Breastfeeding, breast milk and viruses

<p>Abstract</p> <p>Background</p> <p>There is seemingly consistent and compelling evidence that there is no association between breastfeeding and breast cancer. An assumption follows that milk borne viruses cannot be associated with human breast cancer.</p> <p>We challenge this evidence because past breastfeeding studies did not determine "exposure" of newborn infants to colostrum and breast milk.</p> <p>Methods</p> <p>We conducted a prospective review of 100 consecutive births of infants in the same centre to determine the proportion of newborn infants who were "exposed" to colostrum or breast milk, as distinct from being fully breast fed. We also report a review of the breastfeeding practices of mothers of over 87,000 newborn infants in the Australian State of New South Wales.</p> <p>This study was approved by the Human Research Ethics Committee of the University of New South Wales (Sydney, Australia). Approval 05063, 29 September 2005.</p> <p>Results</p> <p>Virtually all (97 of 100) newborn infants in this centre were "exposed" to colostrum or breast milk whether or not they were fully breast fed. Between 82.2% to 98.7% of 87,000 newborn infants were "exposed" to colostrum or breast milk.</p> <p>Conclusion</p> <p>In some Western communities there is near universal exposure of new born infants to colostrum and breast milk. Accordingly it is possible for the transmission of human milk borne viruses. This is contrary to the widespread assumption that human milk borne viruses cannot be associated with breast cancer.</p

Evaluating capability of Green Stormwater Infrastructure on large properties toward adaptive flood mitigation: The HLCA+C methodology

Current flood protection capacities will become inadequate to protect many low-lying coastal cities from climate change-induced flooding in the future. Under climate change uncertainty, an adaptive strategy is required to provide supplemental flood mitigation. Green Stormwater Infrastructure (GSI) in developed areas has the potential to provide substantial catchment runoff reduction. However, individual properties vary in their Flood Mitigation Capability (FMC) depending on their land characteristics. An effective methodology is needed to evaluate the FMC of properties to help urban planners determine which to target for GSI and when to implement GSI in light of increased climate change impacts. We advance the Hydrology-based Land Capability Assessment and Classification (HLCA+C) methodology for evaluating the FMC of large properties over the long term (80 to 100-year). It builds on the strengths of existing methodologies and uses a land unit analysis approach for assessing FMC, considering interdependent hydrological and geographical variables. The FMC classification system groups properties with similar flood mitigation characteristics, helping urban planners to understand their potentials and limitations for flood mitigation toward the development of adaptive strategies through time. Step-by-step instructions demonstrate how to apply the methodology to any low-lying coastal city

Effectiveness of strategically located Green Stormwater Infrastructure networks for adaptive flood mitigation in a context of climate change

Studies indicate Green Stormwater Infrastructure (GSI) on industrial land can provide substantial adaptive flood mitigation within urban catchments under climate change. To identify a cost-effective adaptive GSI network, planners need to evaluate flood mitigation capabilities of industrial properties through time and understand key characteristics informing when, where, and how GSI should be implemented for maximum effect. We applied the Hydrology-based Land Capability Assessment and Classification (HLCA+C) methodology to a catchment in Christchurch, New Zealand, to evaluate the capabilities of industrial properties clustered into Storm Water Management (SWM) zones under different climate change scenarios. SWM zone potentials and limitations were assessed to develop the most capable adaptive flood mitigation network with climate change. We prioritised six of twenty SWM zones for inclusion in the network based on their substantial flood mitigation capabilities. To maximise their capabilities through time, we orchestrated, and implemented GSI in zones incrementally, using different implementation approaches based on key characteristics determining their capability. The results indicated that the most capable zone could mitigate climate change-induced flooding, by itself, up to the end of this century under the moderate climate change scenario. However, if its capability was combined with that of five others, together they could mitigate flooding just shy of that associated with the major climate change scenario up to the end of this century. The resulting adaptive industrial GSI network not only provides substantial flood protection for communities but allows costly investments in flood mitigation structures, such as barriers and levees, to be safely delayed until their cost-effectiveness has been confirmed under increased climate certainty

