Gene expression remodelling and immune response during adaptive divergence in an African cichlid fish

Variation in gene expression contributes to ecological speciation by facilitating population persistence in novel environments. Likewise, immune responses can be of relevance in speciation driven by adaptation to different environments. Previous studies examining gene expression differences between recently diverged ecotypes have often relied on only one pair of populations, targeted the expression of only a subset of genes or used wild-caught individuals. Here, we investigated the contribution of habitat-specific parasites and symbionts and the underlying immunological abilities of ecotype hosts to adaptive divergence in lake-river population pairs of the cichlid fish Astatotilapia burtoni. To shed light on the role of phenotypic plasticity in adaptive divergence, we compared parasite and microbiota communities, immune response, and gene expression patterns of fish from natural habitats and a lake-like pond set-up. In all investigated population pairs, lake fish were more heavily parasitized than river fish, in terms of both parasite taxon composition and infection abundance. The innate immune response in the wild was higher in lake than in river populations and was elevated in a river population exposed to lake parasites in the pond set-up. Environmental differences between lake and river habitat and their distinct parasite communities have shaped differential gene expression, involving genes functioning in osmoregulation and immune response. Most changes in gene expression between lake and river samples in the wild and in the pond set-up were based on a plastic response. Finally, gene expression and bacterial communities of wild-caught individuals and individuals acclimatized to lake-like pond conditions showed shifts underlying adaptive phenotypic plasticity

Internet-based search of randomised trials relevant to mental health originating in the Arab world

BACKGROUND: The internet is becoming a widely used source of accessing medical research through various on-line databases. This instant access to information is of benefit to busy clinicians and service users around the world. The population of the Arab World is comparable to that of the United States, yet it is widely believed to have a greatly contrasting output of randomised controlled trials related to mental health. This study was designed to investigate the existence of such research in the Arab World and also to investigate the availability of this research on-line. METHODS: Survey of findings from three internet-based potential sources of randomised trials originating from the Arab world and relevant to mental health care. RESULTS: A manual search of an Arabic online current contents service identified 3 studies, MEDLINE, EMBASE, and PsycINFO searches identified only 1 study, and a manual search of a specifically indexed, study-based mental health database, PsiTri, revealed 27 trials. CONCLUSION: There genuinely seem to be few trials from the Arab world and accessing these on-line was problematic. Replication of some studies that guide psychiatric/psychological practice in the Arab world would seem prudent

Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt

<p>Abstract</p> <p>Introduction</p> <p>In 2002, the Egypt Ministry of Health and Population faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers.</p> <p>From 1992 to 2000, the Ministry, with donor support, had succeeded in reducing the nationwide maternal mortality rate by 52%. Nevertheless, a gap remained between urban and rural areas.</p> <p>Case description</p> <p>In 2002, the Ministry, with funding from the United States Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Programme (LDP) in Aswan Governorate. The programme aimed to improve health services in three districts by increasing managers' ability to create high performing teams and lead them to achieve results.</p> <p>The programme introduced leadership and management practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated.</p> <p>Discussion and evaluation</p> <p>In 2003, after participation in the LDP, the districts of Aswan, Daraw and Kom Ombo increased the number of new family planning visits by 36%, 68% and 20%, respectively. The number of prenatal and postpartum visits also rose.</p> <p>After the United States funding ended, local doctors and nurses scaled up the programme to 184 health care facilities (training more than 1000 health workers). From 2005 to 2007, the Leadership Development Programme participants in Aswan Governorate focused on reducing the maternal mortality rate as their annual goal. They reduced it from 85.0 per 100,000 live births to 35.5 per 100,000. The reduction in maternal mortality rate was much greater than in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges.</p> <p>Conclusions</p> <p>When teams learn and apply empowering leadership and management practices, they can transform the way they work together and develop their own solutions to complex public health challenges. Committed health teams can use local resources to scale up effective public health interventions.</p

Downstaging hepatocellular carcinoma: A systematic review and pooled analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113108/1/lt24169.pd

From scandal to monastic penance: a reconciliatory manuscript from the early twelfth-century abbey of St. Laurent in Liège

An important element of monastic penance and conflict resolution was its repetitive, almost cyclical nature. The manuscripts that were used during these performances often proceed implicitly, which makes them difficult to contextualize and understand. This article considers a possible example of such "hidden" reconciliatory discourse in a manuscript that was produced for the congregation of St. Laurent in Liege around the turn of the eleventh century: Brussels, Royal Library 9361-9367. It examines the sin of pride in monastic dignitaries, discusses the best way to atone for it, and provides tools for the penitent to start living a more virtuous life in the future. The surviving evidence suggests that this manuscript was produced in reaction to the deeds of abbot Berenger, whose actions in 1095 were considered scandalous by contemporaries because he had led his monks into confusion and sin. The article shows how the combination of texts in this manuscript takes on a different meaning because of these politically charged circumstances, and argues that the St. Laurent manuscript was a discreet but methodical way to end the resulting estrangement between Berenger and his monks. In this interpretation, Brussels RL 9361-9367 is a rare and highly relevant testimony to the ways in which monks in the early twelfth century dealt with psychological and social tensions in the wake of an intra-group conflict

