Study Protocol: Interactive Dynamics of Coral Reef Fisheries and the Nutrition Transition in Kiribati.

The Kiribati 2019 Integrated Household Income and Expenditure Survey (Integrated HIES) embeds novel ecological and human health research into an ongoing social and economic survey infrastructure implemented by the Pacific Community in partnership with national governments. This study seeks to describe the health status of a large, nationally representative sample of a geographically and socially diverse I-Kiribati population through multiple clinical measurements and detailed socio-economic surveys, while also conducting supporting food systems research on ecological, social, and institutional drivers of change. The specific hypotheses within this research relate to access to seafood and the potential nutritional and health benefits of these foods. We conducted this research in 21 of the 23 inhabited islands of Kiribati, excluding the two inhabited islands-Kanton Islands in the Phoenix Islands group with a population of 41 persons (2020 census) and Banaba Island in the Gilbert Islands group with a population of 333 persons (2020 census)-and focusing exclusively on the remaining islands in the Gilbert and Line Islands groups. Within this sample, we focused our intensive human health and ecological research in 10 of the 21 selected islands to examine the relationship between ecological conditions, resource governance, food system dynamics, and dietary patterns. Ultimately, this research has created a baseline for future Integrated HIES assessments to simultaneously monitor change in ecological, social, economic, and human health conditions and how they co-vary over time.

Accuracy of Preoperative Breast MRI Versus Conventional Imaging in Measuring Pathologic Extent of Invasive Lobular Carcinoma.

OBJECTIVE: To determine whether invasive lobular carcinoma (ILC) extent is more accurately depicted with preoperative MRI (pMRI) than conventional imaging (mammography and/or ultrasound). METHODS: After IRB approval, we retrospectively identified women with pMRIs (February 2005 to January 2014) to evaluate pure ILC excluding those with ipsilateral pMRI BI-RADS 4 or 5 findings or who had neoadjuvant chemotherapy. Agreement between imaging and pathology sizes was summarized using Bland-Altman plots, absolute and percent differences, and the intraclass correlation coefficient (ICC). Rates of underestimation and overestimation were evaluated and their associations with clinical features were explored. RESULTS: Among the 56 women included, pMRI demonstrated better agreement with pathology than conventional imaging by mean absolute difference (1.6 mm versus -7.8 mm, P < 0.001), percent difference (10.3% versus -16.4%, P < 0.001), and ICC (0.88 versus 0.61, P = 0.019). Conventional imaging more frequently underestimated ILC span than pMRI using a 5 mm difference threshold (24/56 (43%) versus 10/56 (18%), P < 0.001), a 25% threshold (19/53 (36%) versus 10/53 (19%), P = 0.035), and T category change (17/56 (30%) versus 7/56 (13%), P = 0.006). Imaging-pathology size concordance was greater for MRI-described solitary masses than other lesions for both MRI and conventional imaging (P < 0.05). Variability of conventional imaging was lower for patients ≥ the median age of 62 years than for younger patients (SD: 12 mm versus 22 mm, P = 0.012). CONCLUSION: MRI depicts pure ILC more accurately than conventional imaging and may have particular value for younger women.

Head and pelvic movement asymmetry during lungeing in horses with symmetrical movement on the straight.

REASONS FOR PERFORMING STUDY: Lungeing is commonly used as part of standard lameness examinations in horses. Knowledge of how lungeing influences motion symmetry in sound horses is needed. OBJECTIVES: The aim of this study was to objectively evaluate the symmetry of vertical head and pelvic motion during lungeing in a large number of horses with symmetric motion during straight line evaluation. STUDY DESIGN: Cross-sectional prospective study. METHODS: A pool of 201 riding horses, all functioning well and considered sound by their owners, were evaluated in trot on a straight line and during lungeing to the left and right. From this pool, horses with symmetric vertical head and pelvic movement during the straight line trot (n = 94) were retained for analysis. Vertical head and pelvic movements were measured with body mounted uniaxial accelerometers. Differences between vertical maximum and minimum head (HDmax, HDmin) and pelvic (PDmax, PDmin) heights between left and right forelimb and hindlimb stances were compared between straight line trot and lungeing in either direction. RESULTS: Vertical head and pelvic movements during lungeing were more asymmetric than during trot on a straight line. Common asymmetric patterns seen in the head were more upward movement during push-off of the outside forelimb and less downward movement during impact of the inside limb. Common asymmetric patterns seen in the pelvis were less upward movement during push-off of the outside hindlimb and less downward movement of the pelvis during impact of the inside hindlimb. Asymmetric patterns in one lunge direction were frequently not the same as in the opposite direction. CONCLUSIONS: Lungeing induces systematic asymmetries in vertical head and pelvic motion patterns in horses that may not be the same in both directions. These asymmetries may mask or mimic fore- or hindlimb lameness.

Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma.

BACKGROUND: To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC). PATIENTS AND METHODS: A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48). RESULTS: Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005). CONCLUSION: In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.

Neurological impairment in a surviving twin following intrauterine fetal demise of the co-twin: a case study.

It has been established that twin pregnancies are at an increased risk for complications, including the risk of morbidity or mortality for one or both of the infants. Cerebral palsy and other associated neurological deficits also occur at higher rates in twin pregnancies. This report examines two cases of intrauterine demise of one twin with subsequent survival of the co-twin. In both cases, the surviving infant suffered significant neurological sequelae. Impairments observed in these two cases include multicystic encephalomalacia and periventricular leukomalacia as well as the subsequent development of cerebral palsy. This case study explores the predisposing factors, incidence, pathophysiology, consequences, and future research implications of these findings.

Single intranasal neuropeptide Y infusion attenuates development of PTSD-like symptoms to traumatic stress in rats.

Exposure to severe stress leads to development of neuropsychiatric disorders, including depression and Post-Traumatic Stress Disorder (PTSD) in at-risk individuals. Neuropeptide Y (NPY) is associated with resilience or improved recovery. Therefore exogenous administration to the brain has therapeutic potential although peripheral administration can trigger undesirable side effects. Here, we established conditions with intranasal (IN) NPY infusion to rats to obtain CSF concentrations in the proposed anxiolytic range without significant change in plasma NPY. Rats were pretreated with IN NPY or vehicle before exposure to single prolonged stress (SPS) animal model of PTSD and compared to untreated controls. The IN NPY appeared to lessen the perceived severity of stress, as these animals displayed less time immobile in forced swim part of the SPS. Thirty minutes after SPS the elevation of plasma adrenocorticotropic hormone (ACTH) and corticosterone was not as pronounced in NPY-infused rats and the induction of tyrosine hydroxylase (TH) in locus coeruleus (LC) was attenuated. Seven days after SPS, they displayed lower depressive-like behavior on Forced Swim Test and reduced anxiety-like behavior on Elevated Plus Maze. The prolonged effect of SPS on Acoustic Startle Response was also lower in NPY-infused rats. Plasma ACTH, corticosterone, and hippocampal glucocorticoid receptor levels were significantly above controls only in the vehicle - but not IN NPY-treated group 1week after SPS. Baseline TH mRNA levels in LC did not differ among groups, but increased with forced swim in the vehicle - but not NPY-pretreated animals. Administration of IN NPY after exposure to SPS led to similar, but not identical, reduction in development of anxiety, depressive-like behavior and hyperarousal. The results show that single IN NPY can alter stress-triggered dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and activation of central noradrenergic activity. These findings provide proof of concept for potential of IN NPY for non-invasive prophylactic treatment or early intervention in response to traumatic stress.

Comparison of an inertial sensor system of lameness quantification with subjective lameness evaluation.

