Public health priority setting on a national scale: The Scottish experience.

Objectives: Scotland has the lowest life expectancy in Western Europe and significant health inequalities. A national review of public health in 2015 found that there was a lack of coherent action across organisational boundaries, inhibiting progress. This paper describes a rapid (four-month) systematic approach to prioritisation of Scotland's public health challenges, which was evidence-based, transparent and made use of significant stakeholder engagement. Study design: Cross-sectional survey of stakeholders in deliberative meetings. Methods: An independent Expert Advisory Group (EAG) was formed to develop a typology of public health priorities, a long-list of potential priorities and ranking criteria. Deliberative stakeholder events were held at which the criteria were refined and priorities scored by participants from a wide range of stakeholder organisations. Results: The proposed typology identified three types of public health priorities: risk factors, social factors and system factors; medically defined disease entities were not used deliberately, to facilitate broad stakeholder participation. Fifteen criteria were identified to help identify priority issues, based on the scope of their burden, amenability to change, and multi-stakeholder preferences. Six public health priorities were selected by the EAG based on stakeholder scoring of a long-list against these criteria. Conclusion: Prioritisation is important in modern public health but it is challenging due to limited data availability, lack of agreed evidence on effectiveness and efficiency of interventions, and divergent stakeholder views. The Scottish experience nevertheless shows that useful public health priorities can be agreed upon by a wide range of stakeholders through a transparent, participatory and logical process.

Extra corporeal membrane oxygenation support for neonatal vein of Galen aneurysmal malformation: Case report.

BACKGROUND: The vein of Galen aneurysm (VGAM) is the most common type of arteriovenous malformation in the neonate. These neonates commonly present with high output cardiac failure that may be associated with pulmonary hypertension. The medical management and stabilization of these neonates can be challenging before staged transarterial embolization of the aneurysm is undertaken. CASE: A 2.34 kilogram neonate, antenatally diagnosed to have VGAM, was born at 36 weeks of gestation for fetal distress. The neonate failed to respond to medical management including inotropes, high frequency mechanical ventilation and inhaled nitric oxide. The patient's high-output heart failure and persistent pulmonary hypertension were stabilized with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) using central cannulation. Further transarterial staged embolization of the VGAM was undertaken on VA-ECMO support. CONCLUSION: There may be a role of VA-ECMO using central cannulation to optimize management of high output cardiac failure and persistent pulmonary hypertension in neonatal VGAM patients who fail medical management to facilitate staged transarterial embolization of the VGAM.

A RAC-GEF network critical for early intestinal tumourigenesis.

RAC1 activity is critical for intestinal homeostasis, and is required for hyperproliferation driven by loss of the tumour suppressor gene Apc in the murine intestine. To avoid the impact of direct targeting upon homeostasis, we reasoned that indirect targeting of RAC1 via RAC-GEFs might be effective. Transcriptional profiling of Apc deficient intestinal tissue identified Vav3 and Tiam1 as key targets. Deletion of these indicated that while TIAM1 deficiency could suppress Apc-driven hyperproliferation, it had no impact upon tumourigenesis, while VAV3 deficiency had no effect. Intriguingly, deletion of either gene resulted in upregulation of Vav2, with subsequent targeting of all three (Vav2-/- Vav3-/- Tiam1-/-), profoundly suppressing hyperproliferation, tumourigenesis and RAC1 activity, without impacting normal homeostasis. Critically, the observed RAC-GEF dependency was negated by oncogenic KRAS mutation. Together, these data demonstrate that while targeting RAC-GEF molecules may have therapeutic impact at early stages, this benefit may be lost in late stage disease.

[Skin shrinkage study for skin oncologic surgery. Clinical study of 79 cases]. / Étude de la rétraction cutanée en chirurgie carcinologique cutanée. Étude clinique de 79 cas.

BACKGROUND: Skin tumors surgery is common and well established. There is discrepancy between recommendations on macroscopic margins to apply and therapeutic decisions taken on histological margins. The purpose of this study is to examine skin shrinkage upon exeresis, then in formalin, to understand the anatomo-clinical discrepancy, which is often found. MATERIAL AND METHODS: It was a prospective study, lasting a month, including patients receiving skin surgery. For each tumor, the surgeon carried out 4 margins measurements before and after exeresis ; margins measured again in histology. The evaluation criterion was the difference between preoperative, postoperative and histological margins measurement. These data was weighting according to factors linked to the patient and the tumor. RESULTS: Seventy-nine tumors for 61 patients had been studied. The study showed a significant shrinkage between preoperative measurements and postoperative, from 0.4 to 0.6mm. It is correlated with no one tested factors. Significant shrinkage between 0.4 and 0.5mm was also established between preoperative and histological measurements. However, there is a significant augmentation between postoperative and histological measurements. CONCLUSION: This last result could be linked to the inflammatory peri-wound skin that surgeon consider as tumoral process so exclude of his margin, while histology could show a healthy area. In front of these results, an expert committee leading a more important study could include histological margins recommendations to the actual clinical recommendations.

Validated quantitative trait loci for eggshell quality in experimental and commercial laying hens.

Compromised eggshell quality causes considerable economic losses for the egg industry. Breeding for improved eggshell quality has been very challenging. Eggshell quality is a trait that would greatly benefit from marker-assisted selection, which would allow the selection of sires for their direct contribution to the trait and would also allow implementation of measurements integrating a number of shell parameters that are difficult to measure. In this study, we selected the most promising autosomal quantitative trait loci (QTL) affecting eggshell quality on chromosomes 2, 3, 6 and 14 from earlier experiments and we extended the F2 population to include 1599 F2 females. The study was repeated on two commercial populations: Lohmann Tierzucht Rhode Island Red line (n = 692 females) and a Hy-Line White Plymouth Rock line (n = 290 progeny tested males). We analyzed the selected autosomal QTL regions on the three populations with SNP markers at 4-13 SNPs/Mb density. QTL for eggshell quality were replicated on all studied regions in the F2 population. New QTL were detected for eggshell color on chromosomes 3 and 6. Marker associations with eggshell quality traits were validated in the tested commercial lines on chromosomes 2, 3 and 6, thus paving the way for marker-assisted selection for improved eggshell quality.

Ultraviolet photochemistry of 2-bromothiophene explored using universal ionization detection and multi-mass velocity-map imaging with a PImMS2 sensor.

The ultraviolet photochemistry of 2-bromothiophene (C4H3SBr) has been studied across the wavelength range 265-245 nm using a velocity-map imaging (VMI) apparatus recently modified for multi-mass imaging and vacuum ultraviolet (VUV, 118.2 nm) universal ionization. At all wavelengths, molecular products arising from the loss of atomic bromine were found to exhibit recoil velocities and anisotropies consistent with those reported elsewhere for the Br fragment [J. Chem. Phys. 142, 224303 (2015)]. Comparison between the momentum distributions of the Br and C4H3S fragments suggests that bromine is formed primarily in its ground (2P3/2) spin-orbit state. These distributions match well at high momentum, but relatively fewer slow moving molecular fragments were detected. This is explained by the observation of a second substantial ionic product, C3H3+. Analysis of ion images recorded simultaneously for several ion masses and the results of high-level ab initio calculations suggest that this fragment ion arises from dissociative ionization (by the VUV probe laser) of the most internally excited C4H3S fragments. This study provides an excellent benchmark for the recently modified VMI instrumentation and offers a powerful demonstration of the emerging field of multi-mass VMI using event-triggered, high frame-rate sensors, and universal ionization.

Increasing persistency in lay and stabilising egg quality in longer laying cycles. What are the challenges?

In the past 50 years, selection starting initially at the breed level and then using quantitative genetics coupled with a sophisticated breeding pyramid, has resulted in a very productive hybrid for a variety of traits associated with egg production. One major trait currently being developed further is persistency of lay and the concept of the "long life" layer. Persistency in lay however cannot be achieved without due consideration of how to sustain egg quality and the health and welfare of the birds in longer laying cycles. These multiple goals require knowledge and consideration of the bird's physiology, nutritional requirements, which vary depending on age and management system, reproductive status and choice of the selection criteria applied. The recent advent of molecular genetics offers considerable hope that these multiple elements can be balanced for the good of all in the industry including the hens. The "long life" layer, which will be capable of producing 500 eggs in a laying cycle of 100 weeks, is therefore on the horizon, bringing with it the benefits of a more efficient utilisation of diminishing resources, including land, water, raw materials for feed as well as a reduction in waste, and an overall reduced carbon footprint.

Neonatal mortality amongst Scottish preterm singleton births (2001-2010): record linkage of maternity data and neonatal mortality data.

OBJECTIVES: To provide a contemporary estimate of singleton neonatal mortality based on birthweight and gestational age at delivery from 2001 to 2010, and to compare this with a similar data set from 1985 to 1994. STUDY DESIGN: Record linkage of maternity data and neonatal mortality data. POPULATION: All singleton preterm deliveries from 24 to 36 weeks inclusive between 2001 and 2010. SETTING: Scotland, UK. METHODS: NHS National Services Scotland uses a standardized maternity discharge record to collect details of maternities in Scotland. These delivery records were linked to the infant death files from the National Records of Scotland. MAIN OUTCOME MEASURE: Neonatal death. RESULTS: Between 2001 and 2010 there were 525,997 liveborn singleton deliveries of which 31,280 were preterm (5.95%). In this preterm group the neonatal mortality rate was 18.2/1000, a significant reduction from 41.3/1000 in 1985-1994 (P < 0.001). The neonatal mortality rate fell with advancing gestation from 451/1000 at 24 weeks to 2.74/1000 at 36 weeks. CONCLUSIONS: This is the largest recent study to use both birthweight and gestational age at delivery to consider neonatal mortality. These data will aid the management and prognostic guidance of preterm delivery.

Effectiveness of pictorial health warning on cigarette packages: A cross-sectional study in Sarawak, Malaysia.

INTRODUCTION: Specific health warning placed on the tobacco product packages is considered as an effective and low-cost method for increasing the knowledge and awareness among the community. Thus, a study was conducted to assess the perception of pictorial health warnings (PHWs) against smoking among the adult rural population of Sarawak. METHODS: Cross-sectional data were collected from 10 villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Nonprobability sampling method was adopted to select the villages. All the households of the selected villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software IBM SPSS 20.0 version. RESULTS: Analysis showed that 28.8% of the respondents were current smokers, 7.8% were past smokers and the rest were non-smokers. Six items of pictorial health warnings were evaluated with five point Likert's scales for attractiveness, fearfulness and adequacy of the information. Analysis revealed that the majority of the respondents had perceived awareness on PHWs, but the smokers believed that this was not adequate to make them quit smoking. Only one-fifth (19.7%) of them reported that current pictorial health warnings were sufficient to motivate people to quit smoking. CONCLUSION: Though the PHWs on cigarette packages are appealing, it is not sufficient as a reason to stop smoking. Thus, an approach using an integrated anti-tobacco public health programme should be focused into the specific targeted community.

Effectiveness of pictorial health warning on cigarette packages: A cross-sectional study in Sarawak, Malaysia

Introduction: Specific health warning placed on the tobacco product packages is considered as an effective and low-cost method for increasing the knowledge and awareness among the community. Thus, a study was conducted to assess the perception of pictorial health warnings (PHWs) against smoking among the adult rural population of Sarawak. Methods: Cross-sectional data were collected from 10 villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Nonprobability sampling method was adopted to select the villages. All the households of the selected villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software IBM SPSS 20.0 version. Results: Analysis showed that 28.8% of the respondents were current smokers, 7.8% were past smokers and the rest were non-smokers. Six items of pictorial health warnings were evaluated with five point Likert’s scales for attractiveness, fearfulness and adequacy of the information. Analysis revealed that the majority of the respondents had perceived awareness on PHWs, but the smokers believed that this was not adequate to make them quit smoking. Only one-fifth (19.7%) of them reported that current pictorial health warnings were sufficient to motivate people to quit smoking. Conclusion: Though the PHWs on cigarette packages are appealing, it is not sufficient as a reason to stop smoking. Thus, an approach using an integrated anti-tobacco public health programme should be focused into the specific targeted community.

An assessment of work environment factors correlating with burnout status of physicians employed with the Public Hospital Authority in the Bahamas

OBJECTIVES: To identify factors associated with the Burnout Syndrome in light of the prevalence of that syndrome in physicians working in the Public Hospital Authority (PHA), Nassau, Bahamas. DESIGN AND METHODS: A cross-sectional study was done utilizing a self-administered survey comprising of demographics, general health, work environment, and Maslach Burnout Inventory items to assess burnout among salaried Physicians working in 9 departments of PHA. The Statistical Package for Social Sciences was used for data analysis. RESULTS: 153 physicians participated. Their mean age was 35.84 (ñ 7.09) years; median 34.00 (IQR: 31.00, 40.00) years . 64.7% (99) were females. No association was found between these, other socio-demographic variables measured and burnout status. Physicians in the department of Internal Medicine represented 22.2% (34), Family Medicine 20.3% (31), Emergency Medicine 19.6% (30), Pediatrics 13.7 (21), and physicians in other departments 22.3% (34) of the sample, 55.7% of physicians employed under the PHA collectively exhibited a moderate level of burnout, 9.9% of these physicians having severe burnout Separately, poor balance of family, 15 work environment potential stressors and 4 potential stress relievers were found to be each weakly or very weakly related to burnout status. Postgraduate programme year, irregular sleep pattern and lack of appreciation were moderately strong positively related. Logistic regression analysis showed the key predictors of burnout status to be lack of appreciation (OR=1.69, p=.002) and number of years worked post-internship (OR=.94, p=.039). CONCLUSION: Physicians sensing of appreciation and sleep hygiene were clear predictors of burnout.

Non-clinical health services--what do they contribute to patient care and how can we measure their contribution?

BACKGROUND AND AIMS: Assessing the contribution of 'support services' to improving healthcare is challenging. Despite involving a significant part of the NHS budget, there is very little published literature on methods and approaches. This article describes the development of an integrated approach to assessing and measuring the health impact of these services. METHODS AND RESULTS: An empirical approach was developed by the main provider of national support services to NHS Scotland. This involved identifying meaningful ways to describe health impact of services several steps removed from patient care, applying this to the full range of national support services provided by NHS National Services Scotland and developing relevant measurement methodologies. Through this approach it was possible to assess the relative health impact of all 63 NSS services and to use this for planning and prioritisation. CONCLUSION: Assessing the contribution of support services to improving patient outcomes is a neglected area, despite the significant dependency of direct patient care services upon these services and the resource involved. The methods described in this article have potential to be used across the range of support services within the NHS to improve quality and efficiency of healthcare services.

Enhancing the egg's natural defence against bacterial penetration by increasing cuticle deposition.

The cuticle is a proteinaceous layer covering the avian egg and is believed to form a defence to microorganism ingress. In birds that lay eggs in challenging environments, the cuticle is thicker, suggesting evolutionary pressure; however, in poultry, selection pressure for this trait has been removed because of artificial incubation. This study aimed to quantify cuticle deposition and to estimate its genetic parameters and its role on trans-shell penetration of bacteria. Additionally, cuticle proteins were characterised to establish whether alleles for these genes explained variation in deposition. A novel and reliable quantification was achieved using the difference in reflectance of the egg at 650 nm before and after staining with a specific dye. The heritability of this novel measurement was moderate (0.27), and bacteria penetration was dependent on the natural variation in cuticle deposition. Eggs with the best cuticle were never penetrated by bacteria (P < 0.001). The cuticle proteome consisted of six major proteins. A significant association was found between alleles of one of these protein genes, ovocleidin-116 (MEPE), and cuticle deposition (P = 0.015) and also between alleles of estrogen receptor 1 (ESR1) gene and cuticle deposition (P = 0.008). With the heritability observed, genetic selection should be possible to increase cuticle deposition in commercial poultry, so reducing trans-generational transmission of microorganisms and reversing the lack of selection pressure for this trait during recent domestication.

Adhesion mechanisms in European whitefish Coregonus lavaretus eggs: is this a survival mechanism for high-energy spawning grounds?

