A second vestigial umbilical vein : a case report

A healthy female infant was found to have two umbilical arteries and two umbilical veins at the cut surface of the cord at birth. Detailed inspection of the cord showed the second vein to represent a short segment vestigial vessel that, moreover, was not associated with any other congenital anomaly as is often found in infants with umbilical vein anomalies.peer-reviewe

Validating the Developmental Coordination Disorder Questionnaire for use with children aged between five and fifteen in the Maltese context

The Developmental Coordination Disorder Questionnaire (DCDQ), developed by Wilson (2007), is a subjective parent/guardian screening tool which is used by Maltese paediatric Occupational Therapists. It is available solely in the English language and so within the local context poses several challenges for respondents who are not well versed in this language. This paper reports on a study which was carried out to address the gap in the current situation by translating and validating the original English DCDQ'07. This process involved a forward and backward translation of the DCDQ followed by its administration using a quantitative cross-sectional survey methodology. The translation team involved four translators who worked independently of each other and a moderator who facilitated the whole process. When the final Maltese version was completed, the bilingual test-retest technique using the split-half method was used to determine the validity and reliability of the final Maltese questionnaire. This involved data collected from 44 bilingual parents whose children were receiving Occupational Therapy at a local paediatric centre and completed both the Maltese and English versions at a seven-day interval. Data analysis of the findings compared the final scores achieved from the Maltese translation with those obtained from the original English questionnaire. Statistical tests yielded p values of 0.000 which indicated satisfactory intra-rater reliability implying that the translated Maltese questionnaire can be used with confidence. This would add to the available resources that assist Occupational Therapists in evaluating motor coordination difficulties in children.peer-reviewe

Afrika

Ġabra ta’ poeżiji u proża li tinkludi: Kavallier ta’ Sergio Grech – Tiġrib ta’ Toni Aquilina – Kappella pprofanata ta’ Ġorġ Borg – Leħħiet ta’ Pawlu Aquilina – Fir-raqda ħadra ta’ Carmel Calleja – Epigrammi: X’dinja din! ta’ J. J. Camilleri – Karnival 1999 (Għawdex) ta’ Joe M. Attard – Ħarsti lejn l-art ta’ Ġorġ Zammit – Lill-mewt ta’ J. Zammit Tabona – Tifkira ta’ Lillian Sciberras – Lill-pitirross ta’ K. Vella Haber – Lill-irġiel miżżewġa ta’ Ġanni A. Cilia – Meta Hamlet u l-fjuri eterni jiltaqgħu ta’ Doreen Micallef – It-tren iżomm il-ħin ta’ Pawlu Aquilina – Kemm tiswa tarbija? ta’ Ġorġ Mallia – Jien naf ta’ J. J. Cremona – Odessa ta’ Charles Coleiro – L-isptar ta’ Charles Coleiro – Agunija ta’ Charles Coleiro – Milied XXI ta’ Charles Coleiro – Entużjażmu ta’ Charles Briffa – Londra ta’ Charles Briffa – Dal-ġebel kbir ta’ Emanuel Attard – Lit-Teatru Rjal ta’ Maurice Mifsud Bonnici – Fl-Ewropa magħquda ta’ Doreen Micallef – Fil-mewt ta’ Ġorġ Pisani ta’ Carm Cachia – Lejl id-19 ta’ Diċembru ta’ Charles B. Spiteri – Kont waħdi ta’ Suzanne Gatt – Imħabbti ta’ Nathalie Micallef – Xi ġralek, Ma? ta’ Oliver Friggieri – Anki t-tislima ta’ Oliver Friggieri – Fuq xifer nimxu ta’ Oliver Friggieri – Afrika ta’ Oliver Friggieri.peer-reviewe

Behaviour of plasma citrulline after bariatric surgery in the BARIASPERM cohort

International audienc

Global shortfalls in threat assessments for endemic flora by country

Societal Impact Statement: Plants are fundamental to terrestrial and aquatic ecosystems and are key to human livelihoods. To protect plant diversity, systematic approaches to conservation assessment are needed. Many nations have legislation or other policy instruments that seek to protect biodiversity (including plants), and species-level assessments are essential for identifying the most threatened species that require special and immediate protection measures. Some plants occur in only one place (for instance, a single country) and here we have estimated how many of these ‘endemic’ species have had their threats assessed in each country or close country-equivalent worldwide. We show that the level of assessment completion is only weakly related to the income of countries or the likely level of threat that species face. Summary: The Global Strategy for Plant Conservation ambitiously called for an assessment of the conservation status of all recognised plant taxa by 2020. This target was not met in the short term. Nevertheless, the need for conservation assessments remains urgent as plants go extinct and face increasing threats from human impacts on the biosphere. Here, the completeness of threat assessments for endemic flora in 179 countries or their close equivalents was assessed. To do so, distribution information from the World Checklist of Vascular Plants was combined with assessments collated in the ThreatSearch database. The completeness of assessments was expected to be associated with the objective affluence of countries (measured using inequality-adjusted Human Development Index (IHDI)) and/or the exposure of their plant species to threats associated with human impacts (measured using Global Human Modification index (GHM)). The number of endemic species per country was also hypothesised to influence the completion of assessments. Overall, 58% of all country-based endemic species examined have no conservation assessment (127,643 species). Countries\u27 progress toward the completion of threat assessments for endemic plants could not be confidently predicted by IHDI, GHM or the richness of endemic plant flora. The shortfall in threat assessments identified here restricts national regulation of actions which imperil plant species, with particular consequences for endemic plant species subject to local laws. Some nations with high IHDI scores (i.e. wealthier nations) are not systematically assessing extinction risk in their endemic species. Scarce funding should be directed to global hotspots of endemism with few available resources for assessment

Systematic review of frequency of felt and enacted stigma in epilepsy and determining factors and attitudes toward persons living with epilepsy-Report from the International League Against Epilepsy Task Force on Stigma in Epilepsy

OBJECTIVE: To review the evidence of felt and enacted stigma and attitudes toward persons living with epilepsy, and their determining factors. METHODS: Thirteen databases were searched (1985-2019). Abstracts were reviewed in duplicate and data were independently extracted using a standardized form. Studies were characterized using descriptive analysis by whether they addressed "felt" or "enacted" stigma and "attitudes" toward persons living with epilepsy. RESULTS: Of 4234 abstracts, 132 met eligibility criteria and addressed either felt or enacted stigma and 210 attitudes toward epilepsy. Stigma frequency ranged broadly between regions. Factors associated with enacted stigma included low level of knowledge about epilepsy, lower educational level, lower socioeconomic status, rural areas living, and religious grouping. Negative stereotypes were often internalized by persons with epilepsy, who saw themselves as having an "undesirable difference" and so anticipated being treated differently. Felt stigma was associated with increased risk of psychological difficulties and impaired quality of life. Felt stigma was linked to higher seizure frequency, recency of seizures, younger age at epilepsy onset or longer duration, lower educational level, poorer knowledge about epilepsy, and younger age. An important finding was the potential contribution of epilepsy terminology to the production of stigma. Negative attitudes toward those with epilepsy were described in 100% of included studies, and originated in any population group (students, teachers, healthcare professionals, general public, and those living with epilepsy). Better attitudes were generally noted in those of younger age or higher educational status. SIGNIFICANCE: Whatever the specific beliefs about epilepsy, implications for felt and enacted stigma show considerable commonality worldwide. Although some studies show improvement in attitudes toward those living with epilepsy over time, much work remains to be done to improve attitudes and understand the true occurrence of discrimination against persons with epilepsy

Epilepsy-related stigma and attitudes: Systematic review of screening instruments and interventions - Report by the International League Against Epilepsy Task Force on Stigma in Epilepsy

OBJECTIVE: This is a systematic review aimed at summarizing the evidence related to instruments that have been developed to measure stigma or attitudes toward epilepsy and on stigma-reducing interventions. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A broad literature search (1985-2019) was performed in 13 databases. Articles were included if they described the development and testing of psychometric properties of an epilepsy-related stigma or attitude scale or stigma-reducing interventions. Two reviewers independently screened abstracts, reviewed full-text articles, and extracted data. Basic descriptive statistics are reported. RESULTS: We identified 4234 abstracts, of which 893 were reviewed as full-text articles. Of these, 38 met inclusion criteria for an instrument development study and 30 as a stigma-reduction intervention study. Most instruments were initially developed using well-established methods and were tested in relatively large samples. Most intervention studies involved educational programs for adults with pre- and post-evaluations of attitudes toward people with epilepsy. Intervention studies often failed to use standardized instruments to quantify stigmatizing attitudes, were generally underpowered, and often found no evidence of benefit or the benefit was not sustained. Six intervention studies with stigma as the primary outcome had fewer design flaws and showed benefit. Very few or no instruments were validated for regional languages or culture, and there were very few interventions tested in some regions. SIGNIFICANCE: Investigators in regions without instruments should consider translating and further developing existing instruments rather than initiating the development of new instruments. Very few stigma-reduction intervention studies for epilepsy have been conducted, study methodology in general was poor, and standardized instruments were rarely used to measure outcomes. To accelerate the development of effective epilepsy stigma-reduction interventions, a paradigm shift from disease-specific, siloed trials to collaborative, cross-disciplinary platforms based upon unified theories of stigma transcending individual conditions will be needed

Influenza A virus infection induces viral and cellular defective ribosomal products encoded by alternative reading frames

The importance of antiviral CD8 T cell recognition of alternative reading frame (ARF)-derived peptides is uncertain. In this study, we describe an epitope (NS1-ARF2) present in a predicted 14-residue peptide encoded by the +1 register of NS1 mRNA in the influenza A virus (IAV). NS1-ARF2 elicits a robust, highly functional CD8 T cell response in IAV-infected BALB/c mice. NS1-ARF2 is presented from unspliced NS mRNA, likely from downstream initiation on a Met residue that comprises the P1 position of NS1-ARF2 Derived from a 14-residue peptide with no apparent biological function and negligible impacts on IAV infection, infectivity, and pathogenicity, NS1-ARF2 provides a clear demonstration of how immunosurveillance exploits natural errors in protein translation to provide antiviral immunity. We further show that IAV infection enhances a model cellular ARF translation, which potentially has important implications for virus-induced autoimmunity

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31â127 anaesthetic procedures in 30â874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0â5·5) with an incidence of respiratory critical events of 3·1% (2·9â3·3). Cardiovascular instability occurred in 1·9% (1·7â2·1), with an immediate poor outcome in 5·4% (3·7â7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10â000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86â0·90; p<0·0001), medical history, and physical condition (1·60, 1·40â1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981â0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97â0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology