The Vehicle, Fall 2004

Table of Contents Six-Billion to One AgainstRyan Maneypage 5 May 25th, 2004Megan Rankinpage 6 Summer DeliveryAnthony Shootpage 7 A Young Family, Smithland, Kentucky. October 1935.Clementinepage 8 UntitledJonathan M. Cookpage 9 October 23, 2021Ryan Maneypage 10 Last NightKaty Dwigginspage 11 UntitledMegan Rankinpage 12 Clever DisguiseSarah Johnsonpage 13 conspiracy against grandmaClementinepage 14 ThunderKitty Apodacapage 15 UntitledJonathan M. Cookpage 16 Self PortraitAnnette Carlinpage 17 LeavesAnthony Shootpage 18 UntitledKaty Dwigginspage 19 The Woman I Almost UnderstoodGreg Lyonspage 20 Flesh and SandJonathan M. Cookpage 21 Lunch DateAlisa Habelpage 22 Like and Unlike Everyone ElseC. Alan Doughtypage 23 Thankfully SwayedSarah Johnsonpage 24 A Warm Winter DayJoshua D. Andersonpage 25-26 Oak, Maple, SassafrasClementinepage 27-30https://thekeep.eiu.edu/vehicle/1080/thumbnail.jp

We have already heard that the treatment doesn't do anything, so why should we take it?: A mixed method perspective on Chagas disease knowledge, attitudes, prevention, and treatment behaviour in the Bolivian Chaco

Author summary Chagas disease (CD) is caused by infection with the parasite Trypanosoma cruzi and is on the list of the most neglected tropical diseases on Earth. It has become an international health issue affecting 6-7 million people worldwide, mainly in Latin America. We performed a qualitative and quantitative study in Monteagudo, Bolivia, in order to paint an overall picture of CD in one of the most afflicted regions in the world: the Bolivian Chaco. Community members and key informants, such as patients and healthcare staff helped us to understand their current situation. Even after a large health campaign, persistent knowledge gaps, misconceptions and structural barriers were identified, leading to normalization and acceptance of CD and its social consequences. Relevant findings included the broad use of ivermectin for CD treatment without scientific evidence. We also found that misinterpretations of serologic test results contribute to a critical attitude towards biomedical treatment that is stopping patients from seeking treatment. With this research we aim to update the data on current knowledge and to analyse remaining barriers for transmission control and treatment, in order to focus future interventions and advocate for patient's rights. Background: Chagas disease (CD) is highly endemic in the Bolivian Chaco. The municipality of Monteagudo has been targeted by national interventions as well as by Medecins Sans Frontieres to reduce infection rates, and to decentralize early diagnosis and treatment. This study seeks to determine the knowledge and attitudes of a population with increased awareness and to identify remaining factors and barriers for sustained vector control, health care seeking behaviour, and access, in order to improve future interventions. Methodology/Principal findings A cross-sectional survey was conducted among approximately 10% (n = 669) of the municipality of Monteagudo's households that were randomly selected. Additionally, a total of 14 in-depth interviews and 2 focus group discussions were conducted with patients and key informants. Several attitudes and practices were identified that could undermine effective control against (re-)infection. Knowledge of clinical symptoms and secondary prevention was limited, and revealed specific misconceptions. Although 76% of the participants had been tested for CD, only 18% of those who tested positive concluded treatment with benznidazole (BNZ). Sustained positive serologies after treatment led to perceived ineffectiveness of BNZ. Moreover, access barriers such as direct as well as indirect costs, BNZ stock-outs and a fear of adverse reactions triggered by other community members made patients opt for alternative treatments against CD such as veterinary ivermectin, used by 28% of infected participants in our study. The lack of accessible care for chronic complications as well as socioeconomic consequences, such as the exclusion from both job opportunities and bank loans contributed to the ongoing burden of CD. Conclusions/Significance Large scale interventions should be accompanied by operational research in order to identify misconceptions and unintended consequences early on, to generate accessible data for future interventions, and for rigorous evaluation. An integrated, community-based approach tackling social determinants and including both traditional and animal health sectors might help to overcome current barriers and advocate for patients' rights

Age-related endolysosome dysfunction in the rat urothelium.

Lysosomal dysfunction is associated with a number of age-related pathologies that affect all organ systems. While much research has focused on neurodegenerative diseases and aging-induced changes in neurons, much less is known about the impact that aging has on lower urinary tract function. Our studies explored age-dependent changes in the content of endo-lysosomal organelles (i.e., multivesicular bodies, lysosomes, and the product of their fusion, endolysosomes) and age-induced effects on lysosomal degradation in the urothelium, the epithelial tissue that lines the inner surface of the bladder, ureters, and renal pelvis. When examined by transmission electron microscopy, the urothelium from young adult rats (~3 months), mature adult rats (~12 months), and aged rats (~26 months old) demonstrated a progressive age-related accumulation of aberrantly large endolysosomes (up to 7μm in diameter) that contained undigested content, likely indicating impaired degradation. Stereological analysis confirmed that aged endolysosomes occupied approximately 300% more volume than their younger counterparts while no age-related change was observed in multivesicular bodies or lysosomes. Consistent with diminished endolysosomal degradation, we observed that cathepsin B activity was significantly decreased in aged versus young urothelial cell lysates as well as in live cells. Further, the endolysosomal pH of aged urothelium was higher than that of young adult (pH 6.0 vs pH 4.6). Our results indicate that there is a progressive decline in urothelial endolysosomal function during aging. How this contributes to bladder dysfunction in the elderly is discussed

Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study

BACKGROUND: The value of prehospital blood transfusion (PHBTx) in the management of severe trauma has not been established. This study aimed to evaluate the effect of PHBTx on mortality in combat casualties.METHODS: This is a retrospective cohort study of casualties admitted to the field hospital at Camp Bastion, Afghanistan, by the Medical Emergency Response Team from May 2006 to March 2011. Participants were divided into two consecutive cohorts by the introduction of PHBTx. Paired groups of patients were chosen by combining propensity score methodology with detailed matching of injury profile. Thus recipients of PHBTx were matched with nonrecipients who would have received it had it been available.RESULTS: A total of 1,592 patients were identified. Of the 1,153 patients to whom PHBTx was potentially available, 310 received it (26.9%). The rate of severe injury (Injury Severity Score [ISS] > 15) rose from 28% before PHBTx was available to 43% thereafter (p < 0.001). Mortality in the latter group was higher (14% vs. 10%, p = 0.013) but not in the severely injured patients (32% vs. 28%, p = 0.343). Ninety-seven patients were paired. The mortality of matched patients who received PHBTx, compared with those with similar injury patterns who did not, was less than half (8.2% vs. 19.6%, p < 0.001). However, matched recipients had more prehospital interventions, reached hospital more quickly, and had lower heart rate at admission (all p < 0.05). Matched recipients received more red blood cells within 24 hours (median, 4 U; interquartile range [IQR], 2-10 U) than nonrecipients (median 0 U; IQR, 0-3.5 U) and more fresh frozen plasma (median, 2 U; IQR, 2-9 U vs. median, 0 U; IQR, 0-1 U) (both p < 0.001).CONCLUSION: An aggressive approach to damage control resuscitation including the use of PHBTx was associated with a large improvement in mortality. However, because of confounders resulting from changes in practice, the isolated contribution of PHBTx cannot be determined from this study. (Copyright (C) 2014 by Lippincott Williams & Wilkins

Demographic and geographical characteristics of pediatric trauma in Scotland

AbstractBackgroundTrauma systems reduce mortality and improve functional outcomes. The aim of this study was to analyse the demographic and geospatial characteristics of pediatric trauma patients in Scotland, and determine the level of destination healthcare facility which injured children are taken to, to determine the need for, and general feasibility, of developing a pediatric trauma system for Scotland.MethodsRetrospective analysis of incidents involving children aged 1–14 attended to by the Scottish Ambulance Service between 1 November 2008 and 31 October 2010. A subgroup with physiological derangement was defined. Incident location postcode was used to determine incident location by health board region, rurality and social deprivation. Destination healthcare facility was classified into one of six categories.ResultsOf 10,759 incidents, 72.3% occurred in urban areas and 5.8% in remote areas. Incident location was associated with socioeconomic deprivation. Of the patients, 11.6% were taken to a pediatric hospital with pediatric intensive care facilities, 21.8% to a pediatric hospital without pediatric intensive care service, and 50.2% to an adult large general hospital without pediatric surgical service.ConclusionsThe majority of incidents involving children with injuries occurred in urban areas. Half were taken to a hospital without pediatric surgical service. There was no difference between children with normal and deranged physiology

Comparison of endolysosomes in the umbrella cells of young and aged rats.

<p>(A) Umbrella cell from young rat showing typical endolysosomes (EL) ≤ 1 μm in diameter. (B-D) Endolysosomes in aged umbrella cells are generally much larger than those observed in the young and have a tendency to cluster (D). In C, black asterisks denote large luminally disposed vesicles that may represent undigested MVBs. In C-D, white asterisks denote lysosomes that have not yet dispersed their content. In D, the red arrow marks stacked undigested membrane, whereas the dashed red circles highlight areas of possible fusion between adjacent endolysosomes (magnified in the boxed region as an inset.</p

Aging is associated with decreased endolysosome acidification and loss of cathepsin B activity.

<p>(A) Lysosensor Yellow/Blue DND-160 fluorescence measurements (ratio of emission readings at 450 nm/550 nm, excitation at 365 nm) of urothelial cells from young (red inverted triangles) or aged (blue open circles) rats were converted to pH readings through use of a standard curve (black closed circles, with dotted linear regression line). Note the tendency for endolysosomal pH to trend towards neutral pH in aged rat urothelial cells as compared to cells from young animals. (B) Summary of endolysosomal pH measurements. (C,D) Activity assays demonstrate that N-acetylglucosaminidase activity (C) is unaffected by age but Cathepsin B activity (D) is significantly decreased in urothelial cell lysates. (E) Magic Red Cathepsin activity in young and aged cells shows time-dependent increase in enzyme activity with young, but not aged cells. Results are quantified in (F). Values in B,C,D, and F represent mean ± standard deviation. Asterisks denote significant differences (p value < 0.05).</p

The volume of endolyosomes increases in umbrella cells with age.

<p>(A-C) TEM comparing size of MVBs (yellow structures), endolysosomes (green structures), and lysosomes (purple structures) in umbrella cells taken from young, adult, and aged rats. (D,E) Stereological analysis of the fractional volume (V_v) (D) and total organelle volume (E) of MVBs (yellow bars), endolysosomes (green bars), and lysosomes (purple bars) in umbrella cells. Values represent mean ± standard deviation. Asterisks denote significant differences (p value < 0.05).</p

Age-related endolysosome dysfunction in the rat urothelium - Fig 4

<p><b>Comparison of LIMP2-positive organelles in young (A), adult (B), and aged (C) rat urothelium.</b> LIMP2-positive structures (green) shown in umbrella cells (delineated by dashed yellow line). Rhodamine phalloidin (red), which labels the cortical actin cytoskeleton, was used to show cell borders. Umbrella cells show an apparent, age-related increase in LIMP2 staining (white arrows).</p