This study examined the potential biochemical and mechanical structures that may contribute to egg adhesion in European whitefish Coregonus lavaretus. Experiments showed that eggs from a population of C. lavaretus from Loch Eck remained non-adhesive in a solution chemically similar to ovarian fluid but became adhesive seconds after contact with water. Examination of the ultrastructure of the chorion showed that the morphology changed significantly after contact with water, with nodule-like protuberances attached to connective filaments on the surface present in water-hardened but not non-water hardened eggs. Biochemical analysis showed the presence of Chain A, RNase ZF-3e proteins in the chorion of water-hardened but not non-water hardened eggs. Histochemical staining of the chorion of C. lavaretus eggs showed that the externa, but not the interna, stained positively for the presence of glycoproteins. From these results, it was concluded that C. lavaretus from Loch Eck possess both anatomical and biochemical adhesive mechanisms that have been undocumented in this species so far.

Structural and physical changes in the hen's eggshell in response to the inclusion of dietary organic minerals.

1. An experiment was designed to determine whether the inclusion of sodium selenite, Sel-Plex or Sel-plex + Bioplex in the diet exerted any influence on structural and functional properties of the eggshell at 22, 38, 58 and 72 weeks age. 2. Significant age effects were demonstrated for egg weight, dynamic stiffness and total shell thickness. 3. The eggshells from birds fed on the Sel-Plex + Bioplex treatment were statistically stronger than those produced by the birds on sodium selenite. 4. From mid-lay onwards the shells laid by birds fed on the Sel-Plex + Bioplex treatment displayed, at ultrastructural level, the crystal modification termed 'confluence' together with early fusion of the palisade columns which comprised the bulk of the shell. 5. At all periods of lay the shells of birds fed on sodium selenite, Sel-Plex and the control diet demonstrated the presence of a variety of crystalline aggregates localised between the forming palisade columns.

The importance of understanding epidemiology in order to inform financial decisions: a lesson from the Scottish Home Oxygen Service.

OBJECTIVES: To ensure that decisions on the future planning of the Scottish Home Oxygen Service reflect population needs by examining the epidemiology of the main conditions that require home oxygen therapy and trends in their management. STUDY DESIGN: Analysis of routinely available vital event and health service data supplemented by published literature. Use of linked data to provide person-based analyses. METHODS: Consideration of trends in key risk factors, disease incidence, prevalence and mortality for chronic neonatal lung disease, cystic fibrosis, chronic interstitial lung disease in adults and chronic obstructive pulmonary disease. Examination of trends in management of these conditions including hospital admissions, length of stay and re-admissions. RESULTS: The prevalence of all the conditions studied has increased in Scotland over recent years due to a combination of increased incidence, increased survival, more active case finding and demographic changes. There have been changes in management with trends towards shorter hospital stays. CONCLUSIONS: The clinical need for home oxygen therapy is likely to continue to increase over the next 10-20 years. It will encompass all age groups and a complex range of conditions. Public health needs to be proactive in providing relevant needs assessment information to ensure that planning within financial constraints is appropriately informed on population needs.

Genetic variation in eggshell crystal size and orientation is large and these traits are correlated with shell thickness and are associated with eggshell matrix protein markers.

The size and orientation of calcium carbonate crystals influence the structure and strength of the eggshells of chickens. In this study, estimates of heritability were found to be high (0.6) for crystal size and moderate (0.3) for crystal orientation. There was a strong positive correlation (0.65) for crystal size and orientation with the thickness of the shell and, in particular, with the thickness of the mammillary layer. Correlations with shell breaking strength were positive but with a high standard error. This was contrary to expectations, as in man-made materials smaller crystals would be stronger. We believe the results of this study support the hypothesis that the structural organization of shell, and in particular the mammillary layer, is influenced by crystal size and orientation, especially during the initial phase of calcification. Genetic associations for crystal measurements were observed between haplotype blocks or individual markers for a number of eggshell matrix proteins. Ovalbumin and ovotransferrin (LTF) markers for example were associated with crystal size, while ovocleidin-116 and ovocalyxin-32 (RARRES1) markers were associated with crystal orientation. The location of these proteins in the eggshell is consistent with different phases of the shell-formation process. In conclusion, the variability of crystal size, and to a lesser extent orientation, appears to have a large genetic component, and the formation of calcite crystals are intimately related to the ultrastructure of the eggshell. Moreover, this study also provides evidence that proteins in the shell influence the variability of crystal traits and, in turn, the shell's thickness profile. The crystal measurements and/or the associated genetic markers may therefore prove to be useful in selection programs to improve eggshell quality.

Synthesis, characterization and antimicrobial activity of dextran stabilized silver nanoparticles in aqueous medium.

A simple one-step rapid synthetic route is described for the preparation of silver nanoparticles by reduction of silver nitrate (AgNO3) using aqueous dextran solution which acts as both reducing and capping agent. The formation of silver nanoparticles is assured by characterization with UV-vis spectroscopy, atomic force microscopy (AFM), transmission electron microscopy (TEM) and X-ray diffraction (XRD). The absorbance of the silver nanoparticles is observed at 423 nm. The AFM image clearly shows the surface morphology of the well-dispersed silver nanoparticles with size range of 10-60 nm. TEM images show that the nanoparticles are spherical in shape with ∼5-10 nm dimensions. The crystallinity of Ag nanoparticles is assured by XRD analysis. The antimicrobial activity of as synthesized silver nanoparticles is tested against the bacteria, Bacillus subtilis, Bacillus cereus, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The bacterial growth is inhibited by gradual reduction of the concentration of the silver nanoparticles.

Effect of egg washing on the cuticle quality of brown and white table eggs.

Egg washing is currently not permitted within the European Union, with few exceptions. This is mainly because there are concerns that cuticle damage could occur during or after the washing process, as a result of a suboptimal operation. In this study, the cuticle coverage levels of 400 washed or unwashed eggs, derived from either a brown or a white egg-laying flock at the end of lay, were compared. The eggs from older hens inherently have poorer cuticle coverage and as a result arguably constitute a greater risk to consumer safety if they are then washed. Thus, the effects of the washing procedure used in this study on cuticle quality were tested under the worst-case scenario. A standard Swedish egg washing process was used. The cuticle coverage of the eggs was assessed by a colorimeter by quantifying the color difference before and after staining with Tartrazine and Green S. The cuticle of an additional 30 eggs from each of the four groups was then visually assessed by scanning electron microscopy. The staining characteristics of the cuticle varied greatly within each group of eggs and showed that the washing process did not lead to cuticle damage. Scanning electron microscopy confirmed that there was no irreversible damage to the cuticle of the washed eggs and that it was not possible to correctly assign the treatment (washed or not) based on a visual assessment. In conclusion, no evidence could be found to suggest that the washing procedure used in this investigation irreversibly changed the quality of the cuticle.

Retrospective evaluation of crib-biting and windsucking behaviours and owner-perceived behavioural traits as risk factors for colic in horses.

REASONS FOR PERFORMING STUDY: Although crib-biting (cribbing)/windsucking has previously been associated with 2 types of colic, additional research into the possible role of other behaviours on incidence of colic by type and severity has not been undertaken. OBJECTIVES: To investigate: a relationship between cribbing/windsucking and colic; a relationship between cribbing/windsucking and different types of colic, both medical and surgical; and whether horses displaying specific behaviour traits were more likely to have had colic. METHODS: A matched case-control retrospective study was conducted evaluating horses with various surgical and medical colic diagnoses, admitted to a referral hospital over a 3 year period. Computerised records and a validated internet questionnaire were used to obtain information on owner-perceived behavioural traits and repetitive behaviours. RESULTS: Cribbing/windsucking was significantly associated with colic but was unassociated with one category or severity of colic over another. No other repetitive behaviour was associated with colic. Age (≥20 years) was significantly associated with colic. An anxious temperament was not associated with risk of colic. CONCLUSION: Animals at higher risk for colic may be identified based on history of cribbing/windsucking behaviour, but this behaviour was unassociated with increased risk for a particular category or severity of colic. Horses characterised as being more anxious were not at increased risk for colic. POTENTIAL RELEVANCE: There is a need to elucidate a causal relationship between cribbing/windsucking and gastrointestinal function as development of more effective and humane strategies to treat cribbing/windsucking behaviour may help to improve equine welfare and reduce the risk of colic.