Osteoporosis

Includes bibliographical references.This paper examines the effects, causes, symptoms, prevention methods, and treatments of osteoporosis. Various forms of literature including journal articles and books were used to research this topic. The information gathered was compacted into a paper that explained and stated the most relevant and proven facts regarding osteoporosis. The information was then compacted further when a pamphlet was made consisting of the most important information. The purpose of the paper was to provide a tool for the college age population to help prevent a common disease that could affect them later in life. The pamphlet was assembled to be a quick reference guide of the most important information and to spread the information more quickly and easily. However, because of technical dilemmas, the pamphlet was unable to be utilized in the manner that was planned but could be used in a clinical situation.B.S. (Bachelor of Science

Characterisation of Chitosan/PVA/PVP Crossed- linked Nanofibrous Scaffolds for the Potential Application in Dermal Tissue Engineering

Severe burn injuries lead to significant morbidity and mortality as they are traumatic and affect nearly every organ system. Commonly used clinical practices are early burn lesion removal and skin grafting which have improved outcomes for patients with severe burns by lessening mortality rate and length of hospitalisation (Wood 2014). However, the challenges of sourcing donor site tissue especially as in the case of large burn wounds, and poor healing outcomes, for example, scarring, still remain. Tissue engineering combines science and engineering to create functional tissue and organs to maintain, restore or replace diseased parts of the body (Peltola et al. 2008). The applications of tissue engineering are broad; from aiding the growth of new skin, to the delivery of biologically active molecules such as stem cells and growth factors in order to enhance wound healing and regeneration of skin tissue (Kang et al. 2018). The fundamental goal of dermal tissue engineering is to create new fully functional skin including all skin appendages such as blood vessels, nerves, and sweat glands (Wang et al. 2018). This tool not only aids in healing and regeneration but also to reduce scarring and the long-term consequences associated with having scarred tissue (Chua et al. 2016). The electrospinning technology is a popular choice when it comes to producing nanofibers with large surface area to volume ratios and structural architecture similar to the extracellular matrix (ECM) found in skin tissue. Chitosan is the second most abundant natural biomaterial after cellulose (Schiffman and Schauer 2007) and possesses enticing advantages for use in tissue engineering are due to its intrinsic biocompatibility, biodegradability and high-water adsorption capability. Chitosan based composite nanofibers, blended with carrier polymers polyvinyl alcohol (PVA) and polyvinyl pyyrolidone (PVP) were prepared by the electrospinning method. The blend solutions were characterised before electrospinning using rheology. The synthesised three-dimensional electrospun nanofibrous scaffolds (3DENS) were characterised by SEM, FTIR, degradation, and swelling studies. The biological compatibly of the 3DENS were characterised by MTT and live-dead cell assay using cultured human keratinocytes (HaCaT) and normal human dermal fibroblasts (NHDF) cells lines. The dry weight ratio of materials influences the viscosity and spinnability of the material. 3DENS were successfully fabricated using chitosan, PVA and PVP. The 3DENS mechanical and chemical properties were affected by the varying concentrations of materials. Crosslinking the 3DENS using heat increased the water adsorption capability by increasing the number of functional hydrophilic groups in the 3DENS. Crosslinked 3DENS resisted degradation compared to uncrosslinked 3DENS. The addition of chitosan to PVA/PVP increased the rate of degradation for uncrosslinked and crosslinked scaffolds. All the fabricated 3DENS displayed excellent biocompatibility. Uncrosslinked 3DENS showed better NHDF cell viability than crosslinked 3DENS. However, all 3DENS provided a favourable environment for cell viability and growth for HaCaT and NHDF cells

Utilization and access to health care services among African immigrants living in Pittsburgh

