Histological sub‐classification of cirrhosis using collagen proportionate area in patients with chronic hepatitis C

Collagen proportionate area (CPA, %) is used to quantify liver fibrosis. Here we assessed CPA performance to subclassify cirrhosis. CPA was measured in explanted livers from consecutively transplanted patients for hepatitis C virus‐related cirrhosis. MELD, Child‐Pugh score and decompensating events (ascites, variceal bleeding, non‐obstructive jaundice and encephalopathy) were recorded at the time of liver transplant. Of the 154 patients, 24%, 12%, 35%, 24% and 5% had 0, 1, 2, 3 and 4 previous decompensating events. Patients with decompensation had significantly higher CPA than those without (25.1±8.4 vs. 15.8±5.5, P<0.001). Decompensation was independently associated with CPA, bilirubin and albumin or with CPA and MELD score. CPA did not differ between patients with 1, 2, 3 or 4 decompensating events (22.2±6.3 vs. 26.6±8.9 vs. 24.5±7.7 vs. 24.4±10.9, P=0.242). Overall, CPA correlates with the clinical severity of cirrhosis until the advent of decompensation but not with subsequent decompensating events

A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial

BACKGROUND: We have developed the Promoting Early Presentation (PEP) Intervention to equip older women with the knowledge, skills, confidence and motivation to present promptly with breast symptoms, and thereby improve survival from breast cancer. The PEP Intervention consists of a 10-min interaction between a radiographer and an older woman, supported by a booklet. Our previous report showed that at 1 year, the PEP intervention increased the proportion who were breast cancer aware compared with usual care.METHODS: We randomised 867 women aged 67-70 years attending for their final routine appointment on the National Health Service Breast Screening Programme to receive the PEP Intervention, a booklet alone or usual care. The primary outcome was breast cancer awareness measured using a validated questionnaire asking about knowledge of breast cancer symptoms, knowledge that the risk of breast cancer increases with age and breast checking behaviour.RESULTS: At 2 years, the PEP Intervention increased the proportion who were breast cancer aware compared with usual care (21 vs 6%; odds ratio 8.1, 95% confidence interval 2.7-25.0).CONCLUSIONS: The uniquely large and sustained effect of the PEP Intervention on breast cancer awareness increases the likelihood that a woman will present promptly should she develop breast cancer symptoms up to many years later. British Journal of Cancer (2011) 105, 18-21. doi: 10.1038/bjc.2011.205 www.bjcancer.com Published online 7 June 2011 (C) 2011 Cancer Research U

Perceived Discrimination and Self-Reported Quality of Care Among Latinos in the United States

Given the persistence of health and health-care disparities among Latinos in the United States and evidence that discrimination affects health and health care, an investigation of the relationship between perceived discrimination and quality of health care among Latinos is warranted. To examine the relationship of perceived discrimination (in general and in regard to doctors and medical personnel) with self-reported quality of health care and doctor-patient communication in a nationally representative Latino population sample. Participants were 1,067 Latino adults aged ≥18 years living in the US selected via random-digit dialing. Telephone interviews were conducted in 2008 during Wave 2 of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey. US-born Latinos were twice as likely to report general discrimination as foreign born: 0.32 SD versus −0.23 SD (P &lt; 0.001) on the Detroit Area Survey (DAS) discrimination scale. Higher DAS discrimination was associated with lower self-reported quality of care in US-born Latinos [OR = 0.5; 95% CI (0.3, 0.9); P = 0.009]. For foreign-born Latinos, report of any doctor or medical staff discrimination was associated with lower quality of care [OR = 0.5; 95% CI (0.3, 0.9); P = 0.03], but the DAS was not. For US-born Latinos, doctor discrimination and higher DAS were jointly associated with worse doctor-patient communication. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that observed in US-born Latinos. Given the association between perceived discrimination and quality of care, strategies to address discrimination in health-care settings may lead to improved patient satisfaction with care and possibly to improved treatment outcomes

Development Discourse and Practice: Alternatives and New Directions from Postcolonial Perspectives

Development and aid programs, such as those aimed at promoting economic growth and prosperity in ‘Third World’ nations and transition economies, often arise out of Western and neo-liberal policy ideologies and practices. These programs may, in some cases, provide useful guidelines for restructuring institutional structures and governance mechanisms in nations that have long struggled with poverty, economic instability, health crises, and social and political turmoil. However, a growing number of critical voices are raising concerns over the guiding assumptions and inclusiveness of these policies and programs in their aims to promote economic development and social well-being in non-Western nations. We join these critical perspectives by way of postcolonial frameworks to highlight some of the problematic assumptions and oversights of development programs, while offering new alternatives and directions. By doing so, we contribute to organizational theorizing in a global context, as postcolonial insights provide much needed engagement with international aid policies and programs, as well as development organizations and institutions. To accomplish this, we offer a historical perspective on development, present a critique of the policies and practices guiding many aid programs, and conclude with suggestions emanating from postcoloniality

Perceived Discrimination and Health Outcomes Among Asian Indians in the United States

