Association between STI and child sexual exploitation in children under 16 years old attending sexual health clinics in England: findings from a case-control study

OBJECTIVE: Child sexual exploitation (CSE) can be difficult to identify, as there may be few reliable indicators. Although they may be used in decision-making, there is no evidence that STIs are predictors of CSE. We investigated the relationship between STI presentation at sexual health clinics (SHCs) and CSE. METHODS: SHCs with 18 or more children aged 13-15 years old with STI diagnoses in 2012 were identified using the Genitourinary Medicine Clinic Activity Data Set STI Surveillance System. Cases with confirmed bacterial or protozoal STIs were matched by age, gender and clinic with non-STI controls. Lead clinicians were asked to complete an online questionnaire on CSE-related risk factors of cases and controls irrespective of STI presence. Associations between STI outcome and CSE-related risk factors were analysed using conditional logistic regression. RESULTS: Data were provided on 466 children aged 13-15 years old; 414 (89%) were female, 340 (80%) were aged 15, 108 (23%) were aged 14, and 18 (3.9%) were aged 13 years. In matched univariate analysis, an STI diagnosis was significantly associated with 'highly-likely/confirmed' CSE (OR 3.87, p=0.017) and safeguarding concerns (OR 1.94, p=0.022). Evidence of an association between STI diagnosis and 'highly-likely/confirmed' CSE persisted after adjustment for partner numbers and prior clinic attendance (OR 3.85, p=0.053). CONCLUSION: Presentation with bacterial or protozoal STIs in children aged 13-15 years old at SHCs may be considered a potential marker for CSE. It would be prudent to consider CSE, indepth assessment and potential referral for any children under 16 years old presenting with a bacterial or protozoal STI

Under pressure: Response urgency modulates striatal and insula activity during decision-making under risk

When deciding whether to bet in situations that involve potential monetary loss or gain (mixed gambles), a subjective sense of pressure can influence the evaluation of the expected utility associated with each choice option. Here, we explored how gambling decisions, their psychophysiological and neural counterparts are modulated by an induced sense of urgency to respond. Urgency influenced decision times and evoked heart rate responses, interacting with the expected value of each gamble. Using functional MRI, we observed that this interaction was associated with changes in the activity of the striatum, a critical region for both reward and choice selection, and within the insula, a region implicated as the substrate of affective feelings arising from interoceptive signals which influence motivational behavior. Our findings bridge current psychophysiological and neurobiological models of value representation and action-programming, identifying the striatum and insular cortex as the key substrates of decision-making under risk and urgency

Slow and fast diffusion in a lead sulphate gravity separation process

A model for the growth of lead sulphate particles in a gravity separation system from the crystal glassware industry is presented. The lead sulphate particles are an undesirable byproduct, and thus the model is used to ascertain the optimal system temperature configuration such that particle extraction is maximised. The model describes the evolution of a single, spherical particle due to the mass flux of lead particles from a surrounding acid solution. We divide the concentration field into two separate regions. Specifically, a relatively small boundary layer region around the particle is characterised by fast diffusion, and is thus considered quasistatic. In contrast, diffusion in the far-field is slower, and hence assumed to be time-dependent. The final system consisting of two nonlinear, coupled ordinary differential equations for the particle radius and lead concentration, is integrated numerically

Clades of huge phages from across Earth's ecosystems.

