The Potential for State Attorneys General to Promote the Public’s Health: Theory, Evidence, and Practice

The Attorneys General of the 50 states have considerable legal authority to protect the public’s health, yet their role in the development of health policy is often under-appreciated or misunderstood. This article analyzes state Attorneys’ General current powers and provides a logic model that illustrates how the use of these powers can lead to the protection and promotion of the public’s health. The article then provides four brief case studies to demonstrate how state Attorneys General have used their varied powers to influence policy-making and benefit the public’s health. In addition, this article offers a roadmap for research that could be conducted to better understand the association between state Attorneys’ General actions and the protection of the public’s health. The article concludes with a series of recommendations intended to enhance state Attorneys’ General ability to protect the public’s health, along with suggestions for future research in this area

The Potential for State Attorneys General to Promote the Public’s Health: Theory, Evidence, and Practice

The Attorneys General of the 50 states have considerable legal authority to protect the public’s health, yet their role in the development of health policy is often under-appreciated or misunderstood. This article analyzes state Attorneys’ General current powers and provides a logic model that illustrates how the use of these powers can lead to the protection and promotion of the public’s health. The article then provides four brief case studies to demonstrate how state Attorneys General have used their varied powers to influence policy-making and benefit the public’s health. In addition, this article offers a roadmap for research that could be conducted to better understand the association between state Attorneys’ General actions and the protection of the public’s health. The article concludes with a series of recommendations intended to enhance state Attorneys’ General ability to protect the public’s health, along with suggestions for future research in this area

Biologic response of inguinal hernia prosthetics: A comparative study of conventional static meshes versus 3D dynamic implants

Despite improvements in prosthetics and surgical techniques, the rate of complications following inguinal hernia repair remains high. Among these, discomfort and chronic pain have become a source of increasing concern among surgeons. Poor quality of tissue ingrowth, such as thin scar plates or shrinking scars-typical results with conventional static implants and plugs-may contribute to these adverse events. Recently, a new type of 3D dynamically responsive implant was introduced to the market. This device, designed to be placed fixation-free, seems to induce ingrowth of viable and structured tissue instead of regressive fibrotic scarring. To elucidate the differences in biologic response between the conventional static meshes and this 3D dynamically responsive implant, a histological comparison was planned. The aim of this study was to determine the quality of tissue incorporation in both types of implants excised after short, medium, and long periods post-implantation. The results showed large differences in the biologic responses between the two implant types. Histologically, the 3D dynamic implant showed development of tissue elements more similar to natural abdominal wall structures, such as the ingrowth of loose and well-hydrated connective tissue, well-formed vascular structures, elastic fibers, and mature nerves, with negligible or absent inflammatory response. All these characteristics were completely absent in the conventional static implants, where a persistent inflammatory reaction was associated with thin, hardened, and shrunken fibrotic scar formation. Consequently, as herniation is a degenerative process, the 3D dynamic implants, which induce regeneration of the typical groin components, seem to address its pathogenesis

Die Phylogenie des klonalen Komplexes 398 von Staphylococcus aureus und dessen Interaktionen mit verschiedenen Wirten

