Diminishing Use of Liver Biopsy among Liver Transplant Recipients for Hepatitis C.

Background and Aims: Hepatitis C virus (HCV) cirrhosis is the leading indication for liver transplantation in the United States and recurrent HCV following liver transplantation is a major cause of allograft loss and mortality. Liver biopsies are commonly used to identify recurrent HCV and determine the need for antiviral therapy. The introduction of direct-acting antiviral agents (DAAs) has changed the management of recurrent HCV infection. This study aimed to describe the role of liver biopsies in liver transplant recipients with HCV after the introduction of DAAs. Methods: A retrospective analysis was performed looking at the rate of liver biopsies post-liver transplantation for HCV. The analysis included 475 adult liver transplants for hepatitis C performed at the University of California, Los Angeles from January 1, 2006 to October 1, 2015. Patients were divided into two eras, pre- and post-introduction of DAAs on December 1, 2013. Results: In the era before the introduction of DAAs, the percentage of patients biopsied was significantly higher compared to the era after the introduction of DAAs (56.1% vs. 26.9%, p < 0.001). Conclusions: The introduction of DAAs has changed the management of liver biopsy following liver transplantation and the management of recurrent HCV. Given that DAAs are well tolerated and have high efficacy, liver biopsies are no longer routinely used to justify the use antiviral therapy following liver transplantation

The Effects of Kindergarten and First Grade Schooling on Executive Function and Academic Skill Development: Evidence from a School Cutoff Design

Early executive function (EF) skills reliably predict school readiness and future academic success. While children’s skills undergo rapid development during the transition to formal schooling, it remains unclear the extent to which schooling exerts a unique influence on the accelerated development of EF and academic skills during the early years of schooling. In the present study, a quasi-experimental technique known as the school cutoff design was used to examine whether same-aged children who made vs. missed the age cutoff for school entry significantly differed on EF, reading, and math outcomes. Data from 166 pre-k, kindergarten, and first grade children (Range = 3.75–7.58 years, 92 girls) from a longitudinal study of literacy development were analyzed. Children were assessed on EF, reading, and math skills in fall and spring. Results revealed unique effects of kindergarten, but not first grade, on growth in EF and reading over and above the effect of age. Schooling was unrelated to growth in math. Because kindergarten represents the first year of elementary school and children’s first exposure to a formal schooling environment, kindergarten schooling may be uniquely positioned to produce greater gains in academic and behavioral outcomes compared to other grades

Urinary schistosomiasis among preschool children in a rural community near Abeokuta, Nigeria

<p>Abstract</p> <p>Background</p> <p>The control of schistosomiasis in Nigeria is mainly by mass treatment with praziquantel through the school system, with an absence of any provision for pre-school children. We therefore determined the prevalence and intensity of urinary schistosomiasis in pre-school children between the ages of 1-6 years in Ilewo-Orile a rural and endemic community, near Abeokuta, Nigeria as part of providing information on the neglected tropical diseases among this age group. Two urine samples were collected from each pre-school child. The samples were tested for microhaematuria using reagent strips and then processed and examined with a microscope for <it>Schistosoma haematobium </it>ova.</p> <p>Results</p> <p>Of the 167 children examined 97 (58.1%) had infection, with no significant difference (P = 0.809) in infection rates between boys (57.1%) and girls (59.2%). Both prevalence and intensity of infection did not increase significantly with age (P = 0.732). The overall geometric mean egg count was 1.17 eggs/10 ml urine. There was no significant association (<it>P </it>= 0.387) between intensity in boys (1.16 eggs/10 ml urine) and girls (1.19 eggs/10 ml urine). 47.4% of the children had microhaematuria which did not increase significantly with age (P = 0.526). Focus group discussions with guardians and caregivers revealed that infection of pre-school children early in life was due to exposures through bathing in the stream by their mothers, while the older children would visit the stream for washing, fetching of water, bathing and swimming.</p> <p>Conclusion</p> <p>Community participatory health education is needed in this community as a first step in reducing infection and transmission of the disease, while the rehabilitation and repair of the existing water borehole system in the community should be effected. The results of this study have shown that pre-school children also harbour infection and are a source of transmission of schistosomiasis in endemic communities. Planning and provision for their treatment should be considered in control programmes.</p

