“If you can’t see a dilemma in this situation you should probably regard it as a warning”. A metasynthesis and theoretical modeling of general practitioners’ opioid prescription experiences in primary care.

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, interventions to provide better supports in the prescribing of opioids for CNMP. The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986- Feb 2018. Two reviewers independently screened titles and abstracts. Studies were excluded from the review if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, as where quotations were not clearly attributed to GPs participating in the study. The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initially, organising themes were then developed followed by global themes which summarised the key theories emerging from the articles. Finally, a theoretical model was derived by the researchers using the global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 18 full text papers were assessed, and 13 studies included in the synthesis; 9 were from USA, 3 from UK and 1 from Sweden. Seven organising themes were identified including trust and mistrust, the importance of aetiology, monitoring of prescription use, physical, psychological and societal harm, consultation variables, inadequate pain management, stigma and stereotypes and system barriers to effective and safe prescribing such as limited access to specialist care or support from allied healthcare professionals in primary care. Four global themes emerged;suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying the opioid prescribing whereby the physician both consciously and subconsciously quantifies the risk-benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Prescribing of opioids for CNMP is influenced by a myriad of factors. Rather, than a simple risk-benefit view of the process, it is more useful to view this as a dynamic process in which unique considerations such as the morality of opioid use exert an effect. Recognising the inherent complexity of the process and the limitations of healthcare systems, guidelines directed at GPs should offer more nuanced recommendations on managing opioid prescribing consultations in primary care

Interaction between ASIP and MC1R in Black and Brown Alpaca

Animal fibres from South American camelids and other fibre or wool bearing species provide important products for use by the human population. The contemporary context includes the competition with petrocarbon-based artificial fibres and concern about excessive persistence of these in the natural environment. Animal fibres present highly valuable characteristics for sustainable production and processing as they are both natural and renewable. On the other hand, their use is recognised to depend on availability of appropriate quality and quantity, the production of which is underpinned by a range of sciences and processes which support development to meet market requirements. This collection of papers combines international experience from South and North America, China and Europe. The focus lies on domestic South American camelids (alpacas, llamas) and also includes research on sheep and goats. It considers latest advances in sustainable development under climate change, breeding and genetics, reproduction and pathology, nutrition, meat and fibre production and fibre metrology. Publication of this book is supported by the Animal Fibre Working Group of the European Federation of Animal Science (EAAP). ‘Advances in Fibre Production Science in South American Camelids and other Fibre Animals’ addresses issues of importance to scientists and animal breeders, textile processors and manufacturers, specialised governmental policy makers and students studying veterinary, animal and applied biological sciences

Interaction of ASP and MC1R in black and brown alpaca.

Alpaca coat colour is a relevant feature both for breeders than textile industries. Agouti (ASP) and Extension (MC1R) are genes known to be involved in coat colour through pigmentation pathways by regulating type, amount and distribution of eumelanin and pheomelanin pigments in melanocytes. In alpaca genotype of ASP and MC1R genes have already been analysed distinctly, but their epistatic interaction have not been evaluated. In this study have been assessed their segregation more insights on black and brown phenotypes. In several mammals MC1R is epistatic over ASP, id est recessive allele in Agouti (a) and dominant allele in Extension locus (E) produces black phenotype. That is confirmed in alpaca where black coat has aH/aΔ57 and aH/ahT genotype on agouti and E/E or E/e genotype on MC1R locus. Otherwise ASP and MC1R in Brown/Red Brown, have a dominant profile at least in one allele as A/A, A/ahT on Agouti and E/e on Extension. Genotype and phenotype comparison clears that receptor and ligand are in concordance to produce pheomelanin and eumelanin in alpaca. Segregation analysis of 12 alpaca families genotyped by coat color, confirm the dominance of brown over black and could be helpful for coat colour classification and genotyping

Variability of fibre quality on Chinese Alashan Left Banner White Cashmere goat

The heritability and the phenotypic and genetic correlations of down weight (DW), down fibre diameter (DFD), and coefficient of variation of the down fibre diameter (CVDFD) of Chinese Alashan Left Banner White Cashmere goat were estimated on 1375 one-year-old animals, born in 2009, 2011 and 2013 and bred at the Station for Livestock Improvement of Alashan (Left Banner, Inner Mongolia, P.R. China). For all traits, significant effects were for sex, cohort and sex–cohort interaction (p <.001). The heritability for DFD and CVDFD was high, 0.41 ± 0.08 and 0.52 ± 0.06, respectively. Heritability for the DW was low (0.12 ± 0.03). Phenotypic correlation calculated by Pearson’s coefficient showed that DFD is positively correlated with both CVDFD (0.29 ± 0.07) and DW (0.20 ± 0.05). The phenotypic correlation between CVDFD and DW was negative (−0.11 ± 0.06). The genetic correlations between DW and CVDFD and between DFD and CVDFD were both high and positive (0.63 ± 0.16 and 0.39 ± 0.1, respectively) while the DW showed a negative genetic correlation with DFD (−0.27 ± 0.2). Our results suggest that the selection for reducing DFD and its CVDFD is possible and a genetic progress can be achieved quickly in the Chinese Alashan Left Banner White Cashmere goat

Androgenetic alopecia: a review

Androgenetic alopecia, commonly known as male pattern baldness, is the most common type of progressive hair loss disorder in men. The aim of this paper is to review recent advances in understanding the pathophysiology and molecular mechanism of androgenetic alopecia.Using the PubMed database, we conducted a systematic review of the literature, selecting studies published from 1916 to 2016.The occurrence and development of androgenetic alopecia depends on the interaction of endocrine factors and genetic predisposition. Androgenetic alopecia is characterized by progressive hair follicular miniaturization, caused by the actions of androgens on the epithelial cells of genetically susceptible hair follicles in androgen-dependent areas. Although the exact pathogenesis of androgenetic alopecia remains to be clarified, research has shown that it is a polygenetic condition. Numerous studies have unequivocally identified two major genetic risk loci for androgenetic alopecia, on the X-chromosome ARa"EDA2R locus and the chromosome 20p11 locus.Candidate gene and genome-wide association studies have reported that single-nucleotide polymorphisms at different genomic loci are associated with androgenetic alopecia development. A number of genes determine the predisposition for androgenetic alopecia in a polygenic fashion. However, further studies are needed before the specific genetic factors of this polygenic condition can be fully explained

Alpaca FGF5: Hypothetical Post-Transcriptional Readthrough Regulation in Skin Biopsies

Animal fibres from South American camelids and other fibre or wool bearing species provide important products for use by the human population. The contemporary context includes the competition with petrocarbon-based artificial fibres and concern about excessive persistence of these in the natural environment. Animal fibres present highly valuable characteristics for sustainable production and processing as they are both natural and renewable. On the other hand, their use is recognised to depend on availability of appropriate quality and quantity, the production of which is underpinned by a range of sciences and processes which support development to meet market requirements. This collection of papers combines international experience from South and North America, China and Europe. The focus lies on domestic South American camelids (alpacas, llamas) and also includes research on sheep and goats. It considers latest advances in sustainable development under climate change, breeding and genetics, reproduction and pathology, nutrition, meat and fibre production and fibre metrology. Publication of this book is supported by the Animal Fibre Working Group of the European Federation of Animal Science (EAAP). ‘Advances in Fibre Production Science in South American Camelids and other Fibre Animals’ addresses issues of importance to scientists and animal breeders, textile processors and manufacturers, specialised governmental policy makers and students studying veterinary, animal and applied biological sciences

Molecular diagnosis of SARS-CoV-2 in seminal fluid

Purpose Due to relevant repercussions on reproductive medicine, we aimed to evaluate feasibility of RT-PCR as a detection method of SARS-CoV-2 RNA in seminal fluid. Methods A qualitative determination of the RT-PCR assays in semen was performed through different approaches: (1) efficiency of RNA extraction from sperm and seminal plasma was determined using PRM1 and PRM2 mRNA and a heterologous system as control; (2) samples obtained by diluting viral preparation from a SARS-CoV-2 panel (virus cultured in Vero E6 cell lines) were tested; (3) viral presence in different fractions of seminal fluid (whole sample, seminal plasma and post-centrifugation pellet) was evaluated. Semen samples from mild and recovered COVID-19 subjects were collected by patients referring to the Infectious Disease Department of the Policlinico Umberto I Hospital - "Sapienza" University of Rome. Control subjects were recruited at the Laboratory of Seminology-Sperm Bank "Loredana Gandini'' of the same hospital. Results The control panel using viral preparations diluted in saline and seminal fluid showed the capability to detect viral RNA presence with C-t values depending on the initial viral concentration. All tested semen samples were negative for SARS-CoV-2, regardless of the nasopharyngeal swab result or seminal fluid fraction. Conclusion These preliminary data show that RT-PCR for SARS-CoV-2 RNA testing appears to be a feasible method for the molecular diagnosis of SARS-CoV-2 in seminal fluid, supported by results of the control panel. The ability to detect SARS-CoV-2 in semen is extremely important for reproductive medicine, especially in assisted reproductive technology and sperm cryopreservation

Don't stand so close to me: Competitive pressures, proximity and inter-organizational collaboration

This paper investigates how geographical proximity moderates the nonmonotonic relation between niche overlap and the propensity of organizations to collaborate. The main prediction is that the strength of this relation is different for organizations with low versus high levels of geographical proximity. Proposed hypotheses are tested by using data collected within a community of hospital organizations serving more than five million residents in one of the largest Italian geographical regions. After controlling for internal resource complementarities and differences in organizational forms, behavioural orientations and institutional constraints among hospitals, this paper finds strong empirical support to the research hypotheses

Radiotherapy and palliative care outpatient clinic: a new healthcare integrated model in Italy

Background On the basis of substantial evidence demonstrate that palliative care combined with standard care improves patient, caregiver, and society outcomes, we have developed a new healthcare model called radiotherapy and palliative care (RaP) outpatient clinic were a radiation oncologist and a palliative care physician make a joint evaluation of advanced cancer patients. Methods We performed a monocentric observational cohort study on advanced cancer patients referred for evaluation at the RaP outpatient clinic. Measures of quality of care were carried out. Results Between April 2016 and April 2018, 287 joint evaluations were performed and 260 patients were evaluated. The primary tumor was lung in 31.9% of cases. One hundred fifty (52.3%) evaluations resulted in an indication for palliative radiotherapy treatment. In 57.6% of cases was used a single dose fraction of radiotherapy (8 Gy). All the irradiated cohort completed the palliative radiotherapy treatment. An 8% of irradiated patients received the palliative radiotherapy treatment in the last 30 days of life. A total of 80% of RaP patients received palliative care assistance until the end of life. Conclusion At the first descriptive analysis, the radiotherapy and palliative care model seem to respond to the need of multidisciplinary approach in order to obtain an improvement on quality of care for advanced cancer patients