Conception de prothèse surcorrigée pour arthroplastie totale de l’épaule

L’arthrose est une maladie se traduisant par une détérioration progressive du cartilage articulaire. Dans certains cas avancés, cette dégradation peut résulter en une destruction totale du cartilage, contraignant les os à frotter les uns contre les autres. Les personnes atteintes présentent des douleurs articulaires et leur mobilité peut être affectée [1]. Cette maladie peut toucher plusieurs articulations telles que les hanches, les genoux, les doigts ou les épaules. Les causes de l’arthrose de l’épaule sont multiples : instabilité chronique, fracture de l’humérus ou encore rupture de la coiffe des rotateurs. Il existe trois types d’arthrose de l’épaule. Le type A correspond à une érosion symétrique de la glène sans subluxation tandis que le type C désigne une dysplasie sans usure [2]. L’attention est portée ici sur le type B pour lequel l’usure du cartilage apparaît de manière asymétrique, le plus souvent postérieurement. Suivant le degré de détérioration des articulations, l’arthroplastie peut consister à retirer l’articulation malade sans poser de prothèse, sinon à remplacer une partie ou la totalité de l’articulation par une prothèse [3], comme dans le cas de ce projet. Néanmoins, l’arthroplastie totale de l’épaule chez des patients de type B présente des risques post-opératoires de subluxation gléno-humérale. L’implantation d’une prothèse asymétrique spécifique à la morphologie du patient peut être une solution à ce problème. En effet, grâce à la combinaison des images CT de la scapula de chaque patient, du logiciel CAD et d’analyse par éléments finis, il est possible de choisir une surcorrection de la prothèse permettant d’obtenir une répartition des efforts minimisant la subluxation. Ce projet de Bachelor se focalisera sur la conception de deux prothèses surcorrigées uniques, destinées à deux patients de type B, en veillant à obtenir une meilleure répartition des efforts au sein de la scapula et une subluxation plus faible

Quantum properties of a cyclic structure based on tripolar fields

The properties of cyclic structures (toroidal oscillators) based on classical tripolar (colour) fields are discussed, in particular, of a cyclic structure formed of three colour-singlets spinning around a ring-closed axis. It is shown that the helicity and handedness of this structure can be related to the quantum properties of the electron. The symmetry of this structure corresponds to the complete cycle of ${2/3}\pi$-rotations of its constituents, which leads to the exact overlapping of the paths of its three complementary coloured constituents, making the system dynamically colourless. The gyromagnetic ratio of this system is estimated to be g$\approx 2$, which agrees with the Land\'e g-factor for the electron.Comment: 11 pages, 4 figures, journal versio

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

BACKGROUND: Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. METHODS: RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques. RESULTS: The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting. CONCLUSION: There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis

Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk : a prospective population study

Objective: To investigate whether regulatory problems, i.e., crying and feeding problems in infants > 3 months of age, predict cognitive outcome in preschool children born at risk even when controlled for confounding factors. Methods: A prospective longitudinal study of children born in a geographically defined area in Germany. N = 4427 children of 6705 eligible survivors (66%) participated at all four assessment points (neonatal, 5, 20, and 56 months of age). Excessive crying and feeding problems were measured at 5 months. Mental development was assessed with the Griffiths Scale at 20 months, and cognitive assessments were conducted at 56 months. Neonatal complications, neurological, and psychosocial factors were controlled as confounders in structural equation modeling and analyses of variance. Results: One in five infants suffered from single crying or feeding problems, and 2% had multiple regulatory problems, i.e., combined crying and feeding problems at 5 months. In girls, regulatory problems were directly predictive of lower cognition at 56 months, even when controlled for confounders, whereas in boys, the influence on cognition at 56 months was mediated by low mental development at 20 months. Both in boys and girls, shortened gestational age, neonatal neurological complications, and poor parent-infant relationship were predictive of regulatory problems at 5 months and lower cognition at 56 months. Conclusion: Regulatory problems in infancy have a small but significant adverse effect on cognitive development

Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa

Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART) in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI) recipients in South Africa.In 2008, 456 patients on NNRTI-based ART for a median of 44 months (range 12-99 months; 1,510 person-years) were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic (two repeated VL>50 copies/ml) and immunologic failure (as defined by WHO).After a median of 15 months on ART, 19% (n = 88) and 19% (n = 87) had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure (p<0.01). In the final multivariable model, risk factors for virologic failure were incomplete adherence (OR 2.8, 95%CI 1.2-6.7), and previous exposure to single-dose nevirapine or any other antiretrovirals (adj. OR 2.1, 95%CI 1.2-3.9), adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively (logrank p value = 0.02).One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure