3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound.

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.BACKGROUND: Perianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. The aim was to measure regional anal pressures with 3D-HRAM and to compare these with 3D-EUS findings in patients with perianal fistulas. METHODS: Consecutive patients with active perianal fistulas who underwent both 3D-EUS and 3D-HRAM at a clinic specialised in proctology were included. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. The mean and regional anal pressures were measured with 3D-HRAM. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. The study was granted by the VUmc Medical Ethical Committee. RESULTS: Forty patients (21 males, mean age 47) were included. Four patients had a primary fistula, 19 were previously treated with a seton/abscess drainage and 17 had a recurrence after previously performed fistula surgery. On 3D-HRAM, 24 (60%) fistula tract areas were good and 8 (20%) moderately visible. All but 7 (18%) patients had normal mean resting pressures. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area (47 vs. 76 mmHg; p < 0.0001). Only 2 (5%) patients had a regional mean resting pressure < 10 mmHg of the fistula tract area. Using a Δ mean resting pressure ≥ 30 mmHg difference between fistula tract area and non-fistula tract area as alternative cut-off, 21 (53%) patients were identified. In 6 patients 3D-HRAM was repeated after surgery: a local pressure drop was detected in one patient after fistulotomy with increased complaints of faecal incontinence. CONCLUSIONS: Profound local anal pressure drops are found in the fistula tract areas in patients normal mean resting pressures. Fistulotomy may affect local sphincter pressure. This might influence surgical decision making in future

Em-‘powering' niche innovations: learning from cycling inequalities

This paper aims to situate power in ‘niche innovations’ through an investigation of cycling inequalities in the city of Birmingham. Much research has focused on the sustainability and innovation potential of cycling. However, debates usually revolve around the power relations between cycling and the dominant automobility regime, thus ignoring the possible inequalities embedded within niches. This paper aims to contribute to such analyses by unfolding the multiple inequalities and relations of exclusion that can be embedded in the practice of cycling. Drawing on Mobilities research for the EPSRC Liveable Cities programme, it focuses on the car-dependent city of Birmingham, in order to explore cycling as a practice with various socio-material, infrastructural, political and economic entanglements that can embed, reproduce or generate new socio-spatial inequalities, processes of gentrification and immobilities. Through such analysis, this paper aims to situate power in examining niche innovations. However, it also aims to underline that understanding and addressing such inequalities are central for not only locating cycling in the centre of developing a more sustainable mobility future, but also enabling a more sustainable future for cycling itself

The inhibitory effect of an RGD-human chitin-binding domain fusion protein on the adhesion of fibroblasts to reacetylated chitosan films

Biomaterials used for tissue engineering applications must provide a structural support for the tissue development and also actively interact with cells, promoting adhesion, proliferation, and differentiation. To achieve this goal, adhesion molecules may be used, such as the tripeptide Arg-Gly-Asp (RGD). A method based on the use of a carbohydrate-binding module, with affinity for chitin, was tested as an alternative approach to the chemical grafting of bioactive peptides. This approach would simultaneously allow the production of recombinant peptides (alternatively to peptide synthesis) and provide a simple way for the specific and strong adsorption of the peptides to the biomaterial. A fusion recombinant protein, containing the RGD sequence fused to a human chitin-binding module (ChBM), was expressed in E. coli. The adhesion of fibroblasts to reacetylated chitosan (RC) films was the model system selected to analyze the properties of the obtained proteins. Thus, the evaluation of cell attachment and proliferation on polystyrene surfaces and reacetylated chitosan films, coated with the recombinant proteins, was performed using mouse embryo fibroblasts 3T3. The results show that the recombinant proteins affect negatively fibroblasts anchorage to the materials surface, inhibiting its adhesion and proliferation. We also conclude that this negative effect is fundamentally due to the human chitin-binding domain.Fundação para a Ciência e a Tecnologia (FCT) - SFRH/BD/27359/2006, POCTI/BIO/45356/200

First observations of separated atmospheric nu_mu and bar{nu-mu} events in the MINOS detector

The complete 5.4 kton MINOS far detector has been taking data since the beginning of August 2003 at a depth of 2070 meters water-equivalent in the Soudan mine, Minnesota. This paper presents the first MINOS observations of nuµ and [overline nu ]µ charged-current atmospheric neutrino interactions based on an exposure of 418 days. The ratio of upward- to downward-going events in the data is compared to the Monte Carlo expectation in the absence of neutrino oscillations, giving Rup/downdata/Rup/downMC=0.62-0.14+0.19(stat.)±0.02(sys.). An extended maximum likelihood analysis of the observed L/E distributions excludes the null hypothesis of no neutrino oscillations at the 98% confidence level. Using the curvature of the observed muons in the 1.3 T MINOS magnetic field nuµ and [overline nu ]µ interactions are separated. The ratio of [overline nu ]µ to nuµ events in the data is compared to the Monte Carlo expectation assuming neutrinos and antineutrinos oscillate in the same manner, giving R[overline nu ][sub mu]/nu[sub mu]data/R[overline nu ][sub mu]/nu[sub mu]MC=0.96-0.27+0.38(stat.)±0.15(sys.), where the errors are the statistical and systematic uncertainties. Although the statistics are limited, this is the first direct observation of atmospheric neutrino interactions separately for nuµ and [overline nu ]µ

Politics of nanotechnologies in food and agriculture

The chapter discusses the reasons for the delay in the regulatory intervention concerning nanotechnologies used in the agriculture and food sectors. The main finding is that unregulated introduction of nanoinnovation into the food system is due to the current neoliberal food policy and to the power struggles that characterize the economic, social and political dynamics within the global supply chain. Therefore, it is necessary to put the ‘question concerning technology’ at the center of the regulatory debate in order to implement a regulatory system able to face nanorisks. Which means looking at the way in which technology controls power relationships within society. Attention should be shifted from efficiency to power issues, and new technologies should be assessed from a political rather than an economic or ethical perspective

Sickness presenteeism in Spanish-born and immigrant workers in Spain

<p>Abstract</p> <p><b>Background</b></p> <p>Previous studies have shown that immigrant workers face relatively worse working and employment conditions, as well as lower rates of sickness absence than native-born workers. This study aims to assess rates of sickness presenteeism in a sample of Spanish-born and foreign-born workers according to different characteristics.</p> <p>Methods</p> <p>A cross-sectional survey was conducted amongst a convenience sample of workers (Spanish-born and foreign-born), living in four Spanish cities: Barcelona, Huelva, Madrid and Valencia (2008-2009). Sickness presenteeism information was collected through two items in the questionnaire ("Have you had health problems in the last year?" and "Have you ever had to miss work for any health problem?") and was defined as worker who had a health problem (answered yes, first item) and had not missed work (answered no, second item). For the analysis, the sample of 2,059 workers (1,617 foreign-born) who answered yes to health problems was included. After descriptives, logistic regressions were used to establish the association between origin country and sickness presenteeism (adjusted odds ratios aOR; 95% confidence interval 95%CI). Analyses were stratified per time spent in Spain among foreign-born workers.</p> <p>Results</p> <p>All of the results refer to the comparison between foreign-born and Spanish-born workers as a whole, and in some categories relating to personal and occupational conditions. Foreign-born workers were more likely to report sickness presenteeism compared with their Spanish-born counterparts, especially those living in Spain for under 2 years [Prevalence: 42% in Spanish-born and 56.3% in Foreign-born; aOR 1.77 95%CI 1.24-2.53]. In case of foreign-born workers (with time in Spain < 2 years), men [aOR 2.31 95%CI 1.40-3.80], those with university studies [aOR 3.01 95%CI 1.04-8.69], temporary contracts [aOR 2.26 95%CI 1.29-3.98] and salaries between 751-1,200€ per month [aOR 1.74 95% CI 1.04-2.92] were more likely to report sickness presenteeism. Also, recent immigrants with good self-perceived health and good mental health were more likely to report presenteeism than Spanish-born workers with the same good health indicators.</p> <p>Conclusions</p> <p>Immigrant workers report more sickness presenteeism than their Spanish-born counterparts. These results could be related to precarious work and employment conditions of immigrants. Immigrant workers should benefit from the same standards of social security, and of health and safety in the workplace that are enjoyed by Spanish workers.</p

The effect of perceived discrimination on the health of immigrant workers in Spain

Background: Discrimination is an important determinant of health inequalities, and immigrants may be more vulnerable to certain types of discrimination than the native-born. This study analyses the relationship between immigrants' perceived discrimination and various self-reported health indicators. Methods: A cross-sectional survey was conducted (2008) amongst a non-random sample of 2434 immigrants from Ecuador, Morocco, Romania and Colombia in four Spanish cities: Barcelona, Huelva, Madrid and Valencia. A factorial analysis of variables revealed three dimensions of perceived discrimination (due to immigrant status, due to physical appearance, and workplace-related). The association of these dimensions with self-rated health, mental health (GHQ-12), change in self-rated health between origin and host country, and other self-reported health outcomes was analysed. Logistic regression was used adjusting for potential confounders (aOR-95%CI). Subjects with worsening self-reported health status potentially attributable to perceived discrimination was estimated (population attributable proportion, PAP %). Results: 73.3% of men and 69.3% of women immigrants reported discrimination due to immigrant status. Moroccans showed the highest prevalence of perceived discrimination. Immigrants reporting discrimination were at significantly higher risk of reporting health problems than those not reporting discrimination. Workplace-related discrimination was associated with poor mental health (aOR 2.97 95%CI 2.45-3.60), and the worsening of self-rated health (aOR 2.20 95%CI 1.73- 2.80). 40% (95% CI 24-53) PAP of those reporting worse self-rated health could be attributable to discrimination due to immigrant status. Conclusions: Discrimination may constitute a risk factor for health in immigrant workers in Spain and could explain some health inequalities among immigrant populations in Spanish society.This work was supported by the following sources: Carolina Foundation (Spain), Healthcare Research Fund of the Spanish Ministry of Health and Consumption (references PI050497, PI052202, PI052334, PI061701, and PI0790470