Environmental health regulation in urban South Africa: a case study of the Environmental Health Practitioners of the City of Johannesburg Metropolitan Municipality

Environmental health is concerned with relations between the environment and human health and their management and remains a considerable public health challenge into the 21st century, particularly for cities where more than half the world’s population now lives. In South Africa local government Environmental Health Practitioners (EHPs) have been regulating local environmental health since Victorian times and are well placed to bring protective and developmental laws to life but are confronted by challenges not dissimilar to their Victorian forebears. The main research question is therefore: how do the EHPs of the City of Johannesburg Metropolitan Municipality (CoJ) regulate environmental health? A literature review developed an interdisciplinary model of governance to describe and explore how EHPs regulate environmental health (EH) and the factors that could influence this process. This model utilised a socio-legal framework grounded in theoretical perspectives from criminology, history, the law, organisational studies, political science and sociology. A multiple case study strategy was developed to test this model. Qualitative methods were conducted on 10 street-level case EHPs from four CoJ regional offices through observation, interviews, questionnaires and the analysis of regulatory documents. These were supplemented by observations and interviews with other street-level EHPs and their managers and the analysis of other relevant documents, including quantitative data on the activities of CoJ EHPs. A new model of governance was developed by this thesis to describe, analyse and explain how CoJ EHPs regulate and found most of their work focused on a traditional regulatory ‘law enforcement’ pathway alongside other activities, notably an EH monitoring role for other CoJ departments and provincial government. But contrary to their Victorian inspector stereotype, EHPs behaved as responsive regulators and used mainly persuasive approaches (e.g. education, advice, negotiation), with more punitive approaches generally used for serious cases or when persuasion fails. This responsiveness was limited by factors including resources and weaknesses in more punitive approaches. A second regulatory pathway involving EH project and promotion activities was documented but remained secondary to traditional regulatory work. In conclusion, the model of governance conceptualised urban EH regulation as the continuous circulation of power within and between EHPs and local government itself, other spheres of government and civil society. Power was unequally distributed between these actors, but there were many opportunities for challenging power that were rarely captured or closed. Local government EHPs are therefore contributing towards making cities more productive, inclusive, sustainable and better governed and the model of governance created by this thesis was a useful tool for exploring their work

Teprotumumab for Thyroid-Associated Ophthalmopathy

BACKGROUND: Thyroid-associated ophthalmopathy, a condition commonly associated with Graves’ disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy. / METHODS: We conducted a multicenter, double-masked, randomized, placebo-controlled trial to determine the efficacy and safety of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, in patients with active, moderate-to-severe ophthalmopathy. A total of 88 patients were randomly assigned to receive placebo or active drug administered intravenously once every 3 weeks for a total of eight infusions. The primary end point was the response in the study eye. This response was defined as a reduction of 2 points or more in the Clinical Activity Score (scores range from 0 to 7, with a score of ≥3 indicating active thyroid-associated ophthalmopathy) and a reduction of 2 mm or more in proptosis at week 24. Secondary end points, measured as continuous variables, included proptosis, the Clinical Activity Score, and results on the Graves’ ophthalmopathy–specific quality-of-life questionnaire. Adverse events were assessed. / RESULTS: In the intention-to-treat population, 29 of 42 patients who received teprotumumab (69%), as compared with 9 of 45 patients who received placebo (20%), had a response at week 24 (P<0.001). Therapeutic effects were rapid; at week 6, a total of 18 of 42 patients in the teprotumumab group (43%) and 2 of 45 patients in the placebo group (4%) had a response (P<0.001). Differences between the groups increased at subsequent time points. The only drug-related adverse event was hyperglycemia in patients with diabetes; this event was controlled by adjusting medication for diabetes. / CONCLUSIONS: In patients with active ophthalmopathy, teprotumumab was more effective than placebo in reducing proptosis and the Clinical Activity Score. (Funded by River Vision Development and others; ClinicalTrials.gov number, NCT01868997.