The Use of Phenomenological Approach in Evaluating Mentorship Preparation Program in South East Scotland

The Nursing and Midwifery Council for the United Kingdom highlighted the importance of the role of the mentor in the development of competence in student nurses and midwives. Veronica Lambert and Margaret Glacken, as well as Zoe Wilkes, suggested that mentors were fundamental to the students’ smooth entry to the practice environment and clinical learning experience. Furthermore, the Nursing and Midwifery Council Standards for Learning and Assessment in Practice identified the requirement by all providers of clinical education experiences for student nurses and midwives to establish local registers of appropriately prepared mentors in practice, together with the development of a new preparation program for mentors. In 2013, the mentorship team within Edinburgh Napier University, which provides the Nursing and Midwifery Council–accredited Mentorship in Practice Preparatio

Antibiotic treatment patterns across Europe in patients with complicated skin and soft-tissue infections due to meticillin-resistant <em>Staphylococcus aureus</em>:a plea for implementation of early switch and early discharge criteria

AbstractThis retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Patients were randomly sampled from 12 countries (Austria, Czech Republic, France, Germany, Greece, Ireland, Italy, Poland, Portugal, Slovakia, Spain and the UK), aged ≥18 years, with documented MRSA cSSTI, hospitalised between 1 July 2010 and 30 June 2011, discharged alive by 31 July 2011. Of 1502 patients, 1468 received MRSA-targeted therapy. Intravenous-to-oral switch rates ranged from 2.0% to 20.2%, i.v. length of therapy from 10.1 to 18.6 days and hospital length of stay (LoS) from 15.2 to 25.0 days across Europe. Of 341 sites, 82.9% had antibiotic steering committees, 23.7% had i.v.-to-oral switch antibiotic protocols and 12.9% had ED protocols for MRSA cSSTI. ES and ED eligibility ranged from 12.0% (Slovakia) to 56.3% (Greece) and from 10% (Slovakia) to 48.2% (Portugal), respectively. Potential cost savings per ED-eligible patient ranged from €414 (Slovakia) to €2703 (France). MRSA cSSTI treatment patterns varied widely across countries, but further reductions in i.v. therapy, hospital LoS and associated costs could be realised. These data provide insight into clinical practice patterns across diverse European healthcare systems and identify potential opportunities for local clinicians and policy-makers to improve clinical care and cost-effectiveness of this therapeutic area

Influence of real-world characteristics on outcomes for patients with methicillin-resistant Staphylococcal skin and soft tissue infections:a multi-country medical chart review in Europe

BACKGROUND: Patient-related (demographic/disease) and treatment-related (drug/clinician/hospital) characteristics were evaluated as potential predictors of healthcare resource use and opportunities for early switch (ES) from intravenous (IV)-to-oral methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotic therapy and early hospital discharge (ED). METHODS: This retrospective observational medical chart study analyzed patients (across 12 European countries) with microbiologically confirmed MRSA complicated skin and soft tissue infections (cSSTI), ≥3 days of IV anti-MRSA antibiotics during hospitalization (July 1, 2010-June 30, 2011), and discharged alive by July 31, 2011. Logistic/linear regression models evaluated characteristics potentially associated with actual resource use (length of IV therapy, length of hospital stay [LOS], IV-to-oral antibiotic switch), and ES and ED (using literature-based and expert-verified criteria) outcomes. RESULTS: 1542 patients (mean ± SD age 60.8 ± 16.5 years; 61.5% males) were assessed with 81.0% hospitalized for MRSA cSSTI as the primary reason. Several patient demographic, infection, complication, treatment, and hospital characteristics were predictive of length of IV therapy, LOS, IV-to-oral antibiotic switch, or ES and ED opportunities. Outcomes and ES and ED opportunities varied across countries. Length of IV therapy and LOS (r = 0.66, p < 0.0001) and eligibilities for ES and ED (r = 0.44, p < 0.0001) showed relatively strong correlations. IV-to-oral antibiotic switch patients had significantly shorter length of IV therapy (−5.19 days, p < 0.001) and non-significantly shorter LOS (−1.86 days, p > 0.05). Certain patient and treatment characteristics were associated with increased odds of ES (healthcare-associated/ hospital-acquired infection) and ED (patient living arrangements, healthcare-associated/ hospital-acquired infection, initiating MRSA-active treatment 1–2 days post cSSTI index date, existing ED protocol), while other factors decreased the odds of ES (no documented MRSA culture, ≥4 days from admission to cSSTI index date, IV-to-oral switch, IV line infection) and ED (dementia, no documented MRSA culture, initiating MRSA-active treatment ≥3 days post cSSTI index date, existing ES protocol). CONCLUSIONS: Practice patterns and opportunity for further ES and ED were affected by several infection, treatment, hospital, and geographical characteristics, which should be considered in identifying ES and ED opportunities and designing interventions for MRSA cSSTI to reduce IV days and LOS while maintaining the quality of care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2334-14-476) contains supplementary material, which is available to authorized users