Older People Are Not All The Same: Lessons From A Major Trauma Database

Objectives & Background While there is extensive research on the differences between older and younger patients with serious injuries, little is known about variations within the older age group. However, increased frailty over the age of 85 suggests that these ‘oldest old’ patients are likely to be significantly different to younger seniors. Methods The aim of this study was do determine whether the demographic, premorbid and injury characteristics of older patients (aged ≥65) varied with age. A cross-sectional study of of patients from the Trauma Audit and Research Network (TARN) admitted between June 2013 and May 2015 was undertaken, comparing those aged 65 to 74; 75–84 and ≥85 years old. Demographic, premorbid and injury characteristics were compared using Chi-squared analysis, while multiple logistic regression was used to calculate risk adjusted mortality, utilising the PS14 TARN predictive model. Results 51,491 patients on the TARN database were eligible for inclusion. Of these, 18,664 (36.3%) were≥85 years; 19,157 (37.2%) 75–84 years and 13670 (26.5%) 65–74 years. Patients ≥85 years were significantly more likely to be female (68.8% vs 46.6% aged 65–74 years, p<0.001) and suffer low level falls (89.0% vs 63.0% aged 65–74 years, p<0.001). These patients were also more likely to have multiple comorbidities, with a median Charlson comorbidity score of 4 (IQR 0–5) compared to a median CCI of 0 (IQR 0–4) in patients aged 65–74 years. Despite having the lowest median injury severity scores, patients aged ≥85 years had significantly higher crude mortality rates (12.9% vs 5.9% in patients aged 65–74 years). Risk adjusted mortality was also highest in patients ≥85 years, with an adjusted odds ratio of 4.55 (95% CI 3.87–5.35) compared to patients aged 65–74 years. Conclusion There are significant variations in the demographic, comorbid and injury characteristics between different age groups of older trauma patients, which are associated with marked differences in crude and risk adjusted mortality. The most senior (over 85) were the most likely to sustain major trauma and the least likely to survive

Special Considerations in Facial Transplantation: A Systematic Review

Background: Vascularized composite allotransplantation (VCA) of the face is an exceedingly complex procedure, requiring extensive planning and surgical precision in order to successfully manage patients with facial disfigurements. This review aims to present an overview of the salient anatomic considerations in facial transplantation, as well as give attention to unique patient populations and special considerations. Methods: A literature review was performed in search of articles pertaining to considerations in facial transplantation using the databases PubMed, Web of Science, and Cochrane. Articles selected for further review included full-text articles with an emphasis on specific anatomic defects and how they were addressed in the transplant process, as well as management of special patient populations undergoing facial transplantation. Results: In total, 19 articles were deemed appropriate for inclusion. This systematic review of the literature pertaining to considerations in facial transplantation revealed common themes, as well as the importance of a multidisciplinary approach to the procedure. The ultimate outcome is dependent upon the synchronization of subunits of the allograft and the desired functional outcomes, including osseous, ocular, oral, and otologic considerations. Management of specific pathology and subgroups of patients are critical aspects. Although pediatric face transplantation has not yet been performed, it is likely a future step in the evolution of this procedure. Conclusion: When performing a face transplantation, many components must be considered pre-, intra-, and post-operatively. This systematic review presents specific anatomic considerations, as well as information about special patient populations within this cross-section of multidisciplinary microsurgery, psychiatry, and transplant immunology

Mind Control Robotic Arm: Augmentative and Alternative Communication in the Classroom Environment