BRCA1 and BRCA2 mutations in a population-based study of male breast cancer

Background: The contribution of BRCA1 and BRCA2 to the incidence of male breast cancer (MBC) in the United Kingdom is not known, and the importance of these genes in the increased risk of female breast cancer associated with a family history of breast cancer in a male first-degree relative is unclear. Methods: We have carried out a population-based study of 94 MBC cases collected in the UK. We screened genomic DNA for mutations in BRCA1 and BRCA2 and used family history data from these cases to calculate the risk of breast cancer to female relatives of MBC cases. We also estimated the contribution of BRCA1 and BRCA2 to this risk. Results: Nineteen cases (20%) reported a first-degree relative with breast cancer, of whom seven also had an affected second-degree relative. The breast cancer risk in female first-degree relatives was 2.4 times (95% confidence interval [CI] = 1.4–4.0) the risk in the general population. No BRCA1 mutation carriers were identified and five cases were found to carry a mutation in BRCA2. Allowing for a mutation detection sensitivity frequency of 70%, the carrier frequency for BRCA2 mutations was 8% (95% CI = 3–19). All the mutation carriers had a family history of breast, ovarian, prostate or pancreatic cancer. However, BRCA2 accounted for only 15% of the excess familial risk of breast cancer in female first-degree relatives. Conclusion: These data suggest that other genes that confer an increased risk for both female and male breast cancer have yet to be found

A rapid mechanism to remobilize and homogenize highly crystalline magma bodies

International audienceThe largest products of magmatic activity on Earth, the great bodies of granite and their corresponding large eruptions, have a dual nature: homogeneity at the large scale and spatial and temporal heterogeneity at the small scale1-4. This duality calls for amechanism that selectively removes the large-scale heterogeneities associated with the incremental assembly4 of these magmatic systems and yet occurs rapidly despite crystal-rich, viscous conditions seemingly resistant to mixing2,5. Here we show that a simple dynamic template can unify a wide range of apparently contradictory observations from both large plutonic bodies and volcanic systems by a mechanism of rapid remobilization (unzipping) of highly viscous crystalrich mushes. We demonstrate that this remobilization can lead to rapid overturn and produce the observed juxtaposition ofmagmatic materials with very disparate ages and complex chemical zoning. What distinguishes our model is the recognition that the process has two stages. Initially, a stiff mushy magma is reheated from below, producing a reduction in crystallinity that leads to the growth of a subjacent buoyant mobile layer. When the thickening mobile layer becomes sufficiently buoyant, it penetrates the overlying viscous mushy magma. This second stage rapidly exports homogenized material from the lower mobile layer to the top of the system, and leads to partial overturn within the viscous mush itself as an additional mechanism of mixing. Model outputs illustrate that unzipping can rapidly produce large amounts of mobile magma available for eruption. The agreement between calculated and observed unzipping rates for historical eruptions at Pinatubo and at Montserrat demonstrates the general applicability of the model. This mechanism furthers our understanding of both the formation of periodically homogenized plutons (crust building) and of ignimbrites by large eruptions

Development of a healthy biscuit: an alternative approach to biscuit manufacture

OBJECTIVE: Obesity (BMI >30) and related health problems, including coronary heart disease (CHD), is without question a public health concern. The purpose of this study was to modify a traditional biscuit by the addition of vitamin B(6), vitamin B(12), Folic Acid, Vitamin C and Prebiotic fibre, while reducing salt and sugar. DESIGN: Development and commercial manufacture of the functional biscuit was carried out in collaboration with a well known and respected biscuit manufacturer of International reputation. The raw materials traditionally referred to as essential in biscuit manufacture, i.e. sugar and fat, were targeted for removal or reduction. In addition, salt was completely removed from the recipe. PARTICIPANTS: University students of both sexes (n = 25) agreed to act as subjects for the study. Ethical approval for the study was granted by the University ethics committee. The test was conducted as a single blind crossover design, and the modified and traditional biscuits were presented to the subjects under the same experimental conditions in a random fashion. RESULTS: No difference was observed between the original and the modified product for taste and consistency (P > 0.05). The modified biscuit was acceptable to the consumer in terms of eating quality, flavour and colour. Commercial acceptability was therefore established. CONCLUSION: This study has confirmed that traditional high-fat and high-sugar biscuits which are not associated with healthy diets by most consumers can be modified to produce a healthy alternative that can be manufactured under strict commercial conditions

Echium oil is not protective against weight loss in head and neck cancer patients undergoing curative radio(chemo)therapy: a randomised-controlled trial

Background: Therapy-induced mucositis and dysphagia puts head and neck (H&N) cancer patients at increased risk for developing cachexia. Omega-3 fatty acids (n-3 FA) have been suggested to protect against cachexia. We aimed to examine if echium oil, a plant source of n-3 FA, could reduce weight loss in H&N cancer patients undergoing radio(chemo)therapy with curative intent. Methods: In a double-blind trial, patients were randomly assigned to echium oil (intervention (I) group; 7.5 ml bis in die (b.i.d.), 235 mg/ml α-linolenic acid (ALA) + 95 mg/ml stearidonic acid (SDA) + 79 mg/ml γ-linolenic acid (GLA)) or n-3 FA deficient sunflower oil high oleic (control (C) group; 7.5 ml b.i.d.) additional to standard nutritional support during treatment. Differences in percentage weight loss between both groups were analysed according to the intention-to-treat principle. Erythrocyte FA profile, body composition, nutritional status and quality of life were collected. Results: Ninety-one eligible patients were randomised, of whom 83 were evaluable. Dietary supplement adherence was comparable in both groups (median, I: 87%, C: 81%). At week 4, the I group showed significantly increased values of erythrocyte n-3 eicosapentanoic acid (EPA, 14% vs −5%) and n-6 GLA (42% vs −20%) compared to the C group, without a significant change in n-6 arachidonic acid (AA, 2% vs −1%). Intention-to-treat analysis could not reveal a significant reduction in weight loss related to echium oil consumption (median weight loss, I: 8.9%, C: 7.6%). Also, no significant improvement was observed in the other evaluated anthropometric parameters. Conclusions: Echium oil effectively increased erythrocyte EPA and GLA FAs in H&N cancer patients. It failed however to protect against weight loss, or improve nutritional parameters. Trial registration: ClinicalTrials.gov Identifier NCT01596933

Baseline Levels of Influenza-Specific CD4 Memory T-Cells Affect T-Cell Responses to Influenza Vaccines

BACKGROUND: Factors affecting immune responses to influenza vaccines have not been studied systematically. We hypothesized that T-cell and antibody responses to the vaccines are functions of pre-existing host immunity against influenza antigens. METHODOLOGY/PRINCIPAL FINDINGS: During the 2004 and 2005 influenza seasons, we have collected data on cellular and humoral immune reactivity to influenza virus in blood samples collected before and after immunization with inactivated or live attenuated influenza vaccines in healthy children and adults. We first used cross-validated lasso regression on the 2004 dataset to identify a group of candidate baseline correlates with T-cell and antibody responses to vaccines, defined as fold-increase in influenza-specific T-cells and serum HAI titer after vaccination. The following baseline parameters were examined: percentages of influenza-reactive IFN-gamma(+) cells in T and NK cell subsets, percentages of influenza-specific memory B-cells, HAI titer, age, and type of vaccine. The candidate baseline correlates were then tested with the independent 2005 dataset. Baseline percentage of influenza-specific IFN-gamma(+) CD4 T-cells was identified as a significant correlate of CD4 and CD8 T-cell responses, with lower baseline levels associated with larger T-cell responses. Baseline HAI titer and vaccine type were identified as significant correlates for HAI response, with lower baseline levels and the inactivated vaccine associated with larger HAI responses. Previously we reported that baseline levels of CD56(dim) NK reactivity against influenza virus inversely correlated with the immediate T-cell response to vaccination, and that NK reactivity induced by influenza virus depended on IL-2 produced by influenza-specific memory T-cells. Taken together these results suggest a novel mechanism for the homeostasis of virus-specific T-cells, which involves interaction between memory helper T-cells, CD56(dim) NK and DC. SIGNIFICANCE: These results demonstrate that assessment of baseline biomarkers may predict immunologic outcome of influenza vaccination and may reveal some of the mechanisms responsible for variable immune responses following vaccination and natural infection

Dressed for Sex: Red as a Female Sexual Signal in Humans

Background: In many non-human primate species, a display of red by a female serves as a sexual signal to attract male conspecifics. Red is associated with sex and romance in humans, and women convey their sexual interest to men through a variety of verbal, postural, and behavioral means. In the present research, we investigate whether female red ornamentation in non-human primates has a human analog, whereby women use a behavioral display of red to signal their sexual interest to men. Methodology/Principal Findings: Three studies tested the hypothesis that women use red clothing to communicate sexual interest to men in profile pictures on dating websites. In Study 1, women who imagined being interested in casual sex were more likely to display red (but not other colors) on their anticipated web profile picture. In Study 2, women who indicated interest in casual sex were more likely to prominently display red (but not other colors) on their actual web profile picture. In Study 3, women on a website dedicated to facilitating casual sexual relationships were more likely to prominently exhibit red (but not other colors) than women on a website dedicated to facilitating marital relationships. Conclusions/Significance: These results establish a provocative parallel between women and non-human female primates in red signal coloration in the mating game. This research shows, for the first time, a functional use of color in women’s sexual self-presentation, and highlights the need to extend research on color beyond physics, physiology, and preference to psychological functioning