The Epstein-Barr Virus G-Protein-Coupled Receptor Contributes to Immune Evasion by Targeting MHC Class I Molecules for Degradation

Epstein-Barr virus (EBV) is a human herpesvirus that persists as a largely subclinical infection in the vast majority of adults worldwide. Recent evidence indicates that an important component of the persistence strategy involves active interference with the MHC class I antigen processing pathway during the lytic replication cycle. We have now identified a novel role for the lytic cycle gene, BILF1, which encodes a glycoprotein with the properties of a constitutive signaling G-protein-coupled receptor (GPCR). BILF1 reduced the levels of MHC class I at the cell surface and inhibited CD8+ T cell recognition of endogenous target antigens. The underlying mechanism involves physical association of BILF1 with MHC class I molecules, an increased turnover from the cell surface, and enhanced degradation via lysosomal proteases. The BILF1 protein of the closely related CeHV15 c1-herpesvirus of the Rhesus Old World primate (80% amino acid sequence identity) downregulated surface MHC class I similarly to EBV BILF1. Amongst the human herpesviruses, the GPCR encoded by the ORF74 of the KSHV c2-herpesvirus is most closely related to EBV BILF1 (15% amino acid sequence identity) but did not affect levels of surface MHC class I. An engineered mutant of BILF1 that was unable to activate G protein signaling pathways retained the ability to downregulate MHC class I, indicating that the immune-modulating and GPCR-signaling properties are two distinct functions of BILF1. These findings extend our understanding of the normal biology of an important human pathogen. The discovery of a third EBV lytic cycle gene that cooperates to interfere with MHC class I antigen processing underscores the importance of the need for EBV to be able to evade CD8+ T cell responses during the lytic replication cycle, at a time when such a large number of potential viral targets are expressed

A qualitative exploration of Malaysian cancer patients' perspectives on cancer and its treatment

<p>Abstract</p> <p>Background</p> <p>Cancer patients' knowledge about cancer and experiences with its treatment play an important role in long-term adherence in their disease management. This study aimed to explore cancer patients' knowledge about cancer, their perceptions of conventional therapies and the factors that contribute to medication adherence in the Malaysian population.</p> <p>Methods</p> <p>A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by cancer patients. Twenty patients were interviewed using a semi-structured interview guide. A saturation point was reached after the 18^thinterview, and no new information emerged with the subsequent 2 interviews. All interviews were transcribed verbatim and analysed by means of a standard content analysis framework.</p> <p>Results</p> <p>The majority of patients related the cause of their cancer to be God's will. Participants perceived conventional therapies as effective due to their scientific methods of preparations. A fear of side effects was main reasons given for delay in seeking treatment; however, perceptions were reported to change after receiving treatment when effective management to reduce the risk of side effects had been experienced.</p> <p>Conclusions</p> <p>This study provides basic information about cancer patients' perceptions towards cancer and its treatment. These findings can help in the design of educational programs to enhance awareness and acceptances of cancer screening. Priorities for future research should focus on patients who refused the conventional therapies at any stage.</p