REASONS FOR PERFORMING STUDY: Subjective evaluation of mild lameness has been shown to have poor interobserver reliability. Traditional methods of objective lameness evaluation require specialised conditions and equipment. Wireless inertial sensor systems have been developed to allow for simple, rapid, objective lameness detection in horses trotted over ground. OBJECTIVE: The purpose of this study was to compare the sensitivities of an inertial sensor system and subjective evaluation performed by experienced equine practitioners at detecting lameness in horses. We hypothesised that the inertial sensor system would identify lameness at a lower level of sole pressure than a consensus of 3 experienced equine veterinarians. METHODS: Fifteen horses were fitted with special shoes that allowed for lameness induction via sole pressure. Horses were simultaneously evaluated by 3 equine veterinarians and a wireless inertial sensor system. Horses were subjected to multiple trials: 1) before inserting the screw; 2) after inserting the screw to just touch the sole; and 3) after tightening the screw in half turn increments. The number of screw turns required for lameness identification in the correct limb by the inertial sensors and by consensus of 3 equine veterinarians was compared using the Wilcoxon test. RESULTS: The inertial sensor system selected the limb with the induced lameness after fewer screw turns than did the 3 veterinarians (P<0.0001). The inertial sensor system selected the correct limb before the 3 veterinarians in 35 trials (58.33%), the evaluators selected the correct limb before the inertial sensors in 5 trials (8.33%), and in 20 trials (33.33%) they selected the correct limb at the same time. POTENTIAL RELEVANCE: The inertial sensor system was able to identify lameness at a lower level of sole pressure than the consensus of 3 equine veterinarians. The inertial sensor system may be an effective aid to lameness localisation in clinical cases.

Non-traumatic anterior cruciate ligament abnormalities and their relationship to osteoarthritis using morphological grading and cartilage T2 relaxation times: data from the Osteoarthritis Initiative (OAI).

OBJECTIVES: The aim of this work was to study anterior cruciate ligament (ACL) degeneration in relation to MRI-based morphological knee abnormalities and cartilage T2 relaxation times in subjects with symptomatic osteoarthritis. METHODS: Two radiologists screened the right knee MRI of 304 randomly selected participants in the Osteoarthritis Initiative cohort with symptomatic OA, for ACL abnormalities. Of the 52 knees with abnormalities, 28 had mucoid degeneration, 12 had partially torn ACLs, and 12 had completely torn ACLs. Fifty-three randomly selected subjects with normal ACLs served as controls. Morphological knee abnormalities were graded using the WORMS score. Cartilage was segmented and compartment-specific T2 values were calculated. RESULTS: Compared to normal ACL knees, those with ACL abnormalities had a greater prevalence of, and more severe, cartilage, meniscal, bone marrow, subchondral cyst, and medial collateral ligament lesions (all p < 0.05). T2 measurements did not significantly differ by ACL status. CONCLUSIONS: ACL abnormalities were associated with more severe degenerative changes, likely because of greater joint instability. T2 measurements may not be well suited to assess advanced cartilage degeneration.

Hindlimb kinematics before and after laser fibrotomy in horses with fibrotic myopathy.

REASONS FOR PERFORMING STUDY: Fibrotic myopathy can cause incapacitating gait abnormalities. Transection of the fibrotic mass followed by early post operative exercise is the best treatment for fibrotic myopathy. A laser may be used to transect the fibrotic mass. Assessment of the effectiveness of therapies for fibrotic myopathy has been limited to subjective evaluation. OBJECTIVES: To objectively assess gait abnormalities associated with fibrotic myopathy before and after laser fibrotomy followed by early post operative exercise. METHODS: Kinematic evaluation of horses with fibrotic myopathy walking and trotting on a treadmill was used to investigate hindfeet trajectories (n = 8) and lameness (n = 5) before and after laser fibrotomy Hoof flight trajectory length (HFTL), relative protraction length (% PL), maximum hoof height during swing (MXHH), hoof height at end of protraction (HH(pro)) and retraction (HH(ret)) were measured and differences between fibrotic myopathy affected and nonaffected limbs were calculated. Lameness was quantified by measuring maximum and minimum pelvic height differences between right and left halves of the stride. RESULTS: Before surgery the foot of the fibrotic myopathy affected limb had abnormal trajectories characterised as increased HFTL, MXHH and HH(pro) and decreased % PL and HH(ret) and the 5 horses objectively evaluated for lameness were lame in the fibrotic myopathy affected limb. Immediately after surgery the difference between affected and nonaffected limbs decreased for HFTL, % PL and HH(pro). Six to 11 weeks after surgery, the HFTL difference increased but was still smaller than before surgery, which was interpreted as partial recurrence of the gait abnormality; all horses objectively evaluated for lameness were either improved (n = 1) or not lame (n = 4) in the previously affected, operated limb. CONCLUSIONS: Fibrotic myopathy affects the foot flight and leads to asymmetric vertical excursion of the pelvis. Laser fibrotomy followed by early post operative exercise can minimise these abnormalities. POTENTIAL RELEVANCE: Laser fibrotomy combined with early post operative exercise is a viable therapy for fibrotic myopathy.