Research indicates the health of many immigrant populations’ deteriorates the longer they live in the U.S., leading to the “immigrant health advantage” phenomenon. Several studies suggest new immigrants tend to have healthier behaviors when they first arrive in America compared to U.S. natives. Immigrants tend to originate from cultures with patterns of lower stress levels and strong familial and societal networks that promote healthier lifestyles. Structural and systematic barriers to accessing and utilizing health care services could potentially explain the eventual decline in immigrant health. Immigrants lacking access to health care services are likelier to have poorer health outcomes. According to research studies, many African immigrants face barriers to accessing and utilizing health care due to limited English proficiency, lack of insurance, immigration status and overall lack of understanding of the complex American health care system. African immigrants have arguably been the most underserved communities within the United States despite being one of the fasting growing immigrant subgroups. As economic pressures and political conflicts continue to influence increased African migration to the U.S., host communities must prepare to become one of the major destinations for African immigrants. Public health agencies, health care providers and community-based nonprofit organizations must understand the needs of these communities and address their health attitudes to better promote access and utilization of health care services. If the health care needs and practices of African immigrants remain poorly understood, they are at risk for worsening health outcomes. The result would be increased burden on health care service providing agencies. This incomplete understanding warrants a further evaluation. To answer this question, a congregation of African immigrants from the Pittsburgh Gospel Tabernacle Church served as a representative sample of immigrants accessing and utilizing health care services in Pittsburgh. The congregation was asked to participate in a voluntary survey. The survey questions were organized around 3 major themes 1) Perceived barriers to access of healthcare services; 2) Perceived quality of healthcare provided; 3) Previous access to healthcare services. Results were not completely consistent with current literature but data did reveal patterns of barriers to accessing and utilizing health care among participants. The reasons for disparity in access to health care were mainly attributable to income, transportation and language barriers. Newly arriving immigrants face tremendous challenges and the lack of country-of-origin data on African immigrant populations provides an even further limited understanding of the barriers immigrants face in utilizing and accessing health care services. The African immigrant population’s burden of disease can affect their social and economic capital, which determines their long-term success in acclimating in the U.S. This research intends to shed light on the possibility of interventions that can improve the health of African immigrants and increase their potential for upward mobility

Determining the crystal structure of SseB, a product of the Salmonella Pathogenicity Island II Type III Secretion System of Salmonella typhimurium

Salmonella typhimurium is a bacterium that causes many food-borne illnesses such as gastrointestinal infections, diarrhea, and abdominal cramps. It affects 700,000 to 3.8 million people each year. The SseB protein, a part of the Salmonella Pathogenicity Island II (SPI2), plays a critical role in the pathogenesis of gastrointestinal infections. It is part of the Type III Secretion System (TTSS) that is involved in translocating proteins from the bacteria to the host gastro intestinal-epithelial cells. The aim of the research project is to clone, purify the SseB protein from Salmonella typhimurium and obtain a diffracting-quality crystal that will give high resolution data so that the structure of the protein can be determined using x-ray diffraction patterns. The SseB gene was amplified and cloned into pET30b vector and transformed into E. coli novablue cells. The SseB protein is then expressed into E. coli BL21 cells and purified using various chromatographic methods. Purified protein was used for crystallization and diffracting quality crystals were obtained using grid screening method. SseB protein crystallized in P-orthorhombic space group (P 21 21 21) and diffracted to 3.8Å. Further optimization is underway to get a good diffracting quality crystal. It is important to determine the crystal structure of SseB since this will reveal its role in the interaction with other translocation complex such as (SseC and SseD). Based on the structural information, potential drug targets can be designed for translocon complex, which can further prevent diseases caused by the bacterium Salmonella and other closely related bacteria

Health service delivery and workforce in northern Australia: a scoping review

Introduction: Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues influencing the coverage, quality and responsiveness of health services across this region by examining the available published literature and identifying key policy-relevant gaps. Methods: A scoping review design was adopted with searches incorporating both peer-reviewed and grey literature (eg strategy documents, annual reports and budgets). Grey literature was predominantly sourced from websites of key organisations in the three northern jurisdictions, with peer-reviewed literature sourced from electronic database searches and reference lists. Key articles and documents were also contributed by health sector experts. Findings were synthesised and reported narratively using the WHO health system ‘building blocks’ to categorise the data. Results: From the total of 324 documents and data sources included in the review following screening and eligibility assessment, 197 were peer-reviewed journal articles and 127 were grey literature. Numerous health sector actors across the north – comprising planning bodies, universities and training organisations, peak bodies and providers – deliver primary, secondary and tertiary healthcare and workforce education and training in highly diverse contexts of care. Despite many exemplar health service and workforce models in the north, this synthesis describes a highly fragmented sector with many and disjointed stakeholders and funding sources. While the many strengths of the northern health system include expertise in training and supporting a fit-for-purpose health workforce, health systems in the north are struggling to meet the health needs of highly distributed populations with poorly targeted resources and ill-suited funding models. Ageing of the population and rising rates of chronic disease and mental health issues, underpinned by complex social, cultural and environmental determinants of health, continue to compound these challenges. Conclusion: Policy goals about developing northern Australia economically need to build from a foundation of a healthy and productive population. Improving health outcomes in the north requires political commitment, local leadership and targeted investment to improve health service delivery, workforce stability and evidence-based strengthening of community-led comprehensive primary health care. This requires intersectoral collaboration across many organisations and the three jurisdictions, drawing from previous collaborative experiences. Further evaluative research, linking structure to process and outcomes, and responding to changes in the healthcare landscape such as the rapid emergence of digital technologies, is needed across a range of policy areas to support these efforts

Progression of MRI markers in cerebral small vessel disease: sample size considerations for clinical trials.

Detecting treatment efficacy using cognitive change in trials of cerebral small vessel disease (SVD) has been challenging, making the use of surrogate markers such as magnetic resonance imaging (MRI) attractive. We determined the sensitivity of MRI to change in SVD and used this information to calculate sample size estimates for a clinical trial. Data from the prospective SCANS (St George's Cognition and Neuroimaging in Stroke) study of patients with symptomatic lacunar stroke and confluent leukoaraiosis was used (n=121). Ninety-nine subjects returned at one or more time points. Multimodal MRI and neuropsychologic testing was performed annually over 3 years. We evaluated the change in brain volume, T2 white matter hyperintensity (WMH) volume, lacunes, and white matter damage on diffusion tensor imaging (DTI). Over 3 years, change was detectable in all MRI markers but not in cognitive measures. WMH volume and DTI parameters were most sensitive to change and therefore had the smallest sample size estimates. MRI markers, particularly WMH volume and DTI parameters, are more sensitive to SVD progression over short time periods than cognition. These markers could significantly reduce the size of trials to screen treatments for efficacy in SVD, although further validation from longitudinal and intervention studies is required.Journal of Cerebral Blood Flow & Metabolism advance online publication, 3 June 2015; doi:10.1038/jcbfm.2015.113

Mechanisms of Cognitive Impairment in Cerebral Small Vessel Disease: Multimodal MRI Results from the St George's Cognition and Neuroimaging in Stroke (SCANS) Study.

Cerebral small vessel disease (SVD) is a common cause of vascular cognitive impairment. A number of disease features can be assessed on MRI including lacunar infarcts, T2 lesion volume, brain atrophy, and cerebral microbleeds. In addition, diffusion tensor imaging (DTI) is sensitive to disruption of white matter ultrastructure, and recently it has been suggested that additional information on the pattern of damage may be obtained from axial diffusivity, a proposed marker of axonal damage, and radial diffusivity, an indicator of demyelination. We determined the contribution of these whole brain MRI markers to cognitive impairment in SVD. Consecutive patients with lacunar stroke and confluent leukoaraiosis were recruited into the ongoing SCANS study of cognitive impairment in SVD (n = 115), and underwent neuropsychological assessment and multimodal MRI. SVD subjects displayed poor performance on tests of executive function and processing speed. In the SVD group brain volume was lower, white matter hyperintensity volume higher and all diffusion characteristics differed significantly from control subjects (n = 50). On multi-predictor analysis independent predictors of executive function in SVD were lacunar infarct count and diffusivity of normal appearing white matter on DTI. Independent predictors of processing speed were lacunar infarct count and brain atrophy. Radial diffusivity was a stronger DTI predictor than axial diffusivity, suggesting ischaemic demyelination, seen neuropathologically in SVD, may be an important predictor of cognitive impairment in SVD. Our study provides information on the mechanism of cognitive impairment in SVD

Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease.

BACKGROUND AND PURPOSE: Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time. METHODS: Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition. RESULTS: Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up. CONCLUSIONS: Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy