Surgical Management of Massive Labial Edema in a Gravid Preeclamptic Diabetic

Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome� leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered

Mind-Body Skills Groups for Adolescents with Depression in Primary Care: A Pilot Study

Objective: To determine acceptability and preliminary effectiveness of Mind-Body Skills Groups (MBSGs) as a treatment for depressed adolescents in primary care. Methods: A single arm clinical trial was conducted. A 10-week MBSG program was implemented in primary care. Participants completed self-report measures at baseline, post-intervention, and 3-months following the MBSGs. Measures included the Children’s Depression Inventory-2, Suicidal Ideation Questionnaire, Mindful Attention Awareness Scale, Self-Efficacy for Depressed Adolescents, rumination subscale of the Children’s Response Style Questionnaire, and a short acceptability questionnaire. Results: Participants included 43 adolescents. The total depression scores significantly improved following the MBSG intervention and continued to improve significantly from post-treatment to follow-up. Mindfulness, self-efficacy, rumination, and suicidal ideation all had significant improvement following the intervention. Acceptability of the program was strong, and attendance was excellent. Discussion: Preliminary evidence suggests that MBSGs are an acceptable treatment for primary care settings and lead to improved depression symptoms in adolescents.Sandra Eskenazi Mental Health Center and the Herbert Simon Family Foundation (070241-00002B

Closing the brief case: A Fatal Case of Necrotizing Fasciitis Due to Multidrug-Resistant Acinetobacter baumannii

ANSWERS TO SELF-ASSESSMENT QUESTIONS 1. What is the most common etiology of monomicrobial (type 2) necrotizing fasciitis? a. Acinetobacter baumannii b. Staphylococcus aureus c. Streptococcus pyogenes d. Vibrio vulnificus Answer: c. Although all of the organisms listed cause type 2 necrotizing fasciitis, the most common cause is still S. pyogenes, with an incidence of 0.4 per 100,000 in the United States. Due to variations in reporting practices, the exact incidences of other etiologies are not known, but they are less common than S. pyogenes

Cancer survivor rehabilitation and recovery: Protocol for the Veterans Cancer Rehabilitation Study (Vet-CaRes)

Background: Cancer survivors are a rapidly growing and aging population in the U.S., but there are many challenges associated with the survivorship experience such as functional disabilities and psychosocial distress. When viewed next to the general population, Veterans are especially at risk for these challenges as they are older and have a high incidence of co-morbid conditions. While the Institute of Medicine (IOM) has called for further cancer survivorship research to address these challenges, we still know little about this experience from the perspective of aging Veterans. Methods/design We conducted a longitudinal, mixed-methods study over the course of three and a half years at the Boston and Houston VA Medical Centers. We recruited 170 Veterans diagnosed with head and neck, colorectal and esophageal/gastric cancers that were identified from the VA tumor registry. Veterans completed three in-depth interviews, conducted at 6, 12 and 18 months after pathology confirmation, measuring the physical, social and psychological factors related to cancer survivorship. The longitudinal design allowed us to assess any changes in cancer related disability and distress over time. Discussion Weekly teleconference study team meetings were a key aspect to the research process. Issues related to recruitment, data management and analysis, and the dissemination of research results was discussed. Interviewers presented detailed case reports of completed interviews that allowed us to refine our interview protocols. We also discussed issues relevant to the Veteran population of which we were previously unaware and some of the challenges of the research process itself. This novel study produced a robust data set that documents the functional and psychosocial cancer survivorship experiences of aging Veterans. The longitudinal design will help us more fully understand the recovery patterns for this specific population, and identify the unique needs and gaps in health services

Socioeconomic drivers of illegal bushmeat hunting in a Southern African Savanna

Illegal bushmeat hunting of economically and ecologically valuable wildlife populations is emerging as a threat across African savannas. Due to the cryptic nature of illegal hunting, little information exists on the drivers of the bushmeat industry. Here we report on the socioeconomic drivers identified in a broader investigation into illegal bushmeat hunting in rural villages around a southern African savanna ecosystem, the Okavango Delta, Botswana. We conducted interviews with bushmeat hunters and heads of rural households about hunting activities, rural livelihoods, attitudes towards wildlife, and market characteristics of illegal bushmeat. Using generalized linear models, we identified and investigated a set of independent variables that characterize illegal-hunter households. Results revealed that compared to non-hunter households, illegal hunter households (n = 119, 25% of the sample) lived in closer proximity to wildlife, were more likely to farm crops, and more often received income from formal employment by at least one household member. Bushmeat hunting was positively correlated with livestock wealth but not associated with household income. Only 11.4% (n = 44) of non-hunter households reported purchasing bushmeat. Most households (84%) reported incurring costs associated with living near wildlife (e.g., damages to crops or livestock), with no difference between hunter and non-hunter households. Hunters were more likely to say they valued wildlife. We conclude that bushmeat hunting in Botswana is generally supplemental to household core income sources rather than essential for subsistence. We propose two interventions to counter the negative impacts of illegal hunting on the region's lucrative wildlife-based economy: 1) more effective law enforcement that imposes costs for hunting illegally, and 2) development of alternative wildlife-based revenue streams that motivate communities to conserve wildlife.The Food and Agriculture Organization of the United Nations provided the majority of funding for this research under Technical Cooperation Programme project TCP/BOT/3501. The study was also supported by Panthera and the Botswana Predator Conservation Trust. JRBM was supported in part by National Science Foundation Coupled Human and Natural Systems Grant 115057.http://www.elsevier.com/locate/biocon2019-10-01hj2018Zoology and Entomolog

Archaeology and modern reflections on death

Ye

Modeling Landowner Interactions and Development Patterns at the Urban Fringe

Population growth and unrestricted development policies are driving low-density urbanization and fragmentation of peri-urban landscapes across North America. While private individuals own most undeveloped land, little is known about how their decision-making processes shape landscape-scale patterns of urbanization over time. We introduce a hybrid agent-based modeling (ABM) – cellular automata (CA) modeling approach, developed for analyzing dynamic feedbacks between landowners’ decisions to sell their land for development, and resulting patterns of landscape fragmentation. Our modeling approach builds on existing conceptual frameworks in land systems modeling by integrating an ABM into an established grid-based land-change model – FUTURES. The decision-making process within the ABM involves landowner agents whose decision to sell their land to developers is a function of heterogeneous preferences and peer-influences (i.e., spatial neighborhood relationships). Simulating landowners’ decision to sell allows an operational link between the ABM and the CA module. To test our hybrid ABM-CA approach, we used empirical data for a rapidly growing region in North Carolina for parameterization. We conducted a sensitivity analysis focusing on the two most relevant parameters—spatial actor distribution and peer-influence intensity—and evaluated the dynamic behavior of the model simulations. The simulation results indicate different peer-influence intensities lead to variable landscape fragmentation patterns, suggesting patterns of spatial interaction among landowners indirectly affect landscape-scale patterns of urbanization and the fragmentation of undeveloped forest and farmland

Characterization and Effect of Metal Ions on the Formation of the \u3cem\u3eThermus thermophilus\u3c/em\u3e Sco Mixed Disulfide Intermediate

The Sco protein from Thermus thermophilus has previously been shown to perform a disulfide bond reduction in the CuA protein from T. thermophilus, which is a soluble protein engineered from subunit II of cytochrome ba 3 oxidase that lacks the transmembrane helix. The native cysteines on TtSco and TtCuA were mutated to serine residues to probe the reactivities of the individual cysteines. Conjugation of TNB to the remaining cysteine in TtCuA and subsequent release upon incubation with the complementary TtSco protein demonstrated the formation of the mixed disulfide intermediate. The cysteine of TtSco that attacks the disulfide bond in the target TtCuA protein was determined to be TtSco Cysteine 49. This cysteine is likely more reactive than Cysteine 53 due to a higher degree of solvent exposure. Removal of the metal binding histidine, His 139, does not change MDI formation. However, altering the arginine adjacent to the reactive cysteine in Sco (Arginine 48) does alter the formation of the MDI. Binding of Cu2+ or Cu+ to TtSco prior to reaction with TtCuA was found to preclude formation of the mixed disulfide intermediate. These results shed light on a mechanism of disulfide bond reduction by the TtSco protein and may point to a possible role of metal binding in regulating the activity. Importance: The function of Sco is at the center of many studies. The disulfide bond reduction in CuA by Sco is investigated herein and the effect of metal ions on the ability to reduce and form a mixed disulfide intermediate are also probed