No Complaining...

It is said that hunger is a great motivator. If only the hunger for knowledge were as great as the hunger for physical sustenance. This statement could be lodged as a complaint, but that would defeat the purpose of this essay. How is it possible to turn the toil of our learning into the enlightenment for self-improvement

Psychological and physiological predictors of the development and modulation of instrusive images

Researchers have suggested that engaging in visuospatial tasks, such as the videogame Tetris™, following a trauma may interfere with the development of intrusive images associated with posttraumatic stress disorder (PTSD). The present study attempted to replicate this finding using a trauma film paradigm. Furthermore, we were interested in identifying if participants who played Tetris would show changes in other symptoms associated with PTSD, such as enhanced startle responses. Participants (N = 129) were asked to view a film with traumatic content and were then randomly assigned to play either Tetris or to sit quietly for 10 min. Psychological reactivity (positive affect, negative affect, and dissociation) and physiological reactivity (cardiac measure of sympathetic and parasympathetic activity, heart rate, and salivary alpha amylase) were examined as potential predictors of the frequency of intrusive images. Our findings indicated that intrusive images occurred significantly less often amongst individuals assigned to the Tetris game-play condition. We were able to identify that the frequency of intrusive images was modulated by patterns of sympathetic arousal, dissociation, and affective reactivity. Furthermore, our results indicated that individuals who engaged in the Tetris task showed a heightened startle response to aversive material. These findings are discussed in terms of their relevance to etiological models, and the prevention of PTSD

Exclusive Breastfeeding and Clinical Malaria Risk in 6-Month-Old Infants: A Cross-Sectional Study from Kinshasa, Democratic Republic of the Congo

The World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months of life. However, the effect of EBF on malaria risk remains unclear. In the present study, 137 EBF infants and 358 non-EBF infants from the Democratic Republic of the Congo were assessed for fever and malaria infections by polymerase chain reaction, at 6 months of age. EBF was associated with a reduced risk of clinical malaria (odds ratio = 0.13; 95% confidence interval = 0.00–0.80), suggesting a protective effect of EBF against malaria

Continuity Culture: A Key Factor for Building Resilience and Sound Recovery Capabilities

This article investigates the extent to which Jordanian service organizations seek to establish continuity culture through testing, training, and updating of their business continuity plans. A survey strategy was adopted in this research. Primary and secondary data were used. Semistructured interviews were conducted with five senior managers from five large Jordanian service organizations registered with the Amman Stock Exchange. The selection of organizations was made on the basis of simple random sampling. Interviews targeted the headquarters only in order to obtain a homogenous sample. Three out of five organizations could be regarded as crisis prepared and have better chances for recovery. The other two organizations exhibited characteristics of standard practice that only emphasizes the recovery aspect of business continuity management (BCM), while paying less attention to establishing resilient cultures and embedding BCM. The findings reveal that the ability to recover following major incidents can be improved by embedding BCM in the culture of the organization and by making BCM an enterprise-wide process. This is one of few meticulous studies that have been undertaken in the Middle East and the first in Jordan to investigate the extent to which service organizations focus on embedding BCM in the organizational culture

Can standardized patients replace physicians as OSCE examiners?

BACKGROUND: To reduce inter-rater variability in evaluations and the demand on physician time, standardized patients (SP) are being used as examiners in OSCEs. There is concern that SP have insufficient training to provide valid evaluation of student competence and/or provide feedback on clinical skills. It is also unknown if SP ratings predict student competence in other areas. The objectives of this study were: to examine student attitudes towards SP examiners; to compare SP and physician evaluations of competence; and to compare predictive validity of these scores, using performance on the multiple choice questions examination (MCQE) as the outcome variable. METHODS: This was a cross-sectional study of third-year medical students undergoing an OSCE during the Internal Medicine clerkship rotation. Fifty-two students rotated through 8 stations (6 physician, 2 SP examiners). Statistical tests used were Pearson's correlation coefficient, two-sample t-test, effect size calculation, and multiple linear regression. RESULTS: Most students reported that SP stations were less stressful, that SP were as good as physicians in giving feedback, and that SP were sufficiently trained to judge clinical skills. SP scored students higher than physicians (mean 90.4% +/- 8.9 vs. 82.2% +/- 3.7, d = 1.5, p < 0.001) and there was a weak correlation between the SP and physician scores (coefficient 0.4, p = 0.003). Physician scores were predictive of summative MCQE scores (regression coefficient = 0.88 [0.15, 1.61], P = 0.019) but there was no relationship between SP scores and summative MCQE scores (regression coefficient = -0.23, P = 0.133). CONCLUSION: These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence

Pooled Amplicon Deep Sequencing of Candidate Plasmodium falciparum Transmission-Blocking Vaccine Antigens

