The incidence of tuberculosis infection among the native inhabitants of the gold coast and its bearing on the question of immunity

In the Report of the Principal Registrar of Deaths in the Gold Coast for 1933 it was stated that during the previous three years the proportion of deaths from pulmonary tuberculosis had far exceeded that of all other killing diseases with the single exception of non- tuberculous affections of the respiratory tract.This disease accounted for 9.9 per cent. of the total deaths in 1931, 9.2 per cent. in 1932 and 10.5 per cent. in 1933. Tuberculosis of the respiratory tract and consequently the most infective form of the disease was far more common than any other type. In 1933 deaths from pulmonary tuberculosis numbered 658 as compared with 47 from other forms.In the Report of the Medical Department, Gold Coast, for 1932 -33, the Director of Medical Services wrote that the tuberculosis problem was one of the most important to be faced. He attributed the high incidence of this disease to insanitary housing, overcrowding, a total ignorance of the rudimentary laws of hygiene and lack of immunity. This lack of immunity associated with scanty tuberculisation of the native races is stressed by Young' in discussing the spread of tuberculosis among the African population of Nigeria.As resistance to a disease may be natural or acquired, so lack of it may be due to inherent susceptibility or to absence of opportunity to acquire immunity.According to Opie, there is' no proof that the negro race has any inherent susceptibility to tuberculosis, and in another report, the same author writes: "There is indeed very little convincing evidence for or against the opinion that inherited susceptibility on the one hand, or inherited resistance on the other, modifies the progress of tuberculosis in human beings ".Carter, on the other hand, has tried to show that the black races have less innate resistance than the white. He cites the results of sanitorium treatment to show that tuberculosis undergoes improvement more frequently in white people than in negroes, and he attaches particular significance to the observation that Mulattoes are in this respect intermediate between whites and blacks. He points out that Mulattoes and blacks live under practically identical environmental conditions, and he concludes that the Mulatto is more resistant because the White race has transmitted part of its inherited immunity to him.Carter has not considered the other possibility that the whites have by contact transmitted the disease to the Mulatto, and that by reason of this, acquired resistance may have been established. This possibility cannot be excluded.Fishberg states that tuberculosis is inherently not a racial problem and that one human race or ethnic group, when first encountering the tubercle bacillus, is as vulnerable to infection as another. It is only after they have been exposed to infection for generations that they acquire a certain degree of resistance which causes milder clinical forms of the disease than are found in races which are virgin soil to the bacilli.It would appear, therefore, that any want of immunity on the part of West African natives is due rather to lack of opportunity to develop resistance than to any hereditary or racial predisposition to the disease. This view is supported by Griffith6, who says that races previously free from tuberculosis are much more susceptible to the disease than those who have long been exposed to infection. He attributes the greater resistance of infected communities either to a weeding out of the more susceptible human beings, the resistant individuals surviving, or to an acquired immunity produced by slight infections which have been overcome.As acquired immunity depends on exposure to infection it would seem necessary to know the incidence of tuberculous infection before one can consider the degree of resistance to tuberculosis which a given population may have developed.A comparison of the infection rate with the mortality or morbidity rates would then give a measure of the acquired resistance of the population in question. A high infection rate associated with low mortälity or morbidity rates would suggest a considerable degree of resistance; the reverse condition would point to a low degree.It was because the author was unable to find any record of the incidence of tuberculous infection among the native inhabitants of the Gold Coast that the present investigation was begun

Developing a Work flow for Creating a Data Portal for the Eaglebine Oil and Gas Play

The oil production in Texas is growing rapidly with the discoveries of new methods such as Hydraulic Fracking and discoveries of new Oil Plays like The Eagleford Shale Play. The growth is so fast and so large that great amount of data is being produced every day. The ability to compile and research this data is very limited. This is the problem that we are attempting solve by creating and managing a workflow on how to gather and input geological, geophysical and geographical data into a database that will support research from several departments at Texas A&M University. This workflow comprise different stages. First, collecting data from various sources. Second, the data sorting and formatting. Third, the database creation. After the data is transformed into a 2D and 3D interactive webpage that allow the data to be accessed by the users. The advantage of this database is to combine resources from different departments on campus to use this data for research. This instrument will be useful in obtaining data for projects in an oil and gas play area. However the lack of help from industry and problems with free data available to the public can present a challenge. If user do not upload processed data files then the growth of files would be hampered

Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project

Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department

Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project

Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department

Sporopollenin chemistry and its durability in the geological record: an integration of extant and fossil chemical data across the seed plants.

Sporopollenin is a highly resistant biopolymer that forms the outer wall of pollen and spores (sporomorphs). Recent research into sporopollenin chemistry has opened up a range of new avenues for palynological research, including chemotaxonomic classification of morphologically cryptic taxa. However, there have been limited attempts to directly integrate extant and fossil sporopollenin chemical data. Of particular importance is the impact of sample processing to isolate sporopollenin from fresh sporomorphs, and the extent of chemical changes that occur once sporomorphs enter the geological record. Here, we explore these issues using Fourier transform infrared (FTIR) microspectroscopy data from extant and fossil grass, Nitraria (a steppe plant), and conifer pollen. We show a 98% classification success rate at subfamily level with extant grass pollen, demonstrating a strong taxonomic signature in isolated sporopollenin. However, we also reveal substantial chemical differences between extant and fossil sporopollenin, which can be tied to both early diagenetic changes acting on the sporomorphs and chemical derivates of sample processing. Our results demonstrate that directly integrating extant and late Quaternary chemical data should be tractable as long as comparable sample processing routines are maintained. Consistent differences between extant and deeper time sporomorphs, however, suggests that classifying fossil specimens using extant training sets will be challenging. Further work is therefore required to understand and simulate the effects of diagenetic processes on sporopollenin chemistry

Management of patients with advanced prostate cancer—metastatic and/or castration-resistant prostate cancer: report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022

Background: Innovations in imaging and molecular characterisation together with novel treatment options have improved outcomes in advanced prostate cancer. However, we still lack high-level evidence in many areas relevant to making management decisions in daily clinical practise. The 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) addressed some questions in these areas to supplement guidelines that mostly are based on level 1 evidence. Objective: To present the voting results of the APCCC 2022. Design, setting, and participants: The experts voted on controversial questions where high- level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration- resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions. Outcome measurements and statistical analysis: The panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration- resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions. Results and limitations: The voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer. Conclusions: These voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with healthcare providers worldwide. At each APCCC, an expert panel votes on pre-defined questions that target the most clinically relevant areas of advanced prostate cancer treatment for which there are gaps in knowledge. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients and their relatives as part of shared and multidisciplinary decision-making. This report focuses on the advanced setting, covering metastatic hormone-sensitive prostate cancer and both non-metastatic and metastatic castration-resistant prostate cancer. Twitter summary: Report of the results of APCCC 2022 for the following topics: mHSPC, nmCRPC, mCRPC, and oligometastatic prostate cancer. Take-home message: At APCCC 2022, clinically important questions in the management of advanced prostate cancer management were identified and discussed, and experts voted on pre-defined consensus questions. The report of the results for metastatic and/or castration- resistant prostate cancer is summarised here

Colliding Worlds: Asteroid research and the legitimization of war in space

Accepted versio

Management of Patients with Advanced Prostate Cancer. Part I : Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

Background: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. Objective: To present consensus voting results for select questions from APCCC 2022. Design, setting, and participants: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members (“panellists”) who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1–3. Outcome measurements and statistical analysis: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. Results and limitations: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. Conclusions: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.publishedVersionPeer reviewe

Management of patients with advanced prostate cancer. Part I: Intermediate-/high-risk and locally advanced disease, biochemical relapse, and side effects of hormonal treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

© 2023 The Authors. Published by Elsevier on behalf of European Association of Urology. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1016/j.eururo.2022.11.002Background: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. Objective: To present consensus voting results for select questions from APCCC 2022. Design, setting, and participants: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members (“panellists”) who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1–3. Outcome measurements and statistical analysis: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. Results and limitations: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. Conclusions: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.We gratefully acknowledge the following organisations for providing financial support for the APCCC 2022: The City of Lugano and Movember Foundation. Ros Eeles is supported by a National Institute of Health Research grant to the Biomedical Research Centre at The Institute of Cancer Research and Royal Marsden NHS Foundation Trust. We also acknowledge sponsorship from several for-profit organisations for APCCC 2022, including Advanced Accelerator Applications, Amgen, Astellas, AstraZeneca, Bayer Health Care, Debiopharm, MSD, Janssen Oncology, Myovant Sciences, Orion Pharma, Pfizer Oncology, Roche, Telix Innovations SA, Ferring Pharmaceuticals, Lantheus, and Tolmar. These for-profit organisations supported the conference financially but had no input on the scientific content or the final publication.Accepted versio