Identifying and preventing health problems among young drug-misusing offenders

Purpose – The purpose of this paper is to identify the health problems and treatment needs of drug-misusing offenders and to draw out the implications of the findings for health education and prevention. Design/methodology/approach – This analysis is based on data collected as part of the New English and Welsh Arrestee Drug Abuse Monitoring (NEW-ADAM) programme. The survey was based on interviews and urine sample collection with over 3,000 arrestees. Findings – The research found that young arrestees experienced a wide range of drug-related and general health problems. The implications of this are discussed in the context of programmes implemented as part of the government’s drug strategy. Originality/value – The NEW-ADAM surveys provide an original source of information on the drug and general health needs of young people at the first point of entry in the criminal justice system

Microvesicles as biomarkers in diabetes, obesity and non-alcoholic fatty liver disease: current knowledge and future directions

NAFLD is the most common chronic liver disease, frequently associated with diabetes. Both of these insulin resistant states have increased cardiovascular risk factors associated, and a prevalent cause of mortality in these diseases. Microvesicles are heterogonously sized, phospholipid rich spheres released by cells upon activation and apoptosis. Evidence is continuing to accumulate of microvesicles being not only markers of disease severity but as also having a functional role in the pathophysiology of disease progression.<br/

Platelet microvesicles (microparticles) in cardiac surgery

SIGNIFICANT POSTOPERATIVE BLEEDING is a common risk of cardiac surgery, with approximately 3.5% of patients requiring surgical re-exploration.1 Re-exploration is associated with adverse outcomes, including infections, ischemia, and increased 30-day mortality.2 Similar adverse outcomes are related to erythrocyte transfusions associated with cardiac surgery,3 in addition to the immunologic and administrative hazards of transfusion.4 These risks are important because the majority of patients undergoing cardiac surgery receive a blood transfusion despite the lack of evidence to support liberal transfusion strategies.5 The frequency and significance of bleeding after cardiac surgery warrant investigation of the hematologic changes throughout the procedure. This review focuses on the (patho)physiology of platelet-derived microvesicles in the setting of cardiovascular surgery, a developing area in the understanding of the control of coagulation

Building Collaborative Partnerships to Increase Postsecondary Education Opportunities for Students with Intellectual and Developmental Disabilities

Transitioning from high school to the next phase of life can be especially challenging for youth with intellectual and other developmental disabilities (IDD). Federal mandates are in place to provide individualized transition services to students with disabilities up to age 22; however, there is variability in the location of service delivery. A growing number of school districts have partnered with institutions of higher education (IHE) in an effort to enhance postsecondary education (PSE) opportunities for individuals with IDD who are between the ages of 18-21. While there are some differences in PSE programs, the core foundational component is constant across models: establishing and maintaining collaborative partnerships between school districts and IHE. This paper describes PSE program models and highlights the necessity to continue to build partnerships in an effort to expand PSE opportunities for young adults with IDD

