Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury

Impact of a hospice rapid response service on preferred place of death, and costs

Background: Many people with a terminal illness would prefer to die at home. A new palliative rapid response service (RRS) provided by a large hospice provider in South East England was evaluated (2010) to provide evidence of impact on achieving preferred place of death and costs. The RRS was delivered by a team of trained health care assistants and available 24/7. The purpose of this study was to (i) compare the characteristics of RRS users and non-users, (ii) explore differences in the proportions of users and non-users dying in the place of their choice, (iii) monitor the whole system service utilisation of users and non-users, and compare costs. Methods: All hospice patients who died with a preferred place of death recorded during an 18 month period were included. Data (demographic, preferences for place of death) were obtained from hospice records. Dying in preferred place was modelled using stepwise logistic regression analysis. Service use data (period between referral to hospice and death) were obtained from general practitioners, community providers, hospitals, social services, hospice, and costs calculated using validated national tariffs. Results: Of 688 patients referred to the hospice when the RRS was operational, 247 (35.9 %) used it. Higher proportions of RRS users than non-users lived in their own homes with a co-resident carer (40.3 % vs. 23.7 %); more non-users lived alone or in residential care (58.8 % vs. 76.3 %). Chances of dying in the preferred place were enhanced 2.1 times by being a RRS user, compared to a non-user, and 1.5 times by having a co-resident carer, compared to living at home alone or in a care home. Total service costs did not differ between users and non-users, except when referred to hospice very close to death (users had higher costs). Conclusions: Use of the RRS was associated with increased likelihood of dying in the preferred place. The RRS is cost neutral

Troubling meanings of family and competing moral imperatives in the family lives of young people with a parent who is at the end of life

This article draws on a narrative study of young people with a parent who is at the end of life to examine how family lives are troubled by life-limiting parental illness. Young people struggled to reconcile the physical and emotional absence of family members with meanings of ‘family’; the extent to which young people could rely on family to ‘be there’ in these troubling circumstances was of practical, emotional and moral significance. Our discussion is situated in the context of an English end of life care policy predicated on the ideal of a good death as one that takes place at home accompanied by family members. We explore how the shift away from family as a site for nurturing children towards family as a space to care for the dying is experienced by young people, and consider how these competing moral imperatives are negotiated through relational practices of care

Violent and victimized bodies: sexual violence policy in England and Wales

This paper uses the notion of the body to frame an archaeology of sexual violence policy in England and Wales, applying and developing Pillow’s ideas. It argues that the dominant construction is of sexual violence as an individualized crime, with the solution being for a survivor to report, and with support often instrumentalized in relation to criminal justice objectives. However, criminal justice proceedings can intensify or create further trauma for sexual violence survivors. Furthermore, in addition to criminalizing the violent body and supporting the victimized one, there is a need for policy to produce alternative types of bodies through preventative interventions. Much sexual violence is situated within (hetero) sexual dynamics constructing a masculine aggressor and a feminine body which eventually yields. Prevention must therefore focus on developing embodied boundaries, and narratives at the margins of policy could underpin such efforts

The role of tenascin-C in tissue injury and tumorigenesis

The extracellular matrix molecule tenascin-C is highly expressed during embryonic development, tissue repair and in pathological situations such as chronic inflammation and cancer. Tenascin-C interacts with several other extracellular matrix molecules and cell-surface receptors, thus affecting tissue architecture, tissue resilience and cell responses. Tenascin-C modulates cell migration, proliferation and cellular signaling through induction of pro-inflammatory cytokines and oncogenic signaling molecules amongst other mechanisms. Given the causal role of inflammation in cancer progression, common mechanisms might be controlled by tenascin-C during both events. Drugs targeting the expression or function of tenascin-C or the tenascin-C protein itself are currently being developed and some drugs have already reached advanced clinical trials. This generates hope that increased knowledge about tenascin-C will further improve management of diseases with high tenascin-C expression such as chronic inflammation, heart failure, artheriosclerosis and cancer

High-Throughput Melanin-Binding Affinity and In Silico Methods to Aid in the Prediction of Drug Exposure in Ocular Tissue

Drugs possessing the ability to bind to melanin-rich tissue, such as the eye, are linked with higher ocular exposure, and therefore have the potential to affect the efficacy and safety profiles of therapeutics. An in silico method could rapidly assess the melanin binding properties of large numbers of compounds and assist in compound design where the binding to melanin binding is a factor. Previous studies have reported the development of in silico QSAR models based on training sets of relatively small and mostly similar compounds. In this study, we report the development of an in silico model built using the Random Forest algorithm, which is capable of quickly assessing compounds as low, medium or high melanin binders. The model was trained using a relatively larger and more diverse dataset of molecules which cover a broader range of melanin binding affinities, than what has been previously published. The model uses melanin binding data generated from an in house high-affinity chromatography method. This method was validated against a rigorous in house radiolabelled assay and in vivo studies. Additionally, the in silico model identified several physiochemical descriptors from this more diverse data set which agree with those previously found and could be considered in the design of compounds where melanin binding modulation is desired

Procedures for safe movement of cocoa germplasm

Increased productivity on cocoa farms can be achieved through a combination of supplying improved planting materials and good agricultural practice. Targets for improved genotypes typically include high yield potential, good bean size and fat content, resilience to pests and diseases and, increasingly, resilience to environmental stresses (e.g. drought). Access to a diverse range of germplasm is key to the breeding and selection activities that ultimately provide improved planting materials to farmers. However, any movement of germplasm to meet the requirement for such diversity brings with it the concurrent risk of the spread of pests and diseases. Therefore, all movement of cocoa germplasm must adhere to safe movement protocols and quarantine procedures. The Technical Guidelines for the Safe Movement of Cacao Germplasm were originally published by the Food and Agriculture Organisation (FAO) and since 2010 have been updated under the auspices of CacaoNet and published by Bioversity International (now Alliance of Bioversity International-CIAT). The most recent update was published in 2021 and is available on-line, free of charge, in English, French and Spanish. The first part of the guidelines consists of information on the geographical spread of important pests and diseases of cocoa and general recommendations on safe movement procedures. The second part includes up-to-date information on specific pests and diseases along with information on quarantine measures required, each authored/updated by one or more experts of the respective pest/disease. The latest update also includes information on more recently characterised viruses and on pests of emerging importance (e.g. Carmenta spp. in S. America). The International Cocoa Quarantine Centre at the University of Reading (ICQC,R) provides the main hub for international movement of cocoa germplasm and has been in operation for over 35 years. Procedures in place within the facility include visual indexing for viruses and other pests and diseases over a two-year period combined with PCR testing with a suite of primers that are periodically updated according to current information on viruses of cocoa. The list of germplasm available at ICQC, R can be found at www.icgd.reading.ac.uk/icqc/ and detailed information on specific genotypes is provided through links to the International Cocoa Germplasm Database (ICGD)