Psychological Distress Following Surgical Management of Early Pregnancy Loss Detected at Initial Ultrasound Scanning: A Trauma Perspective and Research Portfolio

The last decade has seen increasing research interest into psychological distress following Early Pregnancy Loss (EPL). In theoretical terms, EPL was initially viewed as a loss experience, which led on to depressive symptomatology. More recent research has focused on the occurrence of anxiety symptoms postmiscarriage and has suggested that EPL should be conceptualised from the perspective of a traumatic experience for many women. This study assessed the prevalence of Acute Stress Disorder (ASD), more general post traumatic stress symptoms, anxiety and depression, soon after experiencing an EPL. Follow-up data was also collected on all the above measures except for ASD. It was hypothesised that warning signs of an EPL would result in less psychological distress three weeks after its detection. Any resulting psychopathology was expected to decrease over time. The presence of warning signs was not found to determine levels of psychological distress. It transpired that the actual experience of EPL was stressful for many women, regardless of warning signs of a pregnancy complication. Psychopathology subsided over time with the exception of anxiety which remained clinically signficant. Evidence of acute stress and persistent anxiety supported recent research and highlighted a need for routine follow-up care

Doxorubicin In Vivo Rapidly Alters Expression and Translation of Myocardial Electron Transport Chain Genes, Leads to ATP Loss and Caspase 3 Activation

BackgroundDoxorubicin is one of the most effective anti-cancer drugs but its use is limited by cumulative cardiotoxicity that restricts lifetime dose. Redox damage is one of the most accepted mechanisms of toxicity, but not fully substantiated. Moreover doxorubicin is not an efficient redox cycling compound due to its low redox potential. Here we used genomic and chemical systems approaches in vivo to investigate the mechanisms of doxorubicin cardiotoxicity, and specifically test the hypothesis of redox cycling mediated cardiotoxicity.Methodology/principal findingsMice were treated with an acute dose of either doxorubicin (DOX) (15 mg/kg) or 2,3-dimethoxy-1,4-naphthoquinone (DMNQ) (25 mg/kg). DMNQ is a more efficient redox cycling agent than DOX but unlike DOX has limited ability to inhibit gene transcription and DNA replication. This allowed specific testing of the redox hypothesis for cardiotoxicity. An acute dose was used to avoid pathophysiological effects in the genomic analysis. However similar data were obtained with a chronic model, but are not specifically presented. All data are deposited in the Gene Expression Omnibus (GEO). Pathway and biochemical analysis of cardiac global gene transcription and mRNA translation data derived at time points from 5 min after an acute exposure in vivo showed a pronounced effect on electron transport chain activity. This led to loss of ATP, increased AMPK expression, mitochondrial genome amplification and activation of caspase 3. No data gathered with either compound indicated general redox damage, though site specific redox damage in mitochondria cannot be entirely discounted.Conclusions/significanceThese data indicate the major mechanism of doxorubicin cardiotoxicity is via damage or inhibition of the electron transport chain and not general redox stress. There is a rapid response at transcriptional and translational level of many of the genes coding for proteins of the electron transport chain complexes. Still though ATP loss occurs with activation caspase 3 and these events probably account for the heart damage

RadSTraM: Radiological Source Tracking and Monitoring, Phase II Final Report

This report focuses on the technical information gained from the Radiological Source Tracking and Monitoring (RadSTraM) Phase II investigation and its implications. The intent of the RadSTraM project was to determine the feasibility of tracking radioactive materials in commerce, particularly International Atomic Energy Agency (IAEA) Category 3 and 4 materials. Specifically, Phase II of the project addressed tracking radiological medical isotopes in commerce. These categories of materials are susceptible to loss or theft but the problem is not being addressed by other agencies

HIV Encephalopathy: pediatric case series description and insights from the clinic coalface

Background: The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. Early invasion of the central nervous system by the virus, affecting the developing brain, is believed to result in the most common primary HIV-related neurological complication, HIV Encephalopathy (HIVE). In countries such as South Africa where many children have not been initiated on antiretroviral treatment early, HIVE remains a significant clinical problem. Methods: Children were selected from a clinic for children with neurologic complications of HIV, located at the Red Cross War Memorial Children’s Hospital, South Africa 2008–2012. Eligible subjects fulfilled the following inclusion criteria: aged 6 months-13 years; positive diagnosis of HIV infection, vertically infected and HIVE as defined by CDC criteria. Each participant was prospectively assessed by a Pediatric Neurologist using a standardized proforma which collated relevant details of background, clinical and immunological status. Results: The median age of the 87 children was 64 months (interquartile range 27–95 months). All except one child were on antiretroviral treatment, 45% had commenced treatment <12 months of age. Delayed early motor milestones were reported in 80% and delayed early speech in 75% of children in whom we had the information. Twenty percent had a history of one or more seizures and 41% had a history of behavior problems. Forty-eight percent had microcephaly and 63% a spastic diplegia. CD4 percentages followed a normal distribution with mean of 30.3% (SD 8.69). Viral loads were undetectable (<log 1.6) in 70% of the children. Brain imaging was performed on 56% with 71% of those imaged demonstrating at least one abnormality, most commonly white matter volume loss or signal abnormality. Conclusions: Amongst the cohort of children referred to this clinic, the diagnosis of HIVE was unrecognized in the general medical services, even in its most severe form. Developmental delay and school failure were major presenting problems. Co-morbidities are a frequent finding and should be sought actively in order to optimize management and promote best possible outcomes for this vulnerable group of children

Renal impairment at diagnosis in myeloma: Patient characteristics, treatment, and impact on outcomes. Results trom the Australia and New Zealand myeloma and related diseases registry

Background: Renal impairment (RI) is a common complication of multiple myeloma (MM) and remains a poor prognostic factor despite improved survival with newer therapies. Patients and Methods: We evaluated baseline characteristics, treatment, and outcomes of newly diagnosed MM patients with RI at diagnosis in the Australia and New Zealand Myeloma and Related Diseases Registry over 5 years to April 2018; we compared patients with RI (estimated glomerular filtration rate [eGFR

Exploring student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity

BACKGROUND: As the prevalence of obesity increases worldwide the field of bariatric medicine has emerged, focussing on the causes, prevention and treatment of obesity. People who are obese regularly face bias from healthcare professionals, which can negativity impact on care delivery and patient outcomes. The introduction of bariatric empathy suits into simulated practice may enable student nurses to appreciate the needs of, and influence their attitudes towards, obese people. OBJECTIVES: The aim of this study was to explore student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity. DESIGN: A mixed methods study incorporating a pre-post design. SETTING: A UK university which provides pre-registration nursing education. PARTICIPANTS: Nursing students in part 1 (n = 39) and part 2 (n = 29) in adult and mental health fields. METHODS: Part 1 and 2 nursing students completed the "Nurses' attitudes towards obesity and obese patients scale" (NATOOPS) questionnaire. Part 2 students also took part in a simulation activity while wearing a bariatric empathy suit and completed the NATOOPS questionnaire again immediately after the simulation activity. Students who wore the empathy suits were invited to a focus group. RESULTS: Part 1 students reported poorer attitudes on the NATOOPS scale than Part 2 students. After wearing the bariatric empathy suits students reported changed attitudes on the NATOOPS in three areas: response to obese patients, characteristics of obese patients and supportive roles in caring for obese patients. Five themes emerged from the focus groups related to physical and psychological impact of the suits; thinking differently; simulation as a learning experience and challenges and recommendations. CONCLUSIONS: Following a structured educational experience student nurses' attitudes were more positive towards obese patients. The characteristics of the educational activity that appeared to influence student nurses' attitudes was related to the "lived experience" of wearing bariatric empathy suits

Metabolic dysfunction in female mice with disruption of 5α-reductase 1

5α-Reductases irreversibly catalyse A-ring reduction of pregnene steroids, including glucocorticoids and androgens. Genetic disruption of 5α-reductase 1 in male mice impairs glucocorticoid clearance and predisposes to glucose intolerance and hepatic steatosis upon metabolic challenge. However, it is unclear whether this is driven by changes in androgen and/or glucocorticoid action. Female mice with transgenic disruption of 5α-reductase 1 (5αR1-KO) were studied, representing a ‘low androgen’ state. Glucocorticoid clearance and stress responses were studied in mice aged 6 months. Metabolism was assessed in mice on normal chow (aged 6 and 12 m) and also in a separate cohort following 1-month high-fat diet (aged 3 m). Female 5αR1-KO mice had adrenal suppression (44% lower AUC corticosterone after stress), and upon corticosterone infusion, accumulated hepatic glucocorticoids (~27% increased corticosterone). Female 5αR1-KO mice aged 6 m fed normal chow demonstrated insulin resistance (~35% increased area under curve (AUC) for insulin upon glucose tolerance testing) and hepatic steatosis (~33% increased hepatic triglycerides) compared with controls. This progressed to obesity (~12% increased body weight) and sustained insulin resistance (~38% increased AUC insulin) by age 12 m. Hepatic transcript profiles supported impaired lipid β-oxidation and increased triglyceride storage. Female 5αR1-KO mice were also predisposed to develop high-fat diet-induced insulin resistance. Exaggerated predisposition to metabolic disorders in female mice, compared with that seen in male mice, after disruption of 5αR1 suggests phenotypic changes may be underpinned by altered metabolism of glucocorticoids rather than androgens

Lessons learned from organizing and teaching virtual phylogenetics workshops

No abstract available

Update of the best practice dietetic management of overweight and obese children and adolescents: a systematic review protocol

To update an existing systematic review series of randomized controlled trials (RCT) that include a dietary intervention for the management of overweight or obesity in children or adolescents.Specifically, the review questions are: In randomized controlled trials of interventions which include a dietary intervention for the management of overweight or obesity in children or adolescents