Cancer incidence in the south Asian population of California, 1988–2000

BACKGROUND: Although South Asians (SA) form a large majority of the Asian population of U.S., very little is known about cancer in this immigrant population. SAs comprise people having origins mainly in India, Pakistan, Bangladesh and Sri Lanka. We calculated age-adjusted incidence and time trends of cancer in the SA population of California (state with the largest concentration of SAs) between 1988–2000 and compared these rates to rates in native Asian Indians as well as to those experienced by the Asian/Pacific Islander (API) and White, non-Hispanic population (NHW) population of California. METHODS: Age adjusted incidence rates observed among the SA population of California during the time period 1988–2000 were calculated. To correctly identify the ethnicity of cancer cases, 'Nam Pehchan' (British developed software) was used to identify numerator cases of SA origin from the population-based cancer registry in California (CCR). Denominators were obtained from the U.S. Census Bureau. Incidence rates in SAs were calculated and a time trend analysis was also performed. Comparison data on the API and the NHW population of California were also obtained from CCR and rates from Globocan 2002 were used to determine rates in India. RESULTS: Between 1988–2000, 5192 cancers were diagnosed in SAs of California. Compared to rates in native Asian Indians, rates of cancer in SAs in California were higher for all sites except oropharyngeal, oesophageal and cervical cancers. Compared to APIs of California, SA population experienced more cancers of oesophagus, gall bladder, prostate, breast, ovary and uterus, as well as lymphomas, leukemias and multiple myelomas. Compared to NHW population of California, SAs experienced more cancers of the stomach, liver and bile duct, gall bladder, cervix and multiple myelomas. Significantly increasing time trends were observed in colon and breast cancer incidence. CONCLUSION: SA population of California experiences unique patterns of cancer incidence most likely associated with acculturation, screening and tobacco habits. There is need for early diagnosis of leading cancers in SA. If necessary steps are not taken to curb the growth of breast, colon and lung cancer, rates in SA will soon approximate those of the NHW population of California

Effects of Shambhavi Mahamudra Kriya, a Multicomponent Breath-Based Yogic Practice ( Pranayama), on Perceived Stress and General Well-Being

Stress-induced disorders such as anxiety represent the leading causes of adult disability worldwide. Previous studies indicate that yoga and other contemplative practices such as pranayama, or controlled yogic breathing techniques, may be effective in the treatment of mood disorders and stress. In this study, 142 individuals (mean age = 43 years; SD = 13.90) participated in a 3-day retreat program during which they learned Shambhavi Mahamudra kriya, which is a yogic practice that includes both deep breathing and meditation techniques. Participants were instructed to practice the kriya each day for 21 minutes. After 6 weeks of daily practice, participants reported subjectively lower levels of perceived stress (Perceived Stress Scale) and higher levels of general well-being (General Well-Being Scale) compared to baseline. These results support the notion that Shambhavi Mahamudra kriya may represent a natural treatment for stress reduction

Immune Dysfunction and Autoimmunity as Pathological Mechanisms in Autism Spectrum Disorders

Autism spectrum disorders (ASD) are a group of heterogeneous neurological disorders that are highly variable and are clinically characterized by deficits in social interactions, communication, and stereotypical behaviors. Prevalence has risen from 1 in 10,000 in 1972 to 1 in 59 children in the United States in 2014. This rise in prevalence could be due in part to better diagnoses and awareness, however, these together cannot solely account for such a significant rise. While causative connections have not been proven in the majority of cases, many current studies focus on the combined effects of genetics and environment. Strikingly, a distinct picture of immune dysfunction has emerged and been supported by many independent studies over the past decade. Many players in the immune-ASD puzzle may be mechanistically contributing to pathogenesis of these disorders, including skewed cytokine responses, differences in total numbers and frequencies of immune cells and their subsets, neuroinflammation, and adaptive and innate immune dysfunction, as well as altered levels of immunoglobulin and the presence of autoantibodies which have been found in a substantial number of individuals with ASD. This review summarizes the latest research linking ASD, autoimmunity and immune dysfunction, and discusses evidence of a potential autoimmune component of ASD

Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction

Background: Several inflammation biomarkers have been implicated in the pathogenesis and prognosis of acute coronary syndromes. However, the prognostic role of the neutrophil-lymphocyte white cell interactive response to myocardial injury in predicting short- and long-term mortality after ST elevation myocardial infarction (STEMI) remains poorly defined.Methods: We evaluated 250 consecutive STEMI patients presenting acutely for revascularization to our tertiary care center over 1 year. Patients with acute sepsis, trauma, recent surgery, autoimmune diseases, or underlying malignancy were excluded. Data gathered included demographics, clinical presentation, leukocyte markers, electrocardiograms, evaluations, therapy,major adverse cardiac events, and all-cause mortality.Results: Mean age was 62 ± 15 years, 70.4% of subjects were males while majority (49.4%) were Caucasians. Mean duration of follow-up was 571 ± 291 days (median 730 days). Univariate analysis of several inflammatory biomarkers including C-reactive protein, revealed white cell count (OR = 1.09, p < 0.001) and neutrophil to lymphocyte ratio (NLR) (OR = 1.05, p = 0.011) as predictors of short- and long-term mortality; but not mean neutrophil count (OR = 1.04, p = 0.055) or lymphocyte count alone (OR = 0.96, p = 0.551). Multivariate analysis using backward stepwise regression revealed NLR (OR = 2.64, p = 0.026), female gender (OR = 5.35, p < 0.001), cerebrovascular accident history (OR = 3.36, p = 0.023), low glomerular filtration rate (OR = 0.98, p = 0.012) and cardiac arrest on admission (OR = 17.43, p < 0.001) as robust independent predictors of long-term mortality. NLR was divided into two sub-groups based on an optimal cut off value of 7.4. This provided the best discriminatory cut off point for predicting adverse mortality outcome. Both short-term (≤ 30 days) and long-term (≤ 2 years) mortality were predicted with Kaplan-Meier survival curve separation best stratified by a NLR cut off value of 7.4.Conclusions: NLR based on an optimal cut off value of 7.4, was an excellent predictor of short- and long-term survival in patients with revascularized STEMI and warrants larger scale multi-center prospective evaluation, as a prognostic indicator. NLR offers improved prognostic capacity when combined with conventional clinical scoring systems, such as the Thrombolysis In Myocardial Infarction risk score.

The changing landscape of practice education in physiotherapy: an investigation into the educator and student experience of a rotational placement pilot

Background: As the number of physiotherapy programs has increased over recent years, there is a corollary need to explore all means of ensuring there are sufficient clinical placement opportunities. As well as meeting capacity requirements, it is vital that the quality of clinical education remains high. One area of clinical placement provision not widely used in physiotherapy is ‘placement rotation’, whereby students complete several placements in different clinical areas within one trust. This concept is well established throughout nursing programmes. As an adjunct to a pilot model of rotational placements for physiotherapy students, of which the first author’s institution was the lead partner alongside a single NHS Foundation Trust in the north west of England, this study qualitatively explores the student and Clinical Educator (henceforth CE) experiences thereof. Method: With full institutional ethical approval, and using purposive sampling, a total of N=12 participants were recruited. Of these, N=6 were (a) second-year postgraduate (MSc) physiotherapy students who had (b) completed a full rotation, and N=6 were CEs (a) working within the participating NHS Trust and (b) directly involved in physiotherapy placement supervision. All participants sat for a single semi-structured online interview using Microsoft Teams, which was transcribed verbatim (with redactions made for identity protection), and analysed using reflexive thematic analysis. Findings: Analysis of the student interviews yielded four main themes: 1. Constructive induction, 2. Inclusion within the professional team, 3. Strong peer support, 4. Guaranteed breadth of clinical experience. Analysis of CE interviews also yielded four main themes: 1. Induction and infrastructure, 2. Time efficiency, 3. Rapid patient contact, 4. Rapid team integration. Conclusions: Although they were not without some problems, experiences of the physiotherapy rotational placement pilot among both groups were overwhelmingly positive. Moreover, the study revealed a number of prospectively unexpected and novel ways in which both students and CEs felt benefits from the rotational model, not least around the technical and personal value of a single umbrella-type induction, and rapid social and professional integration of teams. It is hoped that the findings described will both promote and inform future interventions

Changing the landscape of physiotherapy practice education: students’ experiences of a rotational placement pilot initiative in England

Purpose: Not least as a consequence of the NHS staffing shortages exposed by the Covid-19 pandemic, UK higher education institutions (HEIs) have been charged with increasing the numbers of allied healthcare professionals trained across-the-board. In physiotherapy, enlarging core student numbers within universities themselves has proven considerably less challenging than finding sufficient practice placements for these students during their degrees. Finding creative solutions to this problem - and evidencing their efficacy in terms consistency, quality and student experience - has, thus, become a key priority in contemporary physiotherapy education. This paper addresses one prospective solution: the use of ‘placement rotation’. Therein, students complete several rotations in different clinical areas within a single trust as one ostensibly ongoing placement, with a single induction and a consistent group of peers and educators. Rotational placements have been a routine feature of nurse training for some time, with robust research underscoring their value, but remain largely untested in physiotherapy. Focusing on a three-rotation pilot initiative run by the authors’ HEI and a single NHS trust in northwest England, findings qualitatively address the nuances of student experiences. Methods: With full institutional ethical approval (ref:21/44), N=6 participants were purposively recruited. All were final-year postgraduate (MSc) physiotherapy students, who had (a) completed a full rotation, and (b) had prior experience of more ‘conventional’ physiotherapy placements as a comparative touchstone. Each participant provided a single, in-depth semi-structured online interview. The full data corpus was transcribed verbatim, with key redactions made for the protection of participants’ identities and analysed using reflexive thematic analysis. Results: Analysis of the interviews yielded four major themes. (1) Induction, IT and continuity: A single induction, and particularly a single issuing of IT login and smart card to cover multiple rotations, was highly lauded by all participants in terms of increasing the speed at which they could know their workplace, access records and engage in direct patient contact on later rotations. (2) Professional inclusion: All participants reported that the pilot enabled them to quickly assimilate into the professional team during their latter rotations, feeling (and being treated) more like full members of staff, rather than ‘just students’. (3) Peer relationships: Being with the same group of peers throughout the rotations was viewed as a core strength of pilot. (4) Guaranteed diversity of experience: Key to the success of the pilot for all participants was the security and confidence it provided, regarding what they could expect. They ‘signed-up’ to one placement, knowing where there would be, with whom, and what they would be doing over several rotations. Conclusions: The student experience of the rotational pilot was overwhelmingly positive, both professionally and interpersonally. The key cross-cutting issue was the value of relatively certainty to participants, regarding ‘what’s next’ in their working and social environment. This reinforced both their learning and confidence. Impact: Although the reported findings are small-scale and emergent of a local pilot scheme, there is little extant data on rotational placements in physiotherapy education elsewhere. As such, it is hoped, this analysis might help ground future interventions and research

Changing the landscape of physiotherapy practice education: clinical educators’ experiences of a rotational pilot initiative in England

Purpose: Practice-based learning is a mandatory element of physiotherapy training which facilitates students to apply acquired theoretical knowledge in a clinical setting. Instrumental to the success of any placement scheme, meanwhile, is the work of Clinical Educators (CEs), for whom the challenge of managing multidimensional roles has been well-documented; this includes being skilled practitioners, acting as role models and juggling competing needs of patients, students, and associated administrative tasks. As the number of physiotherapy programs in the UK has increased over recent years, there has been a corollary need to explore new means of ensuring (a) there are sufficient clinical placement opportunities for all students, and (b) that the quality of clinical education does not decline, without (c) placing additional or unmanageable strain on CEs. This paper reports qualitative findings relating to the experiences of CEs with respect to a trial of a novel model of placement provision not widely used (or researched for efficacy) in physiotherapy to date: ‘placement rotation’. Herein, as an ostensible single placement, a group of students completed three ‘rotations’ in different clinical areas, but with consistent set of CEs, within a single NHS Foundation Trust in the northwest of England. Methods: With full institutional ethical approval (ref: 21/44), N=6 CEs directly involved with the rotational placement initiative were recruited. All participants sat for a single semi-structured online interview once they had worked with students through at least one full set of rotations. Data were captured using Microsoft Teams, transcribed verbatim (with redactions made for identity protection), and analysed using reflexive thematic analysis. Results: Analysis of data from the CE interviews yielded three main themes. 1. Induction, infrastructure and efficiency: All participants highlighted how having a single induction greatly increased the rate at which students could access key systems across the full placement, and smoothed movement between rotations. 2. Rapid patient contact: Relatedly, participants highlighted how both students’ familiarity with patients and comfort in the ward/hospital workplace across rotations was of great benefit to students, patients and working rhythms alike. 3. Rapid team integration: The structure of the rotational placement was taken to boost teamwork among the students, which the participants deemed beneficial for both education and service delivery, as well as student wellbeing. It also, however, was reported to have boosted teamwork among the CEs themselves; the consistent co-presence of the professional group helping them coordinate their own work and enhance interpersonal support. Conclusions: The CEs’ experiences of the physiotherapy rotational placement pilot were overwhelmingly positive. Moreover, the study revealed ways in which CEs felt personal and professional benefits from the rotational model, not least around the technical and personal value of a single umbrella-type induction, and rapid and sustained social and professional integration of student and staff teams. Impact: It is hoped that the findings described will both promote and inform future interventions, and also serve as a reminder that the experience of CEs should not be overlooked in the design and execution of future rotational placement schemes

Characterization of an electron conduit between bacteria and the extracellular environment

A number of species of Gram-negative bacteria can use insoluble minerals of Fe(III) and Mn(IV) as extracellular respiratory electron acceptors. In some species of Shewanella, deca-heme electron transfer proteins lie at the extracellular face of the outer membrane (OM), where they can interact with insoluble substrates. To reduce extracellular substrates, these redox proteins must be charged by the inner membrane/periplasmic electron transfer system. Here, we present a spectro-potentiometric characterization of a trans-OM icosa-heme complex, MtrCAB, and demonstrate its capacity to move electrons across a lipid bilayer after incorporation into proteoliposomes. We also show that a stable MtrAB subcomplex can assemble in the absence of MtrC; an MtrBC subcomplex is not assembled in the absence of MtrA; and MtrA is only associated to the membrane in cells when MtrB is present. We propose a model for the modular organization of the MtrCAB complex in which MtrC is an extracellular element that mediates electron transfer to extracellular substrates and MtrB is a trans-OM spanning ß-barrel protein that serves as a sheath, within which MtrA and MtrC exchange electrons. We have identified the MtrAB module in a range of bacterial phyla, suggesting that it is widely used in electron exchange with the extracellular environment

High-Q Si3N4 Ring Resonators for Locking 780nm GaAs-Based Distributed Feedback Laser

High-Q microring resonators have applications in gyroscopes, frequency comb generation, and feedback systems to control narrow linewidth integrated lasers [1–3]. This paper demonstrates the highest Q values measured for microring resonators at 780 nm wavelength. These sub mm integrated cavities can be used to provide an error signal for locking a distributed feedback laser (DFB), Fig. 1(a), using the Pound-Drever-Hall (PDH) method. High stability DFBs can also be achieved using a micro-electro-mechanical system (MEMS) cell containing 87 Rb vapour and taking advantage of the absorption line at 780.24 nm. This provides an absolute reference for locking the laser but only to the 87 Rb transition wavelengths. The microring resonator can be tailor made for any wavelength but is susceptible to thermal effects; this could in part be overcome using a top cladding with a thermo-optic coefficient that counteracts that of the waveguide core