providing them with an alternative arrangement that can make up for the lack of such milieu. This research should not be seen in isolation but in the context of local policy developments in the field of out-of-home care. In this respect, I would like to mention and applaud the strong investment that has been made in recent years to shift the balance of out-of-home care from residential care to foster care, the importance of which is strongly borne out by the findings of this research. This should in no way reflect badly on the care given by religious institutions. Rather it should be seen as a development that recognizes the fact that children’s needs are best met in a family enviroment. We are also at a time where a much needed national strategy for out-of-home care is being formulated to map out the road ahead in this sector. I am confident that this research will provide a useful compass to chart such a roadmap. I cannot conclude without paying thanks to Ms Carmen Zammit, the former Commissioner for Children, who took the visionary step of commissioning the research. Heartfelt thanks are due also to the research team, led by Professor Angela Abela, to the focus groups which helped set the parameters of this research and to the the staff of the Office of the Commissioner for Children for their untiring logisitcal support. Finally, my sincere thanks goes to all the children who at the time were in care, those who had already left the care system but were ready to share their experiences as well as the carers, social workers and teachers whose participation forms the very core of this research. The only way that justice can be made to their selfless efforts is by ensuring that this research is effectively used as a tool to improve the well-being of all children in care, and that further research is carried out, as suggested in the research report, to shed more light on the reality of out-of-home care in Malta.peer-reviewe

Pleiotropic effects of anti-thrombotic therapies: have direct oral anticoagulants any anti-inflammatory effect?

Direct oral anticoagulants (DOACs) are currently recommended by European guidelines as the first line therapy for both stroke prevention in patients with atrial fibrillation (AF) and the prevention and the treatment of venous thromboembolism (VTE). Recently, it has been speculated that DOACs have anti-inflammatory capabilities in reducing the abnormal release of pro-inflammatory factors in addition to inhibiting the activation of factor X or factor II of the coagulation cascade. However, this hypothesis is based on limited pathophysiological data with small sample size, often on in vitro studies. Real-world, in vivo, and large clinical data are scarce. The aim of the present study was the evaluation of the possible anti-inflammatory and anti-proliferative effects of DOACs treatment in a cohort of patients affected by AF or VTE, by analyzing an extensive panel of cytokines and molecules involved in the process of vascular and tissue remodeling. Our data evidenced that DOACs treatment is associated with variations in systemic inflammation markers and in metalloproteinases. Further studies with larger number of patients are required to confirm these data

RadioActive Europe: promoting engagement, informal learning and employability of at risk and excluded people across Europe through internet radio and social media (RadioActive101)

RadioActive is an innovative education project that has developed and implemented a radical technology-enabled pedagogy to promote the inclusion, engagement and informal learning of excluded people, or those at-risk of exclusion, across Europe. It does this through harnessing primarily internet radio and also social media, or, as our motto states: "RadioActive101: Learning through radio, learning for life!" The project developed, implemented and is sustaining a pan-European Internet Radio platform, incorporating Web 2.0 ideas and features. This is linked to innovative community based pedagogies to address inclusion, employability and active citizenship in an original and exciting way, whilst recognising informal learning through electronic Open badges. The consortium was led by the University of East London (UK), with other partners from Portugal (CIMJ), Germany (UKL), the UK (Pontydysgu), Romania (ODIP) and Malta (KIC). These partners have direct links and ongoing collaborations with 13 primary Associate Partner organisations and a network of 39 mostly grass-roots organisations that facilitate access to the RadioActive101 participants, or 'radio-activists' as we define them. So the Associate Partners perform and deliver RadioActive 'on the ground' and are the vehicle for the learning experiences required for their production. These represent a particularly diverse range of groups and this was deliberate to allow us to test and refine our model, and show that it potentially works with virtually all excluded groups, and across Europe. We actively developed, implemented and ran five national RadioActive 'stations' (or hubs) that are accessible via the European Support Hub (ESH). Through making the radio shows the target groups (schools, vocational education, Higher Education, informal and adult education) are developing digital competencies and employability skills 'in vivo' that are transferable to the 21st Century workplace. These competencies and skills align with six of the EU Key Competencies for Lifelong Learning and we have developed a progression and accreditation model linking the key competencies to RadioActive activities and performances that are recognised through Open electronic 'badges'. These badges provide concrete recognition measures and represent proficiencies that are relevant to further education or employment in particular related to the knowledge and creative and digital industries. Evaluation findings were obtained through conducting a phased evaluation incorporating a full in depth ‘prototype’ evaluation in the UK during year one, a similar evaluation in Portugal and a smaller one in Germany in year two, that were followed by a broader and larger international survey of radio-activists (subjects) towards the end of the project. All these showed particularly positive and interesting results, such as the delivery of additional impact and value beyond the informal learning of technical and employability skills. Additionally, we found improvements in confidence, self-esteem and general self-efficacy of individuals, plus additional improvements in groups and organisations. It appears that once our excluded groups developed the confidence and competence to perform activities they often thought were beyond them, they seem then empowered, to learn many other things and to develop a number of key competencies. At the European and national levels we have produced an extensive amount of dissemination activities to make the RadioActive Europe project public and well known, and also won two additional funding awards towards the end of the project.Other exploitation activities include embedding locally and internationally, with the latter being realised through the establishment of an international Foundation that will also support and advise about funding models to support further expansion at the European level