Physical activity is associated with magnetic resonance imaging-based knee cartilage T2 measurements in asymptomatic subjects with and those without osteoarthritis risk factors.

OBJECTIVE: To evaluate the association of exercise and knee-bending activities with magnetic resonance imaging (MRI)-based knee cartilage T2 relaxation times and morphologic abnormalities in asymptomatic subjects from the Osteoarthritis Initiative, with or without osteoarthritis (OA) risk factors. METHODS: We studied 128 subjects with knee OA risk factors and 33 normal control subjects ages 45-55 years, with a body mass index of 18-27 kg/m(2) and no knee pain. Subjects were categorized according to exercise level, using the leisure activity component of the Physical Activity Scale for the Elderly, and by self-reported frequent knee-bending activities. Two radiologists graded the cartilage of the right knee on MR images, using the Whole-Organ MRI Score (WORMS). Cartilage was segmented, and compartment-specific T2 values were calculated. Differences between the exercise groups and knee-bending groups were determined using multiple linear and logistic regression models. RESULTS: Among subjects with risk factors for knee OA, light exercisers had lower T2 values compared with sedentary and moderate/strenuous exercisers. When the sexes were analyzed separately, female moderate/strenuous exercisers had higher T2 values compared with sedentary individuals and light exercisers. Subjects without risk factors displayed no significant differences in T2 values according to exercise level. However, frequent knee-bending activities were associated with higher T2 values in both subjects with OA risk factors and those without OA risk factors and with more severe cartilage lesions in the group with risk factors. CONCLUSION: In subjects at risk of knee OA, light exercise was associated with low T2 values, whereas moderate/strenuous exercise in women was associated with high T2 values. Higher T2 values and WORMS grades were also observed in frequent knee-benders, suggesting greater cartilage degeneration in these individuals.

Complications of pelvic lymph node dissection for prostate cancer.

Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal metastases from prostate cancer, and may be performed separately from or at the time of radical prostatectomy. In addition to its potential for diagnostic staging, a PLND may be therapeutic in some patients. However, considerable debate centers on the appropriate candidates for the procedure, the extent and proper boundaries of dissection, optimal surgical approach, and absolute oncologic benefit. Several series suggest that there likely is limited benefit of PLND in low-risk patients and that PLND can be safely omitted in a high percentage of men undergoing contemporary radical prostatectomy. Furthermore, the value of PLND in patients with intermediate- and high-risk disease must be balanced against the potential morbidity of the procedure. In the setting of this debate, concern over morbidity directly attributable to this procedure is of paramount importance. This review focuses on the complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury, nerve injury, vascular injury, and lymphedema.

Repeatability of subjective evaluation of lameness in horses.

REASONS FOR PERFORMING STUDY: Previous studies have suggested that agreement between equine veterinarians subjectively evaluating lameness in horses is low. These studies were limited to small numbers of horses, evaluating movement on the treadmill or to evaluating previously-recorded videotape. OBJECTIVES: To estimate agreement between equine practitioners performing lameness evaluations in horses in the live, over ground setting. METHODS: 131 mature horses were evaluated for lameness by 2-5 clinicians (mean 3.2) with a weighted-average of 18.7 years of experience. Clinicians graded each limb using the AAEP lameness scale by first watching the horse trot in a straight line only and then after full lameness evaluation. Agreement was estimated by calculation of Fleiss' (kappa). Evaluators agreed if they picked the same limb as lame or not lame regardless of the severity of perceived lameness. RESULTS: After only evaluating the horse trot in a straight line clinicians agreed whether a limb was lame or not 76.6% of the time (kappa= 0.44). After full lameness evaluation clinicians agreed whether a limb was lame or not 72.9% of the time (kappa= 0.45). Agreement on forelimb lameness was slightly higher than on hindlimb lameness. When the mean AAEP lameness score was >1.5 clinicians agreed whether or not a limb was lame 93.1% of the time (kappa= 0.86), but when the mean score was < or = 1.5 they agreed 61.9% (kappa= 0.23) of the time. When given the task of picking whether or not the horse was lame and picking the worst limb after full lameness evaluation, clinicians agreed 51.6% (kappa= 0.37) of the time. CONCLUSIONS: For horses with mild lameness subjective evaluation of lameness is not very reliable. POTENTIAL RELEVANCE: A search for and the development of more objective and reliable methods of lameness evaluation is justified and should be encouraged and supported.

The use of alternative medicine in pediatric patients with atopic dermatitis.

Alternative medicine has been defined as forms of therapy or examination that have no scientific basis and for which no effective or diagnostic reliability has been demonstrated by scientific methods. The use of complementary or alternative medicine is increasing and controlled clinical trials on the subject are few. We performed a questionnaire-based study of 80 pediatric patients with atopic dermatitis. This questionnaire assessed the duration of treatment, the reason(s) for trying alternative therapy, the approximate cost and the success of the treatment, the duration of the childhood eczema, and whether the child had ever required hospital admission for eczema. Of the total, 34 (42.5%) patients had used alternative medicine. Herbal remedies and homeopathy were used most often. Most treatments were reported to show no benefit and in three instances deterioration was reported. This study has prompted us to enquire routinely regarding alternative medicine use. Alternative therapies are subject to minimal regulation and have been associated with serious side effects. We would recommend enquiries regarding alternative medicine use in all pediatric dermatology patients.

Factors in implementing interprofessional education and collaborative practice initiatives: findings from key informant interviews.

Health Canada (the federal government department in Canada responsible for health issues) commissioned a research team to conduct an environmental scan and research report in order to understand interprofessional education and collaborative patient-centred practice (IECPCP). This paper presents the findings from semi-structured telephone interviews with key informants conducted as part of the environmental scan. Grounded theory analysis was employed in order to identify factors associated with interprofessional education and collaborative practice initiatives. These factors were grouped according the following themes: lack of consensus regarding terminology; the need for both champions and external support; sensitization to the effects of professional culture, and logistics of implementation. Findings are discussed related to the literature and to the other papers included in this supplement to the Journal of Interprofessional Care.

Interprofessional care review with medical residents: lessons learned, tensions aired--a pilot study.

Integrated interprofessional care teams are the focus of Canadian and American recommendations about the future of health care. Keeping with this, a family medicine teaching site developed an educational initiative to expose trainees to interprofessional care processes and learning (Interprofessional Care Review; IPC). A formative evaluation pilot study was completed using one-on-one interviews and a focus group (n = 6) with family medicine residents. A semi-structured guide was utilized regarding: knowledge, skills and attitudes related to interprofessional care; their experience of the processes utilized in IPC. Data were analyzed using content analysis. Residents' perspectives on their learning revolved around four themes: changes to understanding and practice of interprofessional care; personal impact of IPC; learning about other health professionals; tension and challenges of IPC learning and clinical implementation. Residents valued the educational experience, but identified that faculty supervisors provided "mixed messages" in the value of collaborating with other health professionals. Implications regarding future educational and research opportunities are discussed.

Detection of spinal ataxia in horses using fuzzy clustering of body position uncertainty.

REASONS FOR PERFORMING STUDY: Subjective neurological evaluation in horses is prone to bias. An objective method of spinal ataxia detection is not subject to these limitations and could be of use in equine practice and research. HYPOTHESIS: Kinematic data in the walking horse can differentiate normal and spinal ataxic horses. METHODS: Twelve normal and 12 spinal ataxic horses were evaluated by kinematic analysis walking on a treadmill. Each body position signal was reduced to a scalar measure of uncertainty then fuzzy clustered into normal or ataxic groups. Correct classification percentage (CCP) was then calculated using membership values of each horse in the 2 groups. Subsequently, a guided search for measure combinations with high CCP was performed. RESULTS: Eight measures of body position resulted in CCP > or = 70%. Several combinations of 4-5 measures resulted in 100% CCP. All combinations with 100% CCP could be obtained with one body marker on the back measuring vertical and horizontal movement and one body marker each on the right fore- and hindlimb measuring vertical movement. CONCLUSIONS AND POTENTIAL RELEVANCE: Kinematic gait analysis using simple body marker combinations can be used objectively to detect spinal ataxia in horses.