Polymorphisms within Plasmodium falciparum vaccine candidate antigens have the potential to compromise vaccine efficacy. Understanding the allele frequencies of polymorphisms in critical binding regions of antigens can help in the designing of strain-transcendent vaccines. Here, we adopt a pooled deep-sequencing approach, originally designed to study P. falciparum drug resistance mutations, to study the diversity of two leading transmission-blocking vaccine candidates, Pfs25 and Pfs48/45. We sequenced 329 P. falciparum field isolates from six different geographic regions. Pfs25 showed little diversity, with only one known polymorphism identified in the region associated with binding of transmission-blocking antibodies among our isolates. However, we identified four new mutations among eight non-synonymous mutations within the presumed antibody-binding region of Pfs48/45. Pooled deep sequencing provides a scalable and cost-effective approach for the targeted study of allele frequencies of P. falciparum candidate vaccine antigens

Risk maps for range expansion of the Lyme disease vector, Ixodes scapularis, in Canada now and with climate change

<p>Abstract</p> <p>Background</p> <p>Lyme disease is the commonest vector-borne zoonosis in the temperate world, and an emerging infectious disease in Canada due to expansion of the geographic range of the tick vector <it>Ixodes scapularis</it>. Studies suggest that climate change will accelerate Lyme disease emergence by enhancing climatic suitability for <it>I. scapularis</it>. Risk maps will help to meet the public health challenge of Lyme disease by allowing targeting of surveillance and intervention activities.</p> <p>Results</p> <p>A risk map for possible Lyme endemicity was created using a simple risk algorithm for occurrence of <it>I. scapularis </it>populations. The algorithm was calculated for each census sub-division in central and eastern Canada from interpolated output of a temperature-driven simulation model of <it>I. scapularis </it>populations and an index of tick immigration. The latter was calculated from estimates of tick dispersion distances by migratory birds and recent knowledge of the current geographic range of endemic <it>I. scapularis </it>populations. The index of tick immigration closely predicted passive surveillance data on <it>I. scapularis </it>occurrence, and the risk algorithm was a significant predictor of the occurrence of <it>I. scapularis </it>populations in a prospective field study. Risk maps for <it>I. scapularis </it>occurrence in Canada under future projected climate (in the 2020s, 2050s and 2080s) were produced using temperature output from the Canadian Coupled Global Climate Model 2 with greenhouse gas emission scenario enforcing '<it>A2</it>' of the Intergovernmental Panel on Climate Change.</p> <p>Conclusion</p> <p>We have prepared risk maps for the occurrence of <it>I. scapularis </it>in eastern and central Canada under current and future projected climate. Validation of the risk maps provides some confidence that they provide a useful first step in predicting the occurrence of <it>I. scapularis </it>populations, and directing public health objectives in minimizing risk from Lyme disease. Further field studies are needed, however, to continue validation and refinement of the risk maps.</p

Critical limb ischemia: an update for interventional radiologists

Critical limb ischemia (CLI) is a growing epidemic with bleak patient outcomes. A variety of treatment modalities have been adopted to address CLI based on comorbidities, life expectancy, and the nature of the arterial disease. With advances in technology and treatment strategies, the clinical outcomes of CLI patients have significantly improved over recent years. However, despite progress, patency rates of both surgical and endovascular interventions, limb-salvage and amputation rates are still dismal. We review the epidemiology, treatment strategies, imaging modalities, and the microcirculation aspect of CLI

Partner-Drug Resistance and Population Substructuring of Artemisinin-Resistant Plasmodium falciparum in Cambodia

Plasmodium falciparum in western Cambodia has developed resistance to artemisinin and its partner drugs, causing frequent treatment failure. Understanding this evolution can inform the deployment of new therapies. We investigated the genetic architecture of 78 falciparum isolates using whole-genome sequencing, correlating results to in vivo and ex vivo drug resistance and exploring the relationship between population structure, demographic history, and partner drug resistance. Principle component analysis, network analysis and demographic inference identified a diverse central population with three clusters of clonally expanding parasite populations, each associated with specific K13 artemisinin resistance alleles and partner drug resistance profiles which were consistent with the sequential deployment of artemisinin combination therapies in the region. One cluster displayed ex vivo piperaquine resistance and mefloquine sensitivity with a high rate of in vivo failure of dihydroartemisinin-piperaquine. Another cluster displayed ex vivo mefloquine resistance and piperaquine sensitivity with high in vivo efficacy of dihydroartemisinin-piperaquine. The final cluster was clonal and displayed intermediate sensitivity to both drugs. Variations in recently described piperaquine resistance markers did not explain the difference in mean IC90 or clinical failures between the high and intermediate piperaquine resistance groups, suggesting additional loci may be involved in resistance. The results highlight an important role for partner drug resistance in shaping the P. falciparum genetic landscape in Southeast Asia and suggest that further work is needed to evaluate for other mutations that drive piperaquine resistance