“For the best interest of the patient and of society;” Sterilization in Virginia’s mental institutions in the 20th century

The science of eugenics, or classifying and grouping people into the categories of genetically “inferior” and “superior” for the purpose of better breeding, thrived during the first decades of the 20th century in Virginia. The first recorded instance of eugenic sterilization in a Virginia Mental Institution occurred in 1915 by Dr. Albert Priddy. In 1924, the combined efforts of Dr. Joseph DeJarnette and Dr. Albert Priddy resulted in the passage of a state-sanctioned eugenic sterilization law that was later deemed constitutional in 1927 by Buck v. Bell. The 1924 law gave Western State Hospital, Central State Hospital, Eastern State Hospital, Southwestern State Hospital, the Virginia State Colony, and later the Petersburg Colony the authority to sexually sterilize patients with hereditary forms of insanity, idiocy, imbecility, feeble- mindedness, or epilepsy. This thesis focuses specifically on Western State Hospital, Central State Hospital, and the Virginia State Colony and how these mental institutions acted with regard to sterilization before and after it was legalized. These three institutions were chosen because they performed the overwhelming majority of sterilizations within the state. The number of sterilizations conducted annually at each institution is recorded and cataloged. Gaps and discrepancies in sterilization numbers are analyzed and possible explanations for these discrepancies are given. However, the actual number of sterilizations in Virginia will never be truly known due to inconsistent record keeping

Non-contact low-frequency ultrasound therapy compared with UK standard of care for venous leg ulcers: a single-centre, assessor-blinded, randomised controlled trial

‘Hard-to-heal’ wounds are those which fail to heal with standard therapy in an orderly and timely manner and may warrant the use of advanced treatments such as non-contact low-frequency ultrasound (NLFU) therapy. This evaluator-blinded, single-site, randomised controlled trial, compared NLFU in addition to UK standard of care [SOC: (NLFU + SOC)] three times a week, with SOC alone at least once a week. Patients with chronic venous leg ulcers were eligible to participate. All 36 randomised patients completed treatment (17 NLFU + SOC, 19 SOC), and baseline demographics were comparable between groups. NLFU + SOC patients showed a −47% (SD: 38%) change in wound area; SOC, −39% (38%) change; and difference, −7·4% [95% confidence intervals (CIs) −33·4–18·6; P = 0·565]. The median number of infections per patient was two in both arms of the study and change in quality of life (QoL) scores was not significant (P = 0·490). NLFU + SOC patients reported a substantial mean (SD) reduction in pain score of −14·4 (14·9) points, SOC patients' pain scores reduced by −5·3 (14·8); the difference was −9·1 (P = 0·078). Results demonstrated the importance of high-quality wound care. Outcome measures favoured NLFU + SOC over SOC, but the differences were not statistically significant. A larger sample size and longer follow-up may reveal NLFU-related improvements not identified in this study

Synthesis of New Heteropolycyclic Bis-Carboxamide: 3,5-Dichloro-N,N’(p-Chlorophenyl)dithieno [3,2-b:2’,3’-d]Furan-2,6-Carboxamide

New heteropolycyclic bis-carboxamide 5 was synthesized in multistep synthesis starting from furylacrylic acid (1). This type of compounds are now being examined as potential anti-AIDS agent. The most important stage in the multistep synthesis is the preparation of intermediate 3,5-dichloro- dithieno[3,2-b:2’,3’-d]furan-2,G-dicarbonyl chloride (4)

Crowdsourced assessment of surgical skill proficiency in cataract surgery

OBJECTIVE: To test whether crowdsourced lay raters can accurately assess cataract surgical skills. DESIGN: Two-armed study: independent cross-sectional and longitudinal cohorts. SETTING: Washington University Department of Ophthalmology. PARTICIPANTS AND METHODS: Sixteen cataract surgeons with varying experience levels submitted cataract surgery videos to be graded by 5 experts and 300+ crowdworkers masked to surgeon experience. Cross-sectional study: 50 videos from surgeons ranging from first-year resident to attending physician, pooled by years of training. Longitudinal study: 28 videos obtained at regular intervals as residents progressed through 180 cases. Surgical skill was graded using the modified Objective Structured Assessment of Technical Skill (mOSATS). Main outcome measures were overall technical performance, reliability indices, and correlation between expert and crowd mean scores. RESULTS: Experts demonstrated high interrater reliability and accurately predicted training level, establishing construct validity for the modified OSATS. Crowd scores were correlated with (r = 0.865, p \u3c 0.0001) but consistently higher than expert scores for first, second, and third-year residents (p \u3c 0.0001, paired t-test). Longer surgery duration negatively correlated with training level (r = -0.855, p \u3c 0.0001) and expert score (r = -0.927, p \u3c 0.0001). The longitudinal dataset reproduced cross-sectional study findings for crowd and expert comparisons. A regression equation transforming crowd score plus video length into expert score was derived from the cross-sectional dataset (r CONCLUSIONS: Crowdsourced rankings correlated with expert scores, but were not equivalent; crowd scores overestimated technical competency, especially for novice surgeons. A novel approach of adjusting crowd scores with surgery duration generated a more accurate predictive model for surgical skill. More studies are needed before crowdsourcing can be reliably used for assessing surgical proficiency

Single-cell RNA-sequencing of peripheral blood mononuclear cells reveals widespread, context-specific gene expression regulation upon pathogenic exposure

Not just differential gene expression but also differential gene regulation in immune cells account for individual differences in the immune response. Authors show here by single-cell RNA-sequencing of peripheral blood mononuclear cells from a large cohort of genetically diverse individuals that gene expression and regulatory changes in these cells depend on the context of and interactions between cell types, genetics, type of pathogen and time after exposure. The host's gene expression and gene regulatory response to pathogen exposure can be influenced by a combination of the host's genetic background, the type of and exposure time to pathogens. Here we provide a detailed dissection of this using single-cell RNA-sequencing of 1.3M peripheral blood mononuclear cells from 120 individuals, longitudinally exposed to three different pathogens. These analyses indicate that cell-type-specificity is a more prominent factor than pathogen-specificity regarding contexts that affect how genetics influences gene expression (i.e., eQTL) and co-expression (i.e., co-expression QTL). In monocytes, the strongest responder to pathogen stimulations, 71.4% of the genetic variants whose effect on gene expression is influenced by pathogen exposure (i.e., response QTL) also affect the co-expression between genes. This indicates widespread, context-specific changes in gene expression level and its regulation that are driven by genetics. Pathway analysis on the CLEC12A gene that exemplifies cell-type-, exposure-time- and genetic-background-dependent co-expression interactions, shows enrichment of the interferon (IFN) pathway specifically at 3-h post-exposure in monocytes. Similar genetic background-dependent association between IFN activity and CLEC12A co-expression patterns is confirmed in systemic lupus erythematosus by in silico analysis, which implies that CLEC12A might be an IFN-regulated gene. Altogether, this study highlights the importance of context for gaining a better understanding of the mechanisms of gene regulation in health and disease

Simulating the effect of perennialized cropping systems on nitrate-N losses using the SWAT model

Several newly released crop varieties, including the perennial intermediate wheatgrass (grain marketed as Kernza®), and the winter hardy oilseed crop camelina, have been developed to provide both economic return for farmers and reduced nutrient losses from agricultural fields. Though studies have indicated that these crops could reduce nitrate-nitrogen (N) leaching, little research has been done to determine their effectiveness in reducing nitrate-N loading to surface waters at a watershed scale, or in comparing their performance to more traditional perennial crops, such as alfalfa. In this study, nitrate-N losses were predicted using the Soil and Water Assessment Tool (SWAT) model for the Rogers Creek watershed located in south-central Minnesota, USA. Predicted looses of nitrate-N under three perennialized cropping systems were compared to losses given current cropping practices in a corn (Zea mays L.)-soybean (Glycine max L. Merr.) rotation. The perennialized systems included three separate crop rotations: intermediate wheatgrass (IWG) in rotation with soybean, alfalfa in rotation with corn, and winter camelina in rotation with soybean and winter rye. Model simulation of these rotations required creation of new crop files for IWG and winter camelina within SWAT. These new crop files were validated using measured yield, biomass, and nitrate-N data. Model results show that the IWG and alfalfa rotations were particularly effective at reducing nutrient and sediment losses from agricultural areas in the watershed, but smaller reductions were also achieved with the winter camelina rotation. From model predictions, achieving regional water-quality goals of a 30% reduction in nitrate-N load from fields in the watershed required converting approximately 25, 34, or 57% of current corn-soybean area to the alfalfa, IWG, or camelina rotations, respectively. Results of this study indicate that adoption of these crops could achieve regional water quality goals

Health care restructuring and family physician care for those who died of cancer

BACKGROUND: During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992) to 30% (1998). These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP) visits to advanced cancer patients in Nova Scotia (NS) during the years of health care restructuring. METHODS: Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics), the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000). Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212). Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department), time of day (regular hours, after hours), total length of inpatient hospital stay and number of hospital admissions during the last six months of life. RESULTS: In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED), 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP visits over time compared to 1992–93 levels (for 1997–98, adjusted RR = 0.88, 95%CI = 0.81–0.95) and an increase in FP ED visits (for 1997–98, adjusted RR = 1.18, 95%CI = 1.05–1.34). CONCLUSION: Despite hospital downsizing and fewer deaths occurring in hospitals, FP ambulatory visits (except for ED visits) did not rise correspondingly. Although such restructuring resulted in more people dying out of hospital, it does not appear FPs responded by providing more medical care to them in the community