The skin immune response to Malassezia furfur

The paradoxical nature of M furfur colonisation versus infection in dermatological disease is subject to much research. The aim of this experimental work was to measure the innate immune response of the skin to M. furfur, via the use of skin models. Living skin equivalents (LSE), excised breast reduction tissue (BRT) and keratinocyte (KC) monolayers were all utilised in an attempt to elucidate the possible immune evasive and stimulatory capabilities of M. furfur. The constitutive production of human p defensin 2 (HBD-2), an inducible antimicrobial peptide, was measured KC monolayers, LSEs and BRT. In addition the skin model's response to fungal challenge was elucidated. Wide variation in the basal expression of HBD-2 was detected in all skin model donors. M. furfur cell wall and killed whole M. furfur initiated a slight depression in HBD-2 expression by KC monolayers, however these results were not statistically significant in all donors and merely indicated a trend. Likewise KC monolayers, BRT and LSEs reacted to viable M. furfur with slight inhibition of HBD-2 production at 24hr with subsequent stimulation of expression. However donor variation in this pattern was detected and these results were not continuously significant. Due to the non-continuous nature of these measurements these results were inconclusive. As M furfur infection of the skin is associated with alteration of the normal pigmentation in patients, melanin synthesis by B16 mouse melanoma cells and BRT was assessed in response to M. furfur. Viable M. jurjur and C. albicans stimulated an increase in melanin synthesis in B16 mouse melanoma cells. The ability of viable M. furfur cells to stimulate melanin synthesis appeared to be localised within the cytoplasm of the organism. However, this 'viable cell stimulation' did not appear to be restricted to M. furfur, as C. albicans also stimulated melanin synthesis. On BRT there was little difference in the melanin and tyrosinase production of BRT in reponse to M. furfur and C. albicans growth. The capacity of M. furfur and C. albicans cell wall to alter the cytokine profile of KCs was also measured and KC monolayers exhibited a time-dependent increase in IL-la, IL-8 and ET-1 expression in response to M. furfur and C. albicans cell wall. C. albicans cell wall initiated a significantly greater increase in the expression of these cytokines by the KCs. However little correlation between the mRNA production and peptide production was measured using RT-PCR. Growth of M furfur and C. albicans on the skin models was assessed using scanning electron microscopy (SEM) and histological observation of the colonized tissue. Growth was also compared by means of viable cell counts. The effect of growth on the proliferation of the epidermis was measured by counting the number of proliferating cells in the basal layer of the epidermis of each tissue. Growth of M. furfur and C. albicans was detected on LSE and BRT and hyphal transformation of both organisms was observed on BRT and LSE, although hyphal transformation of C. albicans was found more commonly on the LSE. Indeed, overall growth of C. albicans was more widespread and rapid on LSE than it was on BRT. By contrast M. furfur appeared to undergo hyphal transformation more frequently on BRT, and this feature was donor-dependent. The viability of M. furfur varied when tested on BRT from different donors or on different batches of LSE. The proliferative index of the tissues indicated that growth of both M. furfur and C. albicans initiated an increase in the proliferation of the BRT and LSE epidermis. Overall, these studies show that growth of M. furfur and C. albicans differs in the various skin models and this effect was dependent on the different qualities of the donor tissue and donor KCs. The growth of M. furfur, while slower than that of C. albicans, does stimulate a larger increase in the proliferation of the BRT epidermis

Impingement of Water Droplets on NACA 65A004 Airfoil and Effect of Change in Airfoil Thickness from 12 to 4 Percent at 4 deg Angle of Attack

The trajectories of droplets in the air flowing past an NACA 65A004 a irfoil at an angle of attack of 4 deg were determined. The amount of water in droplet form impinging on the airfoil, the area of droplet impingement, and the rate of droplet impingement per unit area on the airfoil surface were calculated from the trajectories and presented to cover a large range of flight and atmospheric conditions. The effect of a change in airfoil thickness from 12 to 4 percent at 4 deg angle of attack is presented by comparing the impingement calculations for the NACA 65A004 airfoil with those for the NACA 65(sub 1)-208 and 65(sub 1)-212 airfoils. The rearward limit of impingement on the upper surface decreases as the airfoil thickness decreases. The rearward limit of impingement on the lower surface increases with a decrease in airfoil t hickness. The total water intercepted decreases as the airfoil thickness is decreased

Adverse childhood experiences and lifetime suicide ideation: a cross-sectional study in a non-psychiatric hospital setting

We have assessed the effect of adverse childhood experiences on the lifetime prevalence of suicide ideation in a cross-sectional study involving 182 patients aged 18 to 44 years, consecutive attenders at an A&E review clinic. All participants were interviewed by a psychologist using standardised questionnaire instruments addressing participants’ demographic characteristics, drug use, depressed mood, eight major categories of adverse childhood experiences (including physical, emotional and sexual abuse) and suicide ideation. The response rate was 73%. In multivariate logistic regression analyses, those with a history of two or more forms of childhood adversity relative to those with none were at increased risk of depressed mood (OR = 5.5, 95% CI = 2.3-13.3) and suicide ideation (OR = 3.5, 95% CI = 1.5-8.3). The findings emphasise the need to set suicide prevention within the broader context of society’s obligation to protect children from physical, emotional and sexual abuse

Parents’ experiences of psycho-therapeutic support on the neonatal unit: A mixed methods systematic review to inform intervention development for a multi-cultural population

Aim: To systematically identify sources of psychotherapeutic support available for parents with infants admitted to neonatal care (NNU, Neonatal Intensive Care Unit and Special Care Units)), assess their accessibility and acceptability, and identify challenges and facilitators. Background: Parents of infants admitted to neonatal intensive care require support to minimise the impact on their mental health and to encourage engagement with their infants to support infant neurodevelopment. Many interventions aim to address this need but there is a lack of research considering the accessibility of these for a multicultural population. Methods: Six electronic databases with no restrictions on language or date were used to identify relevant studies following PRISMA guidelines. Publications were included in the review if they reviewed parent experience of an intervention actively in place to support parent experience during the neonatal unit stay. Any studies where the intervention’s primary aim was infant focused, such as developmental care, were excluded. All publications were quality assessed using quality appraisal tools appropriate for their design type. Data were extracted line by line using Sekhon et al.’s theoretical acceptability framework and questionnaire.Results: A total of 3309 studies were found, of which 36 studies met the inclusion criteria. Included studies were published worldwide between 2000 and 2023 and explored 15 different interventions. Challenges for parental engagement were due to preconceived ideas about intervention requirements and parents’ ability to participate in them. Timely information and providers’ experience in delivering the intervention were reported to support engagement and as being valuable for enhancing participant knowledge. The emotional content of interventions was found to be challenging by parents across most studies. This was prominent in interventions designed to be carried out in a group format and where keepsakes were created. However, the value of these interventions was in reducing parents’ feelings of isolation through increased social support and providing a starting point for conversations with wider family and friends about the family’s neonatal experience. Participant demographics were poorly reported, with only 2 studies taking into consideration the ethicality of the intervention. Conclusion: Poor reporting of participant demographics, and a focus on mothers as participants, means findings are not transferrable to the wider population of parents in neonatal units. Future studies should consider how to ensure that research and interventions are accessible to multicultural populations to improve understanding of the acceptability of interventions. Better knowledge of neonates and the NNU setting amongst intervention providers could increase the accessibility of psychotherapeutic support for parents. Training for providers on how to manage sensitive conversations may also be beneficial to support parents during interventions. Relevance to Clinical practice: The impact of neonatal admission on parental mental health is increasingly recognised and reported. Interventions have been developed to reduce the negative impact on the mental health of parents. There continues to be significant health inequalities as a result of many services not taking into account the acceptability and accessibility of interventions in this setting for their multi-cultural populations. This review highlights the need for better reporting of participant demographics in research and the inclusion of those seldom heard to ensure interventions are culturally, religiously, and linguistically appropriate for multi-cultural populations

Nutrition Education and Community Pharmacy: A First Exploration of Current Attitudes and Practices in Northern Ireland

Community pharmacist is one of the most prominent and accessible healthcare professions. The community pharmacists’ role in healthcare is evolving, with opportunities being taken to reduce pressure on primary care services. However, the question remains of how well community pharmacists are equipped for this changing role. This was a sequentially designed study using a mix of methods to explore nutrition education among community pharmacists in Northern Ireland. It consisted of two phases. Phase 1 was a cross-sectional exploration to map the attitudes and practice of Northern Ireland (NI) pharmacists towards diet-related health promotion and disease prevention. An online questionnaire with open and closed questions to gain both quantitative and qualitative responses was developed and distributed to community pharmacists practising in NI. A total of 91% considered nutrition important in reducing the global burden of disease. While the majority (89%) believed patients would value nutritional advice from a pharmacist, 74% were not confident in providing advice to a patient with diabetes. From the consensus gained in Phase 1 a nutrition education intervention (Phase 2) for pre-registration pharmacists was developed using the Hardens 10 question system. The training programme was advertised to pre-registration pharmacy students in NI. It was delivered by nutrition experts who have education qualifications. The intervention was evaluated using a before and after questionnaire that assessed knowledge, attitudes, and practice (KAP). Phase 2 did find sustained improvement from the baseline in KAP but there was a decline from immediately post-training to three months post-training. This suggests the need to further embed nutrition education. The education programme was found to be effective for the target population and sets the stage for the development of an implementation strategy for a wider roll-out with evaluation

Weight status of children aged 2-5 years old, attending a paediatric outpatient clinic and its association with parental feeding style and parental perceptions of weight status

Background: A child’s weight status can allow health care professionals to assess their developmental growth. A child having a low or high weight for height could be due to an imbalance in nutrient intake occurring. It is important to balance dietary intake and physical activity to maintain a healthy weight status. Excessive consumption of food can lead to an overweight/obese weight status which is linked to non-communicable diseases. Parental feeding style can directly impact a child’s set of eating behaviours. Therefore, parents have a strong influence over a child’s growth pattern. In addition, parental awareness of childhood obesity is reported to be poor which could be a barrier to interventions. Aim: To determine; (1) the weight status of children aged 2-5 years attending Sligo University Hospital (SUH); (2) current parental feeding styles being utilised; (3) whether parents were able to correctly classify their own weight status and that of their child and if this was associated with parental misclassification of their own weight status and (4) whether parents are interested in further information in this area, and what form this information/guidance should take. Method: A cross-sectional study was conducted in a paediatric outpatient department between September 2018 and May 2019. Data collected included anthropometric measurements and demographic information as well as a validated parental feeding style questionnaire. Data analysis was conducted using SPSS version 24. Statistical significance was set at p \u3c.05. Results: Fifty parents and children were recruited. 72% of children were classified as having a normal weight status, 22% an overweight status and 6% an obese weight status. No parent correctly classified a child as having an overweight status. No association was found between parental misclassification of a child’s weight status and their own weight status. The majority of parents used an encouragement feeding style. 84% of parents reported to be interested in obtaining healthy lifestyle information. The preferred method of receiving this information is in the form of a leaflet. Discussion/Conclusion: The childhood overweight and obesity rates within this cohort are slightly above the national rates for childhood obesity. Parental awareness of childhood overweight/obesity was found to be poor as illustrated in previous studies. Interventions need to be implemented to improve parental classification of a child’s weight status. Parents expressed an interest in receiving health education material in this setting

Use of freely available datasets and machine learning methods in predicting deforestation

The range and quality of freely available geo-referenced datasets is increasing. We evaluate the usefulness of free datasets for deforestation prediction by comparing generalised linear models and generalised linear mixed models (GLMMs) with a variety of machine learning models (Bayesian networks, artificial neural networks and Gaussian processes) across two study regions. Freely available datasets were able to generate plausible risk maps of deforestation using all techniques for study zones in both Mexico and Madagascar. Artificial neural networks outperformed GLMMs in the Madagascan (average AUC 0.83 vs 0.80), but not the Mexican study zone (average AUC 0.81 vs 0.89). In Mexico and Madagascar, Gaussian processes (average AUC 0.89, 0.85) and structured Bayesian networks (average AUC 0.88, 0.82) performed at least as well as GLMMs (average AUC 0.89, 0.80). Bayesian networks produced more stable results across different sampling methods. Gaussian processes performed well (average AUC 0.85) with fewer predictor variables

Mulberry leaf extract improves glycaemic response and insulaemic response to sucrose in healthy subjects: results of a randomized, double blind, placebo-controlled study

Background. There are many benefits of maintaining healthy blood glucose levels, and studies have shown that lifestyle changes such as changes to diet can successfully restore normoglycaemia in participants with dysglycaemia. Significant health-related lifestyle changes are often difficult to implement and functional ingredients that can reduce glycaemic and insulaemic responses may help at risk populations. The aim of this study was to investigate whether a mulberry leaf extract could lower the glycaemic and insulinaemic responses to 75 g sucrose in healthy individuals. Methods. A double-blind, randomised, placebo-controlled, crossover design trial was conducted by the Oxford Brookes Centre for Nutrition and Health. Thirty-eight participants were recruited into the trial and, after an overnight fast, were given 75 g sucrose + white mulberry leaf extract, or 75 g sucrose alone. Capillary blood samples were collected at 15-min intervals in the first hour and at 30-min intervals over the second hour to determine glucose and plasma insulin levels. Data analysis was conducted using a paired samples T test or a Wilcoxon signed rank test. Results. The addition of mulberry leaf extract to sucrose resulted in a significantly lower glycaemic response and insulinaemic response compared to a matched placebo (sucrose alone). The change in blood glucose measurements were significantly lower at 15 min (p < 0.001), 30 min (p < 0.001), 45 min (p = 0.008), and 120 min (p < 0.001) and plasma insulin measurements were significantly lower at 15 min (p < 0.001), 30 min (p < 0.001), 45 min (p < 0.001), 60 min (p = 0.001) and 120 min (p < 0.001). The glucose iAUC (− 42%, p = 0.001), insulin iAUC (− 40%, p < 0.001), peak glucose (− 40.0%, p < 0.001) and peak insulin (− 41%, p < 0.001) from baseline were significantly lower for white mulberry leaf extract compared with the placebo. White mulberry leaf extract was well tolerated and there were no reported adverse events. Conclusions. Mulberry leaf extract can be used as part of lifestyle changes that may lead to healthy blood glucose levels