How safe is your curry? Food allergy awareness of restaurant staff

Background: Incidents of severe and fatal anaphylaxis to accidentally ingested food allergens are increasing. Individuals are more likely to encounter difficulties when eating away from home. In restaurants, front-of-house and kitchen staff may be called upon to provide information about ingredients or ensure certain food allergens are excluded from dishes. Following a series of reactions related to the accidental ingestion of peanuts in curries we assessed food allergy awareness and allergen avoidance practices amongst the staff of Asian-Indian restaurants. Methods: A questionnaire survey was administered by telephone to one member of staff in each restaurant. Results: Fifty percent (40/80) of restaurants participated. Responders included managers, owners, waiters and chefs. Most (90%) had received food hygiene training, but only 15% food allergy training. 25% could name three common food allergens. 3 in 4 listed nuts, but less than 1in 5 mentioned peanuts. Common misunderstandings included 60% of staff believing an individual experiencing an allergic reaction should drink water to dilute the allergen. A less prevalent, but perhaps more concerning, was the misunderstanding that cooking food would prevent it causing an allergic reaction (25%). Despite poor knowledge, all respondents were comfortable and 65% were “very comfortable” with providing a “safe” meal for a customer with a food allergy. 60% expressed interest in future food allergy training. Conclusions: Despite high confidence in their own understanding of allergy, many staff lacked the knowledge to provide “safe” meals for food allergic customers. Traditionally tree nuts are a common ingredient in Asian-Indian dishes cuisine and there was widespread, but not universal, awareness of tree nuts as a common allergen. Peanuts were less commonly recognised as a common allergen, an observation of extreme concern as peanuts are being substituted for tree nuts as they are cheaper and avoid having to inflate meal prices. Our data highlights the need for greater training of restaurant staff. In parallel, food allergic customers need to exercise vigilance when making meal choices and develop skills to order a safe meal. The management of allergy is multifaceted, and this study indicates the importance of health professionals working beyond the clinical setting to collaborate with colleagues in the hospitality industry, public health and environmental health in coordinated endeavours to improve patient safety

Integrated systems for rapid point of care (PoC) blood cell analysis

Counting the different subpopulations of cells in a fingerprick of human blood is important for a number of clinical point-of-care (PoC) applications. It is a challenge to demonstrate the integration of sample preparation and detection techniques in a single platform. In this paper we demonstrate a generic microfluidic platform that combines sample processing and characterisation and enumeration in a single, integrated system. Results of microfluidic 3-part differential leukocyte (granulocyte, lymphocyte and monocyte) counts, together with erythrocyte and thrombocyte (platelet) counts, in human blood are shown and corroborated with results from hospital clinical laboratory analysis

Fasting and nutrient-stimulated plasma peptide-YY levels are elevated in critical illness and associated with feed intolerance: an observational, controlled study

INTRODUCTION: Delayed gastric emptying and feed intolerance occur frequently in the critically ill. In these patients, gastric motor responses to nutrients are disturbed. Peptide YY (PYY) slows gastric emptying. The aim of this study was to determine fasting and nutrient-stimulated plasma PYY concentrations and their relationship to cholecystokinin (CCK) in critically ill patients. METHODS: Studies were performed in 19 unselected mechanically ventilated critically ill patients (12 males; 48 ± 7 years old) in a randomised, single-blind fashion. Subjects received a 60-minute duodenal infusion of Ensure(® )at either 1 or 2 kcal/minute. Blood samples were collected at baseline and at 20, 40, 60, and 180 minutes following commencement of the nutrient infusion for the measurement of plasma PYY and CCK concentrations (using radioimmunoassay). Patient data were compared to 24 healthy subjects (17 males; 43 ± 2 years old). RESULTS: Fasting PYY concentration was higher in patients (P < 0.05), particularly in those with feed intolerance (P < 0.05). Plasma PYY concentrations were higher in patients during nutrient infusion (area under the curve [AUC] at 1 kcal/minute: 2,265 ± 718 versus 1,125 ± 138 pmol/l.min, P < 0.05; at 2 kcal/minute: 2,276 ± 303 versus 1,378 ± 210 pmol/l.min, P = 0.01) compared to healthy subjects. The magnitude of PYY elevation was greater in patients during the 1 kcal/minute infusion (AUC: 441 ± 153 versus 186 ± 58 pmol/l.min, P < 0.05), but not the 2 kcal/minute infusion. Fasting and nutrient-stimulated plasma CCK concentrations were higher in patients (P < 0.05). There was a relationship between plasma PYY and CCK concentrations during fasting (r = 0.52, P < 0.05) and nutrient infusion (r = 0.98, P < 0.0001). CONCLUSION: In critical illness, both fasting and nutrient-stimulated plasma PYY concentrations are elevated, particularly in patients with feed intolerance, in conjunction with increased CCK concentrations

The relationship between gastric emptying, plasma cholecystokinin, and peptide YY in critically ill patients

© 2007 Nguyen et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background Cholecystokinin (CCK) and peptide YY (PYY) are released in response to intestinal nutrients and play an important physiological role in regulation of gastric emptying (GE). Plasma CCK and PYY concentrations are elevated in critically ill patients, particularly in those with a history of feed intolerance. This study aimed to evaluate the relationship between CCK and PYY concentrations and GE in critical illness. Methods GE of 100 mL of Ensure® meal (106 kcal, 21% fat) was measured using a 13C-octanoate breath test in 39 mechanically ventilated, critically ill patients (24 males; 55.8 ± 2.7 years old). Breath samples for 13CO2 levels were collected over the course of 4 hours, and the GE coefficient (GEC) (normal = 3.2 to 3.8) was calculated. Measurements of plasma CCK, PYY, and glucose concentrations were obtained immediately before and at 60 and 120 minutes after administration of Ensure. Results GE was delayed in 64% (25/39) of the patients. Baseline plasma CCK (8.5 ± 1.0 versus 6.1 ± 0.4 pmol/L; P = 0.045) and PYY (22.8 ± 2.2 versus 15.6 ± 1.3 pmol/L; P = 0.03) concentrations were higher in patients with delayed GE and were inversely correlated with GEC (CCK: r = -0.33, P = 0.04, and PYY: r = -0.36, P = 0.02). After gastric Ensure, while both plasma CCK (P = 0.03) and PYY (P = 0.02) concentrations were higher in patients with delayed GE, there was a direct relationship between the rise in plasma CCK (r = 0.40, P = 0.01) and PYY (r = 0.42, P < 0.01) from baseline at 60 minutes after the meal and the GEC. Conclusion In critical illness, there is a complex interaction between plasma CCK, PYY, and GE. Whilst plasma CCK and PYY correlated moderately with impaired GE, the pathogenetic role of these gut hormones in delayed GE requires further evaluation with specific antagonists.Nam Q Nguyen, Robert J Fraser, Laura K Bryant, Marianne J Chapman, Judith Wishart, Richard H Holloway, Ross Butler, and Michael Horowit

Role of DNA methylation in the association of lung function with body mass index: a two-step epigenetic Mendelian randomisation study

Low lung function has been associated with increased body mass index (BMI). The aim of this study was to investigate whether the effect of BMI on lung function is mediated by DNA methylation.; We used individual data from 285,495 participants in four population-based cohorts: the European Community Respiratory Health Survey, the Northern Finland Birth Cohort 1966, the Swiss Study on Air Pollution and Lung Disease in Adults, and the UK Biobank. We carried out Mendelian randomisation (MR) analyses in two steps using a two-sample approach with SNPs as instrumental variables (IVs) in each step. In step 1 MR, we estimated the causal effect of BMI on peripheral blood DNA methylation (measured at genome-wide level) using 95 BMI-associated SNPs as IVs. In step 2 MR, we estimated the causal effect of DNA methylation on FEV; 1; , FVC, and FEV; 1; /FVC using two SNPs acting as methQTLs occurring close (in cis) to CpGs identified in the first step. These analyses were conducted after exclusion of weak IVs (F statistic < 10) and MR estimates were derived using the Wald ratio, with standard error from the delta method. Individuals whose data were used in step 1 were not included in step 2.; In step 1, we found that BMI might have a small causal effect on DNA methylation levels (less than 1% change in methylation per 1 kg/m2 increase in BMI) at two CpGs (cg09046979 and cg12580248). In step 2, we found no evidence of a causal effect of DNA methylation at cg09046979 on lung function. We could not estimate the causal effect of DNA methylation at cg12580248 on lung function as we could not find publicly available data on the association of this CpG with SNPs.; To our knowledge, this is the first paper to report the use of a two-step MR approach to assess the role of DNA methylation in mediating the effect of a non-genetic factor on lung function. Our findings do not support a mediating effect of DNA methylation in the association of lung function with BMI