RadioActive101 Practices

The RadioActive101 Practices publication is now complete (in both PDF and EPUB versions) following consultation with all our partners. The report contains many of the common practices developed and refined by participants and RadioActive researchers across this European partnership over the last two years. And there are several examples of the significant impact felt by some of the individuals who became ‘radio-activists’ along the way

The Malaria Testing and Treatment Market in Kinshasa, Democratic Republic of the Congo, 2013

Background The Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria. This paper describes the malaria testing and treatment market in the nation’s capital province of Kinshasa, including availability of malaria testing and treatment and relative anti-malarial market share for the public and private sector. Methods A malaria medicine outlet survey was conducted in Kinshasa province in 2013. Stratified multi-staged sampling was used to select areas for the survey. Within sampled areas, all outlets with the potential to sell or distribute anti-malarials in the public and private sector were screened for eligibility. Among outlets with anti-malarials or malaria rapid diagnostic tests (RDT) in stock, a full audit of all available products was conducted. Information collected included product information (e.g. active ingredients, brand name), amount reportedly distributed to patients in the past week, and retail price. Results In total, 3364 outlets were screened for inclusion across Kinshasa and 1118 outlets were eligible for the study. Among all screened outlets in the private sector only about one in ten (12.1%) were stocking quality-assured Artemisinin-based Combination Therapy (ACT) medicines. Among all screened public sector facilities, 24.5% had both confirmatory testing and quality-assured ACT available, and 20.2% had sulfadoxine-pyrimethamine (SP) available for intermittent preventive therapy during pregnancy (IPTp). The private sector distributed the majority of anti-malarials in Kinshasa (96.7%), typically through drug stores (89.1% of the total anti-malarial market). Non-artemisinin therapies were the most commonly distributed anti-malarial (50.1% of the total market), followed by non quality-assured ACT medicines (38.5%). The median price of an adult quality-assured ACT was $6.59, and more expensive than non quality-assured ACT ($3.71) and SP ($0.44). Confirmatory testing was largely not available in the private sector (1.1%). Conclusions While the vast majority of anti-malarial medicines distributed to patients in Kinshasa province are sold within the private sector, availability of malaria testing and appropriate treatment for malaria is alarmingly low. There is a critical need to improve access to confirmatory testing and quality-assured ACT in the private sector. Widespread availability and distribution of non quality-assured ACT and non-artemisinin therapies must be addressed to ensure effective malaria case management

Of Black Swans and Tossed Coins: Is the Description-Experience Gap in Risky Choice Limited to Rare Events?

When faced with risky decisions, people tend to be risk averse for gains and risk seeking for losses (the reflection effect). Studies examining this risk-sensitive decision making, however, typically ask people directly what they would do in hypothetical choice scenarios. A recent flurry of studies has shown that when these risky decisions include rare outcomes, people make different choices for explicitly described probabilities than for experienced probabilistic outcomes. Specifically, rare outcomes are overweighted when described and underweighted when experienced. In two experiments, we examined risk-sensitive decision making when the risky option had two equally probable (50%) outcomes. For experience-based decisions, there was a reversal of the reflection effect with greater risk seeking for gains than for losses, as compared to description-based decisions. This fundamental difference in experienced and described choices cannot be explained by the weighting of rare events and suggests a separate subjective utility curve for experience

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London