In recent years, technological advancements have greatly benefited the field of prosthetics. A large number of disabled people depend on prosthetics because they are an important technology. In order to provide augmentative and alternative methods of communication to these disabled people with various neuromuscular disorders, we must make sure they are provided with appropriate equipment to express themselves. Different types of arms are evaluated under robotic technology in terms of resistance, usability, flexibility, cost, and potential (such as robotic, surgical, bionic, prosthetic, and static arms). The main problems with these techniques are their high cost, the difficulty of installing and maintaining them, and the possibility of requiring surgery may arise. As a result, this paper is going to provide a description of the idea for combining an EEG controlled smart prosthetic arm with a smart robotic hand. An electrode headset is used to capture the signals from the robotic hand in order to control the device. Creating a robot arm that can help disabled people lead a more independent life is the main objective of this paper

Biting behaviour of Simulium damnosum complex and Onchocerca volvulus infection along the Osun River, Southwest Nigeria

<p>Abstract</p> <p>Background</p> <p>Studies on biting behaviours and infectivity status of insect vectors are pre-requisites in understanding the epidemiology of the vector- borne diseases and planning effective control measures. A longitudinal study was carried out to investigate the transmission index of <it>Simulium damnosum </it>complex species along Osun River, South Western Nigeria. Adult flies were collected on human attractants from 07:00 to 18:00 hours for two consecutive days from February 2008 to June 2009 at three communities: Osun Eleja, Osun Ogbere and Osun Budepo. The infectivity rate was determined by dissection and Polymerase Chain Reaction amplification (PCR) of 0-150 genes of <it>Onchocerca </it>parasite using the pool screening technique.</p> <p>Results</p> <p>The results indicated that the majority of the flies collected at the three sampling points were nulliparous as they accounted for 53.90%, 57.86% and 59.58% of the flies dissected at Osun Budepo, Osun Ogbere and Osun Eleja, respectively. The parous rate was higher during the dry season than the wet season but the difference was not statistically significant (<it>p </it>< 0.05). The biting activity of the parous flies showed two peaks at Osun Budepo and three peaks at Osun Eleja and Osun Ogbere. Of the 1,472 flies dissected and 1,235 flies screened by molecular method, none was infected with <it>Onchocerca </it>parasite at the three sampling points however the annual biting rates at the three communities were higher than 1,000 considered as tolerable value for a person living in an onchocerciasis zone by Word Health Organization.</p> <p>Conclusion</p> <p>The study has provided the baseline data for further study on onchocerciasis transmission dynamics and the need to intercept man- simuliid vector contact at the study area.</p

Mating system variation in neotropical black mangrove, Avicennia germinans, at three spatial scales towards an expanding northern distributional limit

Climate-driven range expansion of ecosystem-defining foundation species can have wide-reaching ecological consequences. Expansion may also result in mating system changes in these foundation species because of the ecological characteristics of range margins, such as greater conspecific isolation and reduced pollinator availability. It is important to understand how mating systems may change during expansion due to their direct influence on intraspecific genetic and demographic dynamics. Here, we used 12 microsatellite loci to genotype progeny arrays of the neotropical black mangrove (Avicennia germinans) at six collection sites (n = 23 maternal trees; 1,612 genotyped propagules) along a latitudinal gradient towards a northern distributional limit on the Atlantic coast of Florida, USA (27.56–30.01oN), where mangroves have expanded into salt marsh over the past several decades. We assessed mating system variation at three spatial scales. First, at the species-distribution level, published outcrossing rates for tropical conspecifics were more than two times higher than those for subtropical Florida A. germinans, consistent with reductions in pollinator diversity and in mangrove abundance with latitude. Second, at the population level, Florida outcrossing rates did not systematically decline towards the northern range limit, but instead, a more open pollen-dispersal neighbourhood at the transition from mangrove to salt marsh dominance may elevate outcrossing until conspecific abundances become too low towards the range limit. Third, at the individual level, outcrossing increased as conspecific cover increased at the Florida range margin, consistent with density-dependent plastic shifts in mating system. These findings suggest that ecological structure influences the A. germinans mating system at varying spatial scales. Further research needs to evaluate the effect of A. germinans mating system variation on the survival and fitness of offspring and on the extent of population-level local adaptation at expanding distributional limits