Larval therapy for leg ulcers (VenUS II) : randomised controlled trial

Objective To compare the clinical effectiveness of larval therapy with a standard debridement technique (hydrogel) for sloughy or necrotic leg ulcers. Design Pragmatic, three armed randomised controlled trial. Setting Community nurse led services, hospital wards, and hospital outpatient leg ulcer clinics in urban and rural settings, United Kingdom. Participants 267 patients with at least one venous or mixed venous and arterial ulcer with at least 25% coverage of slough or necrotic tissue, and an ankle brachial pressure index of 0.6 or more. Interventions Loose larvae, bagged larvae, and hydrogel. Main outcome measures The primary outcome was time to healing of the largest eligible ulcer. Secondary outcomes were time to debridement, health related quality of life (SF-12), bacterial load, presence of meticillin resistant Staphylococcus aureus, adverse events, and ulcer related pain (visual analogue scale, from 0 mm for no pain to 150 mm for worst pain imaginable). Results Time to healing was not significantly different between the loose or bagged larvae group and the hydrogel group (hazard ratio for healing using larvae v hydrogel 1.13, 95% confidence interval 0.76 to 1.68; P=0.54). Larval therapy significantly reduced the time to debridement (2.31, 1.65 to 3.2; P<0.001). Health related quality of life and change in bacterial load over time were not significantly different between the groups. 6.7% of participants had MRSA at baseline. No difference was found between larval therapy and hydrogel in their ability to eradicate MRSA by the end of the debridement phase (75% (9/12) v 50% (3/6); P=0.34), although this comparison was underpowered. Mean ulcer related pain scores were higher in either larvae group compared with hydrogel (mean difference in pain score: loose larvae v hydrogel 46.74 (95% confidence interval 32.44 to 61.04), P<0.001; bagged larvae v hydrogel 38.58 (23.46 to 53.70), P<0.001). Conclusions Larval therapy did not improve the rate of healing of sloughy or necrotic leg ulcers or reduce bacterial load compared with hydrogel but did significantly reduce the time to debridement and increase ulcer pain. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692

Population tobacco control interventions and their effects on social inequalities in smoking: systematic review

OBJECTIVE: To assess the effects of population tobacco control interventions on social inequalities in smoking. DATA SOURCES: Medical, nursing, psychological, social science and grey literature databases, bibliographies, hand-searches and contact with authors. STUDY SELECTION: Studies were included (n = 84) if they reported the effects of any population-level tobacco control intervention on smoking behaviour or attitudes in individuals or groups with different demographic or socioeconomic characteristics. DATA EXTRACTION: Data extraction and quality assessment for each study were conducted by one reviewer and checked by a second. DATA SYNTHESIS: Data were synthesised using graphical ("harvest plot") and narrative methods. No strong evidence of differential effects was found for smoking restrictions in workplaces and public places, although those in higher occupational groups may be more likely to change their attitudes or behaviour. Smoking restrictions in schools may be more effective in girls. Restrictions on sales to minors may be more effective in girls and younger children. Increasing the price of tobacco products may be more effective in reducing smoking among lower-income adults and those in manual occupations, although there was also some evidence to suggest that adults with higher levels of education may be more price-sensitive. Young people aged under 25 are also affected by price increases, with some evidence that boys and non-white young people may be more sensitive to price. CONCLUSIONS: Population-level tobacco control interventions have the potential to benefit more disadvantaged groups and thereby contribute to reducing health inequalities

Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance

<p>Abstract</p> <p>Background</p> <p>Improved outcomes for normoglycemic patients suffering acute myocardial infarction (AMI) over the last decade have not been matched by similar improvements in mortality for diabetic patients despite similar levels of baseline risk and appropriate medical therapy. Two of the major determinants of poor outcome following AMI are infarct size and left ventricular (LV) dysfunction.</p> <p>Methods</p> <p>Ninety-three patients with first AMI were studied. 22 patients had diabetes mellitus (DM) based on prior history or admission blood glucose ≥11.1 mmol/l. 13 patients had dysglycemia (admission blood glucose ≥7.8 mmol/l but <11.1 mmol/l) and 58 patients had normoglycemia (admission blood glucose <7.8 mmol/l). Patients underwent cardiac magnetic resonance (CMR) imaging at index presentation and median follow-up of 11 months. Cine imaging assessed LV function and late gadolinium contrast-enhanced imaging was used to quantify infarct size. Clinical outcome data were collected at 18 months median follow-up.</p> <p>Results</p> <p>Patients with dysglycemia and DM had larger infarct sizes by CMR than normoglycemic patients; at baseline percentage LV scar (mean (SD)) was 23.0% (10.9), 25.6% (12.9) and 15.8% (10.3) respectively (p = 0.001), and at 11 months percentage LV scar was 17.6% (8.9), 19.1% (9.6) and 12.4% (7.8) (p = 0.017). Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).</p> <p>Conclusions</p> <p>Patients with dysglycemia or diabetes mellitus sustain larger infarct sizes than normoglycemic patients, as determined by CMR. This may, in part, account for their adverse prognosis following AMI.</p

Is the “Genyornis” egg of a mihirung or another extinct bird from the Australian dreamtime?

© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/. Following 24 month embargo from date of publication (Feb 1 2016)The iconic Australian Genyornis newtoni (Dromornithidae, Aves) is the sole Pleistocene member of an avian clade now hypothesized to be alternatively in Anseriformes or the sister group of crown Galloanseres. A distinctive type of fossil eggshell commonly found in eroding sand dunes, has been referred to Genyornis newtoni since the 1980s. The 126 by 97 mm Spooner Egg, dated at 54.7 ± 3.1 ka by optical dating of its enclosing sediments, is a complete specimen of this eggshell type that was reconstructed from fragments of a broken egg. We show that the size of the eggs from which this ‘Genyornis’ eggshell derives, either as predicted from measurements of fragments, or as indicated by the Spooner Egg, is unexpectedly small given the size of G. newtoni, which has an estimated mass of 275 kg, or about seven times the mass of the emu that has a similar sized egg. We compared the microstructure of the putative Genyornis eggshell to that of other dromornithids and a range of galloanseriform taxa using several microcharacterisation techniques. The ‘Genyornis’ eggshell displays a mosaic of oological characters that do not unambiguously support referral to any known modern bird. Its shell structure, coupled with chemical compounds in the accessory layer, makes it unlikely to have been laid by a dromornithid, whereas several characters support a megapode origin. A potential candidate for the bird that laid the putative ‘Genyornis’ eggs in the Pleistocene fossil avifaunal record has been ignored: Progura, a genus of extinct giant megapodes, whose species were widespread in Australia. Regression of egg size of megapodes and body mass shows that the Spooner Egg approximates the expected size for eggs laid by species of Progura. We advance the suggestion that the fossil eggshell hitherto referred to Genyornis newtoni, is more likely to have been laid by species of the giant extinct Progura. As megapodes, the species of Progura were obligate ectothermic incubators, which we suggest laid their eggs into a hole dug in sand like the modern megapode Macrocephalon maleo, thus explaining the abundant ‘Genyornis’ eggshell in sand dunes. Referral of this eggshell to Progura means that the fossil record of Genyornis newtoni is limited to bones and the timing of the extinction of this last dromornithid is unknown. In addition, structural similarities of eggshell in megapodes, the putative Genyornis eggshell and dromornithids, raise the possibility that these taxa are phylogenetically more closely related to each other than any is to anseriforms. Specifically, this means that dromornithids might be a sister group to galliforms rather than to or within anseriforms

Women, know your limits: Cultural sexism in academia

Despite the considerable advances of the feminist movement across Western societies, in Universities women are less likely to be promoted, or paid as much as their male colleagues, or even get jobs in the first place. One way in which we can start to reflect on why this might be the case is through hearing the experiences of women academics themselves. Using feminist methodology, this article attempts to unpack and explore just some examples of ‘cultural sexism’ which characterise the working lives of many women in British academia.This article uses qualitative methods to describe and make sense of just some of those experiences. In so doing, the argument is also made that the activity of academia is profoundly gendered and this explicit acknowledgement may contribute to our understanding of the under-representation of women in senior positions

An atmospheric perspective on North American carbon dioxide exchange: CarbonTracker

We present an estimate of net CO2 exchange between the terrestrial biosphere and the atmosphere across North America for every week in the period 2000 through 2005. This estimate is derived from a set of 28,000 CO2 mole fraction observations in the global atmosphere that are fed into a state-of-the-art data assimilation system for CO2 called CarbonTracker. By design, the surface fluxes produced in CarbonTracker are consistent with the recent history of CO2 in the atmosphere and provide constraints on the net carbon flux independent from national inventories derived from accounting efforts. We find the North American terrestrial biosphere to have absorbed –0.65 PgC/yr (1 petagram = 10^15 g; negative signs are used for carbon sinks) averaged over the period studied, partly offsetting the estimated 1.85 PgC/yr release by fossil fuel burning and cement manufacturing. Uncertainty on this estimate is derived from a set of sensitivity experiments and places the sink within a range of –0.4 to –1.0 PgC/yr. The estimated sink is located mainly in the deciduous forests along the East Coast (32%) and the boreal coniferous forests (22%). Terrestrial uptake fell to –0.32 PgC/yr during the large-scale drought of 2002, suggesting sensitivity of the contemporary carbon sinks to climate extremes. CarbonTracker results are in excellent agreement with a wide collection of carbon inventories that form the basis of the first North American State of the Carbon Cycle Report (SOCCR), to be released in 2007. All CarbonTracker results are freely available at http://carbontracker.noaa.gov

A new, large-bodied omnivorous bat (Noctilionoidea: Mystacinidae) reveals lost morphological and ecological diversity since the Miocene in New Zealand

A new genus and species of fossil bat is described from New Zealand's only pre-Pleistocene Cenozoic terrestrial fauna, the early Miocene St Bathans Fauna of Central Otago, South Island. Bayesian total evidence phylogenetic analysis places this new Southern Hemisphere taxon among the burrowing bats (mystacinids) of New Zealand and Australia, although its lower dentition also resembles Africa's endemic sucker-footed bats (myzopodids). As the first new bat genus to be added to New Zealand's fauna in more than 150 years, it provides new insight into the original diversity of chiropterans in Australasia. It also underscores the significant decline in morphological diversity that has taken place in the highly distinctive, semi-terrestrial bat family Mystacinidae since the Miocene. This bat was relatively large, with an estimated body mass of ~40 g, and its dentition suggests it had an omnivorous diet. Its striking dental autapomorphies, including development of a large hypocone, signal a shift of diet compared with other mystacinids, and may provide evidence of an adaptive radiation in feeding strategy in this group of noctilionoid bats

The relationship between Lp(a) and CVD outcomes: a systematic review

Summary of QUIPS quality assessment domains (60 studies). (DOCX 54 kb