Bacteriophages typically have small genomes1 and depend on their bacterial hosts for replication2. Here we sequenced DNA from diverse ecosystems and found hundreds of phage genomes with lengths of more than 200 kilobases (kb), including a genome of 735 kb, which is-to our knowledge-the largest phage genome to be described to date. Thirty-five genomes were manually curated to completion (circular and no gaps). Expanded genetic repertoires include diverse and previously undescribed CRISPR-Cas systems, transfer RNAs (tRNAs), tRNA synthetases, tRNA-modification enzymes, translation-initiation and elongation factors, and ribosomal proteins. The CRISPR-Cas systems of phages have the capacity to silence host transcription factors and translational genes, potentially as part of a larger interaction network that intercepts translation to redirect biosynthesis to phage-encoded functions. In addition, some phages may repurpose bacterial CRISPR-Cas systems to eliminate competing phages. We phylogenetically define the major clades of huge phages from human and other animal microbiomes, as well as from oceans, lakes, sediments, soils and the built environment. We conclude that the large gene inventories of huge phages reflect a conserved biological strategy, and that the phages are distributed across a broad bacterial host range and across Earth's ecosystems

Effects of an Alpha-4 Integrin Inhibitor on Restenosis in a New Porcine Model Combining Endothelial Denudation and Stent Placement

Restenosis remains the main complication of balloon angioplasty and/or stent implantation. Preclinical testing of new pharmacologic agents preventing restenosis largely rely on porcine models, where restenosis is assessed after endothelial abrasion of the arterial wall or stent implantation. We combined endothelial cell denudation and implantation of stents to develop a new clinically relevant porcine model of restenosis, and used this model to determine the effects of an α4 integrin inhibitor, ELN 457946, on restenosis. Balloon-angioplasty endothelial cell denudation and subsequent implantation of bare metal stents in the left anterior descending coronary, iliac, and left common carotid arteries was performed in domestic pigs, treated with vehicle or ELN 457946, once weekly via subcutaneous injections, for four weeks. After 1 month, histopathology and morphometric analyses of the arteries showed complete healing and robust, consistent restenotic response in stented arteries. Treatment with ELN 457946 resulted in a reduction in the neointimal response, with decreases in area percent stenosis between 12% in coronary arteries and 30% in peripheral vessels. This is the first description of a successful pig model combining endothelial cell denudation and bare metal stent implantation. This new double injury model may prove particularly useful to assess pharmacological effects of drug candidates on restenosis, in coronary and/or peripheral arteries. Furthermore, the ELN 457946 α4 integrin inhibitor, administered subcutaneously, reduced inflammation and restenosis in stented coronary and peripheral arteries in pigs, therefore representing a promising systemic therapeutic approach in reducing restenosis in patients undergoing angioplasty and/or stent implantation

Do Characteristics of Faces That Convey Trustworthiness and Dominance Underlie Perceptions of Criminality?

BACKGROUND: This study tested whether the 2D face evaluation model proposed by Oosterhof and Todorov can parsimoniously account for why some faces are perceived as more criminal-looking than others. The 2D model proposes that trust and dominance are spontaneously evaluated from features of faces. These evaluations have adaptive significance from an evolutionary standpoint because they indicate whether someone should be approached or avoided. METHOD: Participants rated the emotional state, personality traits, and criminal appearance of faces shown in photographs. The photographs were of males and females taken under naturalistic conditions (i.e., police mugshots) and highly controlled conditions. In the controlled photographs, the emotion display of the actor was systematically varied (happy expression, emotionally neutral expression, or angry expression). RESULTS: Both male and female faces rated high in criminal appearance were perceived as less trustworthy and more dominant in police mugshots as well as in photographs taken under highly controlled conditions. Additionally, emotionally neutral faces were deemed as less trustworthy if they were perceived as angry, and more dominant if they were morphologically mature. Systematically varying emotion displays also affected criminality ratings, with angry faces perceived as the most criminal, followed by neutral faces and then happy faces. CONCLUSION: The 2D model parsimoniously accounts for criminality perceptions. This study extends past research by demonstrating that morphological features that signal high dominance and low trustworthiness can also signal high criminality. Spontaneous evaluations regarding criminal propensity may have adaptive value in that they may help us to avoid someone who is physically threatening. On the other hand, such evaluations could inappropriately influence decision making in criminal identification lineups. Hence, additional research is needed to discover whether and how people can avoid making evaluations regarding criminality from a person's facial appearance

Plasma proteins predict conversion to dementia from prodromal disease.

PublishedJournal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tBACKGROUND: The study aimed to validate previously discovered plasma biomarkers associated with AD, using a design based on imaging measures as surrogate for disease severity and assess their prognostic value in predicting conversion to dementia. METHODS: Three multicenter cohorts of cognitively healthy elderly, mild cognitive impairment (MCI), and AD participants with standardized clinical assessments and structural neuroimaging measures were used. Twenty-six candidate proteins were quantified in 1148 subjects using multiplex (xMAP) assays. RESULTS: Sixteen proteins correlated with disease severity and cognitive decline. Strongest associations were in the MCI group with a panel of 10 proteins predicting progression to AD (accuracy 87%, sensitivity 85%, and specificity 88%). CONCLUSIONS: We have identified 10 plasma proteins strongly associated with disease severity and disease progression. Such markers may be useful for patient selection for clinical trials and assessment of patients with predisease subjective memory complaints.Medical Research Council (MRC)Alzheimer’s Research UKThe National Institute for Health Research (NIHR) Biomedical Research CentreBiomedical Research Unit for DementiaAddNeuroMed through the EU FP6 programInnovative Medicines Initiative Joint Undertaking under an EMIF grantEuropean Union’s Seventh Framework Programme (FP7/2007-2013

Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. The VANISH Randomized Clinical Trial

IMPORTANCE: Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed as an alternative. OBJECTIVE: To compare the effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. DESIGN, SETTING, AND PARTICIPANTS: A factorial (2×2), double-blind, randomized clinical trial conducted in 18 general adult intensive care units in the United Kingdom between February 2013 and May 2015, enrolling adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock. INTERVENTIONS: Patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103). MAIN OUTCOMES AND MEASURES: The primary outcome was kidney failure-free days during the 28-day period after randomization, measured as (1) the proportion of patients who never developed kidney failure and (2) median number of days alive and free of kidney failure for patients who did not survive, who experienced kidney failure, or both. Rates of renal replacement therapy, mortality, and serious adverse events were secondary outcomes. RESULTS: A total of 409 patients (median age, 66 years; men, 58.2%) were included in the study, with a median time to study drug administration of 3.5 hours after diagnosis of shock. The number of survivors who never developed kidney failure was 94 of 165 patients (57.0%) in the vasopressin group and 93 of 157 patients (59.2%) in the norepinephrine group (difference, -2.3% [95% CI, -13.0% to 8.5%]). The median number of kidney failure-free days for patients who did not survive, who experienced kidney failure, or both was 9 days (interquartile range [IQR], 1 to -24) in the vasopressin group and 13 days (IQR, 1 to -25) in the norepinephrine group (difference, -4 days [95% CI, -11 to 5]). There was less use of renal replacement therapy in the vasopressin group than in the norepinephrine group (25.4% for vasopressin vs 35.3% for norepinephrine; difference, -9.9% [95% CI, -19.3% to -0.6%]). There was no significant difference in mortality rates between groups. In total, 22 of 205 patients (10.7%) had a serious adverse event in the vasopressin group vs 17 of 204 patients (8.3%) in the norepinephrine group (difference, 2.5% [95% CI, -3.3% to 8.2%]). CONCLUSIONS AND RELEVANCE: Among adults with septic shock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure-free days. Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further. TRIAL REGISTRATION: clinicaltrials.gov Identifier: ISRCTN 20769191

The role of attachment in body weight gain and weight loss in bariatric patients

Purpose: To explore the role of attachment styles in obesity. Material and methods: The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n=195) and an age, sex and height matched normal weight control group (n=195). It then explored the role of attachment styles in predicting change in BMI one year post bariatric surgery (n=143). Results: The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non obese group. Baseline attachment styles did not, however, predict change in BMI post-surgery. Conclusion: Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post-surgery