Staphylococcus aureus is not only a frequent nasal coloniser of all mammals and birds, but also is a common cause of a wide range of infections in both hospitals and the community. In humans, S. aureus is associated with a wide spectrum of diseases from skin infections to life-threatening endocarditis. Infections caused by methicillin-resistant S. aureus (MRSA) are of particular concern due to limited treatment opportunities. Since the early 2000s, a particular MRSA clonal complex (CC398) was widely disseminated as a coloniser and pathogen in economically important live-stock and companion animals worldwide. Since then, CC398 is of increasing concern to pose a risk to public health. In this study, we investigated the population structure of CC398 through mutation discovery at 97 genetic housekeeping loci, which are distributed along the S. aureus chromosome within 195 CC398 isolates, collected from 11 different host species and various countries. Furthermore, we investigated the phenotypic characters of a certain sub-clone within CC398 by studying its ability to adhere to fibronectin and to invade neutrophils from various host species. To gain a better insight into the genetic determinants of this CC398 sub-clone, we have applied whole genome sequencing approach on eight representative CC398 isolates. This study provided a novel insight into the phylogeny of CC398 concerning the spread of a specific MRSA-CC398 sub-clone within equine settings, which causes infections in horses and nasal colonisation of humans that are in close contact with these horses. Of note, it remained extremely rare among S. aureus isolates from hu-man infections. Furthermore, this MRSA-CC398 sub-clone can initiate colonisation in both human and horse efficiently; however, it was not generally protected from the host immune system response. Lastly, the comparative genomic analysis of CC398 revealed a novel pathogenicity island and two prophages that were harboured by certain CC398 isolates.Staphylococcus aureus ist nicht nur ein häufiger Besiedler des Vestibulum nasi aller Säugetiere, sondern auch Verursacher vielfältiger Infektionen in Krankenhäusern und der nicht hospitalisierten Bevölkerung. Beim Menschen reicht das weite Infektionsspektrum von Infektionen der Haut bis hin zur lebensbedrohlichen Endokarditis. Besonders besorgniserregend sind, auf Grund der begrenzten Möglichkeiten der antibiotischen Therapie, Infektionen mit Methicillin-resistenten S. aureus (MRSA). Seit 2004 wurden MRSA des klonalen Komplexes CC398 weltweit als Besiedler und Infektionserreger bei Nutz- und Haustieren nachgewiesen. Seit dieser Zeit wächst die Besorgnis um damit verbundene gesundheitliche Risiken für den Menschen. In der vorliegenden Arbeit wurde die Populationsstruktur des klonalen Komplexes CC398 durch Analyse von Mutationen in 97 chromosomal lokalisierten Haushaltsgenen bei 195 Isolaten untersucht. Diese stammen von 11 verschiedenen Wirtsspezies aus mehreren Ländern. Des Weiteren wurden bei ausgewählten Isolaten einer bestimmten Subpopulation die Fähigkeit an Fibronectin zu binden und die Phagozytoserate durch Granulozyten von verschiedenen Wirtsspezies untersucht. Um tiefere Einblicke in die genetische Ausstattung dieser Subpopulation zu erhalten, wurden Ganzgenomsequenzierungen für repräsentative Isolate durchgeführt. Die vorliegende Arbeit erweitert unsere Kenntnisse zur Populationsstruktur des klonalen Komplexes CC398. Insbesondere zeigte sich, dass es eine speziell in Pferde-Kliniken verbreitete Subpopulation gibt, die als Besiedler und Infektionserreger bei Pferden und auch als nasaler Besiedler bei Menschen mit engem Kontakt zu diesen Tieren auftritt. Bisher wurden Isolate dieser Subpopulation nur sehr selten als Infektionserreger beim Menschen nachgewiesen. Offenbar kann diese Subpopulation Menschen und Pferde effizient besiedeln, ist aber nicht gegen die Wirtsimmunität geschützt. Die vergleichende Genomanalyse zeigte das Auftreten einer neuen Pathogenitätsinsel, sowie zweier bisher noch nicht beschriebener Prophagen bei Isolaten dieser Subpopulation

Role of Sonography in Clinically Occult Femoral Hernias

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135156/1/jum2016351121.pd

Surgical Management of Inguinal Hernias at Bugando Medical Centre in Northwestern Tanzania: Our Experiences in a Resource-Limited Setting.

Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P=0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P=0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P<0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P<0.001). Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem

How brains make decisions

This chapter, dedicated to the memory of Mino Freund, summarizes the Quantum Decision Theory (QDT) that we have developed in a series of publications since 2008. We formulate a general mathematical scheme of how decisions are taken, using the point of view of psychological and cognitive sciences, without touching physiological aspects. The basic principles of how intelligence acts are discussed. The human brain processes involved in decisions are argued to be principally different from straightforward computer operations. The difference lies in the conscious-subconscious duality of the decision making process and the role of emotions that compete with utility optimization. The most general approach for characterizing the process of decision making, taking into account the conscious-subconscious duality, uses the framework of functional analysis in Hilbert spaces, similarly to that used in the quantum theory of measurements. This does not imply that the brain is a quantum system, but just allows for the simplest and most general extension of classical decision theory. The resulting theory of quantum decision making, based on the rules of quantum measurements, solves all paradoxes of classical decision making, allowing for quantitative predictions that are in excellent agreement with experiments. Finally, we provide a novel application by comparing the predictions of QDT with experiments on the prisoner dilemma game. The developed theory can serve as a guide for creating artificial intelligence acting by quantum rules.Comment: Latex file, 20 pages, 3 figure