Background: Perceived interpersonal discrimination while seeking healthcare services is associated with poor physical and mental health. Yet, there is a paucity of research among Asian Americans or its subgroups. This study examined the correlates of reported interpersonal discrimination when seeking health care among a large sample of Asian Indians, the 3rd largest Asian American subgroup in the US, and identify predictors of adverse self-rated physical health, a well-accepted measure of overall health status. Methods: Cross-sectional survey. Participants comprised of 1824 Asian Indian adults in six states with higher concentration of Asian Indians. Results: Mean age and years lived in the US was 45.7 ± 12.8 and 16.6 ± 11.1 years respectively. The majority of the respondents was male, immigrants, college graduates, and had access to care. Perceived interpersonal discrimination when seeking health care was reported by a relatively small proportion of the population (7.2 %). However, Asian Indians who reported poor self-rated health were approximately twice as likely to perceived discrimination when seeking care as compared to those in good or excellent health status (OR 1.88; 95 % CI 1.12–3. 14). Poor self-rated health was associated with perceived health care discrimination after controlling for all of the respondent characteristics (OR 1.93; 95 % CI: 1.17–3.19). In addition, Asian Indians who lived for more than 10 years in the U.S. (OR 3.28; 95 % CI: 1.73–6.22) and had chronic illnesses (OR 1.39; 95 % CI: 1.17–1.64) (p \u3c 0.05) were more likely to perceive discrimination when seeking health care. However, older Asian Indians, over the age of 55 years, were less likely to perceive discrimination than those aged 18–34 years Indian American. Conclusion: Results offers initial support for the hypothesis that Asian Indians experience interpersonal discrimination when seeking health care services and that these experiences may be related to poor self-rated health status

Modelling human visual navigation using multi-view scene reconstruction

It is often assumed that humans generate a 3D reconstruction of the environment, either in egocentric or world-based coordinates, but the steps involved are unknown. Here, we propose two reconstruction-based models, evaluated using data from two tasks in immersive virtual reality. We model the observer’s prediction of landmark location based on standard photogrammetric methods and then combine location predictions to compute likelihood maps of navigation behaviour. In one model, each scene point is treated independently in the reconstruction; in the other, the pertinent variable is the spatial relationship between pairs of points. Participants viewed a simple environment from one location, were transported (virtually) to another part of the scene and were asked to navigate back. Error distributions varied substantially with changes in scene layout; we compared these directly with the likelihood maps to quantify the success of the models. We also measured error distributions when participants manipulated the location of a landmark to match the preceding interval, providing a direct test of the landmark-location stage of the navigation models. Models such as this, which start with scenes and end with a probabilistic prediction of behaviour, are likely to be increasingly useful for understanding 3D vision

Methods for specifying the target difference in a randomised controlled trial : the Difference ELicitation in TriAls (DELTA) systematic review

Peer reviewedPublisher PD

Use of outpatient care in VA and Medicare among disability-eligible and age-eligible veteran patients

<p>Abstract</p> <p>Background</p> <p>More than half of veterans who use Veterans Health Administration (VA) care are also eligible for Medicare via disability or age, but no prior studies have examined variation in use of outpatient services by Medicare-eligible veterans across health system, type of care or time.</p> <p>Objectives</p> <p>To examine differences in use of VA and Medicare outpatient services by disability-eligible or age-eligible veterans among veterans who used VA primary care services and were also eligible for Medicare.</p> <p>Methods</p> <p>A retrospective cohort study of 4,704 disability- and 10,816 age-eligible veterans who used VA primary care services in fiscal year (FY) 2000. We tracked their outpatient utilization from FY2001 to FY2004 using VA administrative and Medicare claims data. We examined utilization differences for primary care, specialty care, and mental health outpatient visits using generalized estimating equations.</p> <p>Results</p> <p>Among Medicare-eligible veterans who used VA primary care, disability-eligible veterans had more VA primary care visits (<it>p </it>< 0.001) and more VA specialty care visits (<it>p </it>< 0.001) than age-eligible veterans. They were more likely to have mental health visits in VA (<it>p </it>< 0.01) and Medicare-reimbursed visits (<it>p </it>< 0.01). Disability-eligible veterans also had more total (VA+Medicare) visits for primary care (<it>p </it>< 0.01) and specialty care (<it>p </it>< 0.01), controlling for patient characteristics.</p> <p>Conclusions</p> <p>Greater use of primary care and specialty care visits by disability-eligible veterans is most likely related to greater health needs not captured by the patient characteristics we employed and eligibility for VA care at no cost. Outpatient care patterns of disability-eligible veterans may foreshadow care patterns of veterans returning from Afghanistan and Iraq wars, who are entering the system in growing numbers. This study provides an important baseline for future research assessing utilizations among returning veterans who use both VA and Medicare systems. Establishing effective care coordination protocols between VA and Medicare providers can help ensure efficient use of taxpayer resources and high quality care for disabled veterans.</p

Warm Water and Cool Nests Are Best. How Global Warming Might Influence Hatchling Green Turtle Swimming Performance

For sea turtles nesting on beaches surrounded by coral reefs, the most important element of hatchling recruitment is escaping predation by fish as they swim across the fringing reef, and as a consequence hatchlings that minimize their exposure to fish predation by minimizing the time spent crossing the fringing reef have a greater chance of surviving the reef crossing. One way to decrease the time required to cross the fringing reef is to maximize swimming speed. We found that both water temperature and nest temperature influence swimming performance of hatchling green turtles, but in opposite directions. Warm water increases swimming ability, with hatchling turtles swimming in warm water having a faster stroke rate, while an increase in nest temperature decreases swimming ability with hatchlings from warm nests producing less thrust per stroke

Characterization of Mycosphaerellaceae species associated with citrus greasy spot in Panama and Spain

[EN] Greasy spot of citrus, caused by Zasmidium citri-griseum (= Mycosphaerella citri), is widely distributed in the Caribbean Basin, inducing leaf spots, premature defoliation, and yield loss. Greasy spot-like symptoms were frequently observed in humid citrus-growing regions in Panama as well as in semi-arid areas in Spain, but disease aetiology was unknown. Citrus-growing areas in Panama and Spain were surveyed and isolates of Mycosphaerellaceae were obtained from citrus greasy spot lesions. A selection of isolates from Panama (n = 22) and Spain (n = 16) was assembled based on their geographical origin, citrus species, and affected tissue. The isolates were characterized based on multi-locus DNA (ITS and EF-1 alpha) sequence analyses, morphology, growth at different temperatures, and independent pathogenicity tests on the citrus species most affected in each country. Reference isolates and sequences were also included in the analysis. Isolates from Panama were identified as Z. citri-griseum complex, and others from Spain attributed to Amycosphaerella africana. Isolates of the Z. citri-griseum complex had a significantly higher optimal growth temperature (26.8 degrees C) than those of A. africana (19.3 degrees C), which corresponded well with their actual biogeographical range. The isolates of the Z. citri-griseum complex from Panama induced typical greasy spot symptoms in 'Valencia' sweet orange plants and the inoculated fungi were reisolated. No symptoms were observed in plants of the 'Ortanique' tangor inoculated with A. africana. These results demonstrate the presence of citrus greasy spot, caused by Z. citri-griseum complex, in Panama whereas A. africana was associated with greasy spot-like symptoms in Spain.Research was partially funded by 'Programa de Formacion de los INIA Iberoamerica' and INIA RTA2010-00105-00-00-FEDER to Vidal Aguilera Cogley.. We thank J. Martinez-Minaya (UV) for assistance with INLAAguilera-Cogley, VA.; Berbegal Martinez, M.; Català, S.; Collison Brentu, F.; Armengol Fortí, J.; Vicent Civera, A. (2017). Characterization of Mycosphaerellaceae species associated with citrus greasy spot in Panama and Spain. PLoS ONE. 12(12):1-19. https://doi.org/10.1371/journal.pone.0189585S1191212Crous, P. W., Summerell, B. A., Carnegie, A. J., Wingfield, M. J., Hunter, G. C., Burgess, T. I., … Groenewald, J. Z. (2009). Unravelling Mycosphaerella: do you believe in genera? Persoonia - Molecular Phylogeny and Evolution of Fungi, 23(1), 99-118. doi:10.3767/003158509x479487Mondal, S. N., & Timmer, L. W. (2006). Greasy Spot, a Serious Endemic Problem for Citrus Production in the Caribbean Basin. Plant Disease, 90(5), 532-538. doi:10.1094/pd-90-0532Whiteside, J. O. (1970). Etiology and Epidemiology of Citrus Greasy Spot. Phytopathology, 60(10), 1409. doi:10.1094/phyto-60-1409Huang, F., Groenewald, J. Z., Zhu, L., Crous, P. W., & Li, H. 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Species of Mycosphaerella and Their Anamorphs Associated with Leaf Blotch Disease of Eucalyptus in South Africa. Mycologia, 88(3), 441. doi:10.2307/3760885Aguín, O., Sainz, M. J., Ares, A., Otero, L., & Pedro Mansilla, J. (2013). Incidence, severity and causal fungal species of Mycosphaerella and Teratosphaeria diseases in Eucalyptus stands in Galicia (NW Spain). Forest Ecology and Management, 302, 379-389. doi:10.1016/j.foreco.2013.03.021Maxwell, A., Dell, B., Neumeister-Kemp, H. G., & Hardy, G. E. S. J. (2003). Mycosphaerella species associated with Eucalyptus in south-western Australia: new species, new records and a key. Mycological Research, 107(3), 351-359. doi:10.1017/s0953756203007354Otero L, Aguín O, Mansilla J, Hunter G, Wingfield M. Identificación de especies de Mycosphaerella en Eucalyptus globulus y E. nitens en Galicia. In: Proceedings of the 13th Congress of the Spanish Phytopathological Society; 2006; Murcia, Spain.ZHAN, J., & McDONALD, B. A. (2011). 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