Speleothem Paleoclimatology for the Caribbean, Central America, and North America

Speleothem oxygen isotope records from the Caribbean, Central, and North America reveal climatic controls that include orbital variation, deglacial forcing related to ocean circulation and ice sheet retreat, and the influence of local and remote sea surface temperature variations. Here, we review these records and the global climate teleconnections they suggest following the recent publication of the Speleothem Isotopes Synthesis and Analysis (SISAL) database. We find that low-latitude records generally reflect changes in precipitation, whereas higher latitude records are sensitive to temperature and moisture source variability. Tropical records suggest precipitation variability is forced by orbital precession and North Atlantic Ocean circulation driven changes in atmospheric convection on long timescales, and tropical sea surface temperature variations on short timescales. On millennial timescales, precipitation seasonality in southwestern North America is related to North Atlantic climate variability. Great Basin speleothem records are closely linked with changes in Northern Hemisphere summer insolation. Although speleothems have revealed these critical global climate teleconnections, the paucity of continuous records precludes our ability to investigate climate drivers from the whole of Central and North America for the Pleistocene through modern. This underscores the need to improve spatial and temporal coverage of speleothem records across this climatically variable region

Competitive exercise-induced urinary incontinence in adolescent female: aware and prepare!

Pelvic floor stress from physical exercise can contribute to urinary incontinence. This entity, though well described in adult female athletes, has not been described in adolescent female athletes. Significant stress urinary incontinence can be a major cause of social embarrassment and withdrawal from an active lifestyle. Lack of awareness amongst physicians and physical trainers can lead to unnecessary investigations and unchecked provocative exercises, thereby further weakening the pelvic floor muscles of growing girls in the long run. Adequate awareness of the condition, and preparedness with symptom management strategies, are the key tools for successful pelvic floor rehabilitation of these children.Keywords: adolescent, athletes, exercise therapy, healthy lifestyle, stress, pelvic floor, urinary incontinenc

Importance-performance analysis of UK and US bank customer perceptions of service delivery technologies

Importance-performance analysis is utilised to compare the perceptions held by bank customers regarding selected service delivery technologies (SDTs) such as automated teller machines (ATMs), telephone banking and internet banking. Bank patrons in the United Kingdom and the United States are surveyed to examine which service delivery factors they consider to be most important toward assessing the performance of SDTs offered by banking institutions. Customer views are plotted onto importance-performance grids which offer banking strategists a straightforward, graphic illustration of service factors that patrons consider to be salient and well-addressed by current installations of bank SDTs in each respective nation. The grids also offer heuristic decision guides for translating customer perceptions into strategic allocations of organisational investments toward SDT

Complete Genome Sequences of Four Escherichia coli ST95 Isolates from Bloodstream Infections

Finished genome sequences are presented for four Escherichia coli strains isolated from bloodstream infections at San Francisco General Hospital. These strains provide reference sequences for four major fimH-identified sublineages within the multilocus sequence type (MLST) ST95 group, and provide insights into pathogenicity and differential antimicrobial susceptibility within this group

Genomic Analysis of Factors Associated with Low Prevalence of Antibiotic Resistance in Extraintestinal Pathogenic Escherichia coli Sequence Type 95 Strains

Extraintestinal pathogenic Escherichia coli (ExPEC) strains belonging to multilocus sequence type 95 (ST95) are globally distributed and a common cause of infections in humans and domestic fowl. ST95 isolates generally show a lower prevalence of acquired antimicrobial resistance than other pandemic ExPEC lineages. We took a genomic approach to identify factors that may underlie reduced resistance. We fully assembled genomes for four ST95 isolates representing the four major fimH-based lineages within ST95 and also analyzed draft-level genomes from another 82 ST95 isolates, largely from the western United States. The fully assembled genomes of antibiotic-resistant isolates carried resistance genes exclusively on large (\u3e90-kb) IncFIB/IncFII plasmids. These replicons were common in the draft genomes as well, particularly in antibiotic-resistant isolates, but we also observed multiple instances of a smaller (8.3-kb) ampicillin resistance plasmid that had been previously identified in Salmonella enterica. Among ST95 isolates, pansusceptibility to antibiotics was significantly associated with the fimH6 lineage and the presence of homologs of the previously identified 114-kb IncFIB/IncFII plasmid pUTI89, both of which were also associated with reduced carriage of other plasmids. Potential mechanistic explanations for lineage- and plasmid-specific effects on the prevalence of antibiotic resistance within the ST95 group are discussed

Assessment of knowledge, practice and perception of menstruation among adult women in the reproductive age group, in Mangalore, India

Background: Women often lack knowledge regarding reproductive health including menstruation which can be due to socio-cultural barriers in which they grow up. The present study is aimed at assessing the level of knowledge regarding menstruation and hygienic practices and perceptions during menstruation.Methods: It was a cross sectional study, conducted among 110 adult women to assess their knowledge regarding menstruation, practices followed during menstruation and their perceptionof menstruation. The collected data was analyzed using SPSS version 17. 0. Chi square test was applied. P<0.05 was considered to be significant.Results: Only 52% of the study population has satisfactory knowledge regarding menstruation. Women between 15 to 20 years of age and those from the middle and higher socio-economic groups seem to possess maximum knowledge regarding menstruation. Women of the higher socio-economic group practice better sanitary measures during menstruation with 100% of them using pads, as compared to women of lower socio economic group who showed a trend of using cloth (87.5%). Women of the upper socio-economic class (42.78%) had better perception towards menstruation (p<0.05).Conclusions: It is very important that lower socio-economic group should be educated about the importance of maintaining hygiene during menstruation by proper health education and equip them with skills regarding safe and hygienic practices to prevent the risk for reproductive tract infections

Passive heat stress reduces circulating endothelial and platelet microparticles

NEW FINDINGS: What is the central question of this study? Does passive heat stress of +2°C oesophageal temperature change concentrations of circulating arterial endothelial- and platelet-derived microparticles in healthy adults? What is the main finding and its importance? Concentrations of circulating endothelial- and platelet-derived microparticles were markedly decreased in heat stress. Reductions in circulating microparticles might indicate favourable vascular changes associated with non-pathological hyperthermia. Interest in circulating endothelial- and platelet-derived microparticles (EMPs and PMPs, respectively) has increased because of their potential pathogenic role in vascular disease and as biomarkers for vascular health. Hyperthermia is commonly associated with a pro-inflammatory stress but might also provide vascular protection when the temperature elevation is non-pathological. Circulating microparticles might contribute to the cellular adjustments and resultant vascular impacts of hyperthermia. Here, we determined whether circulating concentrations of arterial EMPs and PMPs are altered by passive heat stress (+2°C oesophageal temperature). Ten healthy young men (age 23 ± 3 years) completed the study. Hyperthermia was achieved by circulating ∼49°C water through a water-perfused suit that covered the entire body except the hands, feet and head. Arterial (radial) blood samples were obtained immediately before heating (normothermia) and in hyperthermia. The mean ± SD oesophageal temperature in normothermia was 37.2 ± 0.1°C and in hyperthermia 39.1 ± 0.1°C. Concentrations of circulating EMPs and PMPs were markedly decreased in hyperthermia. Activation-derived EMPs were reduced by ∼30% (mean ± SD; from 61 ± 8 to 43 ± 7 microparticles μl-1 ; P < 0.05) and apoptosis-derived EMPs by ∼45% (from 46 ± 7 to 23 ± 3 microparticles μl-1 ; P < 0.05). Likewise, circulating PMPs were reduced by ∼75% in response to hyperthermia (from 256 ± 43 to 62 ± 14 microparticles μl-1 ). These beneficial reductions in circulating EMPs and PMPs in response to a 2°C increase in core temperature might partly underlie the reported vascular improvements following therapeutic bouts of physiological hyperthermia.This study was funded through a Canadian Research Chair and an NSERC Discovery grant held by P.N.A. and a National Institutes of Health award (HL107715 to C.A.D.). A.R.B. is funded through an NSERC postdoctoral fellowship. D.F. is funded through the Swiss National Science Foundation. J.D. is funded by the Woolf Fisher Trust (New Zealand)

Trust in financial services: Retrospect and prospect

Fostering and maintaining high levels of trust in the financial services sector is seen as crucial because of the characteristics of many financial service and in order to promote consumer engagement in the sector. In this article, we report evidence from a body of work and other commentary to provide an insight into trends in consumer trust in the sector as a whole, in comparison with other organisations and how different types of financial services provider have performed relative to each other. We show that the financial services sector as a whole is trusted more than some comparator institutions, and that aggregate levels of trust in the sector have fluctuated a relatively small amount subsequent to the financial crisis. However, important differences between provider types are apparent and these differences have become more profound in the recent past. We provide suggestions as to how trust in the sector may be improved and provider an analysis of current initiatives to improve trust levels in the sector in general and in banking in particular

Predictors of health-related quality of life after cardiac surgery: a systematic review

Background Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients’ perspective. Aims To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. Methods Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate. Results Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets. Conclusion Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery