Woman to Woman: Implementation of a Cervical Cancer Education Training Program for Grenadian Lay Health Advisors.

The reduction in cervical cancer (CC) in developed countries, due mainly to Pap testing, has not filtered down to Caribbean countries including Grenada despite accessible screening. This is attributed to a lack of knowledge and low screening. Researchers in low resource settings successfully trained lay health advisors (LHAs), using theory-based, culturally relevant interventions to reverse this trend. The use of LHAs in Grenada was not documented in the literature; therefore, the purpose of this study was to implement and evaluate a culturally relevant curriculum in an effort to educate Grenadian LHAs on CC. Using convenience sampling, 8 Grenadian women were recruited from the parishes with the highest rates of CC. They participated in Woman to Woman (W2W), a 2-day CC, and human papilloma virus (HPV) prevention education program facilitated by local content experts. W2W was adapted from an evidence-based curriculum and tailored for the Grenadian context. Training consisted of modules on CC and HPV. Knowledge of LHAs was measured pre- and post-intervention. Summative evaluation was assessed using a focus group discussion. There was a significant increase in CC knowledge among LHA post-training (p < 0.05) and LHAs had positive opinions about the intervention. They had an enhanced sense of self-efficacy and valued feeling part of a team. The W2W results indicated that an evidence-based and culturally tailored educational intervention has the potential for significant gains in CC and HPV knowledge. Future research will evaluate the LHA-led CC and HPV educational intervention in the community setting.

Combining biological and psychosocial baseline variables did not improve prediction of outcome of a very-low-energy diet in a clinic referral population.

Consistent, strong predictors of obesity treatment outcomes have not been identified. It has been suggested that broadening the range of predictor variables examined may be valuable. We explored methods to predict outcomes of a very-low-energy diet (VLED)-based programme in a clinically comparable setting, using a wide array of pre-intervention biological and psychosocial participant data. A total of 61 women and 39 men (mean ± standard deviation [SD] body mass index: 39.8 ± 7.3 kg/m2 ) underwent an 8-week VLED and 12-month follow-up. At baseline, participants underwent a blood test and assessment of psychological, social and behavioural factors previously associated with treatment outcomes. Logistic regression, linear discriminant analysis, decision trees and random forests were used to model outcomes from baseline variables. Of the 100 participants, 88 completed the VLED and 42 attended the Week 60 visit. Overall prediction rates for weight loss of ≥10% at weeks 8 and 60, and attrition at Week 60, using combined data were between 77.8 and 87.6% for logistic regression, and lower for other methods. When logistic regression analyses included only baseline demographic and anthropometric variables, prediction rates were 76.2-86.1%. In this population, considering a wide range of biological and psychosocial data did not improve outcome prediction compared to simply-obtained baseline characteristics.

Ketosis and appetite-mediating nutrients and hormones after weight loss.

BACKGROUND/OBJECTIVES: Diet-induced weight loss is accompanied by compensatory changes, which increase appetite and encourage weight regain. There is some evidence that ketogenic diets suppress appetite. The objective is to examine the effect of ketosis on a number of circulating factors involved in appetite regulation, following diet-induced weight loss. SUBJECTS/METHODS: Of 50 non-diabetic overweight or obese subjects who began the study, 39 completed an 8-week ketogenic very-low-energy diet (VLED), followed by 2 weeks of reintroduction of foods. Following weight loss, circulating concentrations of glucose, insulin, non-esterified fatty acids (NEFA), ß-hydroxybutyrate (BHB), leptin, gastrointestinal hormones and subjective ratings of appetite were compared when subjects were ketotic, and after refeeding. RESULTS: During the ketogenic VLED, subjects lost 13% of initial weight and fasting BHB increased from (mean±s.e.m.) 0.07±0.00 to 0.48±0.07 mmol/l (P<0.001). BHB fell to 0.19±0.03 mmol/l after 2 weeks of refeeding (P<0.001 compared with week 8). When participants were ketotic, the weight loss induced increase in ghrelin was suppressed. Glucose and NEFA were higher, and amylin, leptin and subjective ratings of appetite were lower at week 8 than after refeeding. CONCLUSIONS: The circulating concentrations of several hormones and nutrients which influence appetite were altered after weight loss induced by a ketogenic diet, compared with after refeeding. The increase in circulating ghrelin and subjective appetite which accompany dietary weight reduction were mitigated when weight-reduced participants were ketotic.

The role of genetic structure in the adaptive divergence of populations experiencing saltwater intrusion due to relative sea-level rise.

Saltwater intrusion into estuaries creates stressful conditions for nektonic species. Previous studies have shown that Gambusia affinis populations with exposure to saline environments develop genetic adaptations for increased survival during salinity stress. Here, we evaluate the genetic structure of G. affinis populations, previously shown to have adaptations for increased salinity tolerance, and determine the impact of selection and gene flow on structure of these populations. We found that gene flow was higher between populations experiencing different salinity regimes within an estuary than between similar marsh types in different estuaries, suggesting the development of saline-tolerant phenotypes due to local adaptation. There was limited evidence of genetic structure along a salinity gradient, and only some of the genetic variation among sites was correlated with salinity. Our results suggest limited structure, combined with selection to saltwater intrusion, results in phenotypic divergence in spite of a lack of physical barriers to gene flow.

Usefulness of the secretory unit of islet transplant objects (SUITO) index for evaluation of clinical autologous islet transplantation.

BACKGROUND: Assessing the engrafted islet mass is important in evaluating the efficacy of islet transplantation. We previously demonstrated that the average secretory unit of islet transplant objects (SUITO) index within 1 month of allogeneic islet transplantation was an excellent predictor of insulin independence. However, the usefulness of the SUITO index for evaluating autologous islet transplantation has not been explored. The purpose of the present study was to assess the relationship between the SUITO index and clinical outcomes after total pancreatectomy followed by autologous islet transplantation. METHODS: We performed 27 total pancreatectomies followed by autologous islet transplantation from October 2006 to January 2011. Cases were divided into an insulin-independent group (IIG; n = 12) and an insulin-dependent group (lDG; n = 15). The SUITO index was calculated by the formula [fasting C-peptide (ng/mL)/fasting glucose (mg/dL) -63] × 1,500. The average SUITO index within the first month of transplantation except for days 0, 1, and 2, maximum SUITO index, and most recent SUITO index were calculated in each case, and values were compared between the IIG and the IDG. RESULTS: The average SUITO index within 1 month was significantly higher in the IIG than in the IDG (24.6 ± 3.4 vs 14.9 ± 2.0, respectively; P < .02). The maximum SUITO indices were 45.7 ± 7.7 in the IIG and 30.1 ± 8.1 in the IDG (not significant), and the recent SUITO indices were 36.9 ± 6.7 in the IIG and 22.8 ± 6.1 in the IDG (not significant). CONCLUSIONS: The average SUITO index within 1 month was an excellent predictor of insulin independence after total pancreatectomy followed by autologous islet transplantation.

Adaptation to sea level rise: does local adaptation influence the demography of coastal fish populations?

This study compared the growth of two western mosquitofish Gambusia affinis populations that were previously demonstrated to have genetic adaptations that increased survival under lethal salinity exposures. The objective was to evaluate how genetic adaptations to lethal salinity stress affect population demography when exposed to sublethal salinity stress. Results indicate that chronic salinity exposure had a generally negative impact on population size, but fish originating from one of the two populations established with fish from a brackish site exhibited an increase in population size. Saltwater intrusion seems to result in reduced population size for most populations. Some populations inhabiting more saline sites, however, may develop localized adaptations, mitigating the consequences of increased salinity on population productivity.

Resumenes de articulos de la literatura pediátrica: tratamiento de las infecciones por staphylococcus aereus meticilino-resistente adquirido en la comunidad / Abstracts of articles in the pediatric literature: treatment of infections caused by Staphylococcus aureus methicillin-resistant community-acquired

La rápida emergencia de cepas de Staphylococcus aureus meticilino-resistente adquirido en la comunidad (CA-MRSA) ha requerido importantes cambios en la terapia emprírica de las infecciones provocadas por estos agentes.

Magnetic-field-induced lattice anomaly inside the superconducting state of CeCoIn5: anisotropic evidence of the possible Fulde-Ferrell-Larkin-Ovchinnikov state.

We report high magnetic field linear magnetostriction experiments on CeCoIn5 single crystals. Two features are remarkable: (i) a sharp discontinuity in all the crystallographic axes associated with the upper superconducting critical field B(c2) that becomes less pronounced as the temperature increases and (ii) a distinctive second orderlike feature observed only along the c axis in the high field (10 T < or approximately B< or = B(c2)) low temperature (T < or approximately 0.35 K) region. This second order transition is observed only when the magnetic field lies within 20 degrees of the ab planes and there is no signature of it above B(c2), which raises questions regarding its interpretation as a field induced magnetically ordered phase. Good agreement with previous results suggests that this anomaly is related to the transition to a possible Fulde-Ferrel-Larkin-Ovchinnikov superconducting state.

A low-protein diet exacerbates postprandial chylomicron concentration in moderately dyslipidaemic subjects in comparison to a lean red meat protein-enriched diet.

OBJECTIVE: To investigate whether altering energy intake as red meat protein or carbohydrate modifies chylomicron homeostasis and postprandial lipaemia. DESIGN: Randomized single-blind dietary intervention trial. SETTING: School of Public Health, Division of Health Science, Curtin University, Perth, Western Australia. SUBJECTS: A total of 20 moderately hypertriglyceridaemic but otherwise healthy subjects were recruited and completed the study. INTERVENTION: Participants consumed an isocaloric weight maintenance diet low in protein (14, 53 and 30% of energy as protein, carbohydrate and fat, respectively) or high in protein (25, 35 and 30% energy as protein, carbohydrate and fat) for a period of 6 weeks. Fasting plasma lipids and postprandial lipoprotein studies (triglyceride and apolipoprotein B48) following an oral fat challenge were carried out at the start and conclusion of the dietary intervention period. RESULTS: Consumption of the low- or high-protein diet had no significant effect on fasting plasma or postprandial lipaemia, the latter determined as the incremental area under the triglyceride curve following a fat challenge. However, subjects who consumed a low-protein diet for 6 weeks had a substantially exaggerated postprandial chylomicron response, indicated as the area under the apo B48 curve following a fat challenge. The change in postprandial chylomicron kinetics could not be explained by changes in insulin sensitivity, which appeared to be similar before and after intervention with either diet. CONCLUSIONS: Daily moderate consumption of a lean red meat protein-enriched diet attenuates postprandial chylomicronaemia in response to ingestion of a fatty meal.

Community-acquired methicillin-resistant Staphylococcus aureus infections in south Texas children.

BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infections have increased dramatically from 1990 to 2000. OBJECTIVES: The objectives of this retrospective study were to report the frequency of CAMRSA isolates, to describe the spectrum of disease observed in children infected with CAMRSA and to compare the antibiotic susceptibility patterns of community-acquired and nosocomial methicillin-resistant S. aureus (MRSA) infections. METHODS: All cases of S. aureus including MRSA infections were identified by a computer-assisted search of the Vitek system culture results from 1990 to 2000 and review of the minutes of Infection Control Committee meetings. RESULTS: MRSA was isolated from 147 children (77 boys; 2 weeks to 17 years) from October 1, 1990, to December 31, 2000. Seven cases of CAMRSA were identified from 1990 to 1996, and 53 cases were identified from 1997 to 2000 with 35 cases occurring in 2000. Of the 128 children whose medical records were reviewed, 60 (47%) had CAMRSA infections. In 53 (88%) of these 60 children no risk factor for MRSA was identified. Soft tissue infections accounted for 48 (91%) of the 53 cases of the CAMRSA in children without known risk factors. CAMRSA isolates from children without known risk factors were more susceptible to trimethoprim-sulfamethoxazole (98% vs. 82%; P < 0.005) and clindamycin (92% vs. 57%; P < 0.001) and less susceptible to tetracycline (54% vs. 95%; P < 0.001) than were nosocomial MRSA isolates. CONCLUSIONS: The emergence of CAMRSA as a cause of common infections may require a change in the initial selection of antibiotics to assure appropriate coverage in critically ill children.

Nocardiosis in South Texas children.

Primary cutaneous nocardiosis can present as cellulitis or abscess with or without lymphadenitis. In South Texas children with suspected Staphylococcus aureus or Streptococcus pyogenes skin and soft tissue infections who do not improve as expected with appropriate antibiotics, physicians should consider Nocardia brasiliensis in the differential diagnosis, especially if there are multiple lesions in a lymphocutaneous distribution.

Murine typhus in South Texas children.

BACKGROUND: Murine typhus is a zoonotic infection caused by Rickettsia typhi. This illness used to be endemic in the southeastern and gulf coast of the United States and is now only rarely reported in South Texas and Southern California. Murine typhus causes a febrile illness with headache and rash that has been well-described in adults. OBJECTIVE: To define the epidemiologic and clinical characteristics, laboratory findings, hospital course and response to therapy of children discharged from our hospital with a diagnosis of murine typhus. METHODS: Retrospective chart review of all children discharged from Driscoll Children's Hospital, Corpus Christi, TX, from January 1, 1990, to June 30, 1998, with a diagnosis of murine typhus. Patients. Thirty children (17 females) ages 2 to 17 years (mean, 10 +/- 4 years). RESULTS: Eighty percent of the children were admitted between May and November, and 67% had a history of contact with or exposure to a potential animal reservoir. Children were admitted after a mean of 7 +/- 4 days. The most common clinical features were fever 100%, rash 80% and headache 77%. Laboratory abnormalities included elevated erythrocyte sedimentation rate (75%), elevated serum transaminases (67%), hyponatremia (66%) and increased immature leukocytes without leukocytosis (63%). Only one child had leukocytosis and 40% had leukopenia. Defervescence occurred a mean of 35 +/- 19 h after initiation of appropriate antibiotics. Hospitalization lasted for a mean of 7 +/- 3 days. There were no readmissions and no patients died as a result of the infection. CONCLUSIONS: Despite being rarely reported in this country now, murine typhus continues to be an important cause of fever and hospitalization for children in South Texas. Children with murine typhus develop an illness similar to that reported in adults with fever, rash and headache. Children respond quickly to therapy with doxycycline or tetracycline and recover completely from their illness.

The developmental role of warthog, the notch modifier encoding Drab6.

The warthog (wrt) gene, recovered as a modifier for Notch signaling, was found to encode the Drosophila homologue of rab6, Drab6. Vertebrate and yeast homologues of this protein have been shown to regulate Golgi network to TGN trafficking. To study the function of this protein in the development of a multicellular organism, we analyzed three different warthog mutants. The first was an R62C point mutation, the second a genomic null, and the third was an engineered GTP-bound form. Our studies show, contrary to yeast, that the Drosophila homologue of rab6 is an essential gene. However, it has limited effects on development beyond the larval stage. Only the mechanosensory bristles on the head, notum, and scutellum are affected by warthog mutations. We present models for the modifying effect of Drab6 on Notch signaling.

The role of inflammatory mediators and anti-inflammatory drugs in otitis media.

Despite multiple studies, the role of anti-inflammatory drugs in the treatment of AOM and OME is unclear. Although the AHCPR was against the use of steroids in OME, other studies suggest a possible role with potential cost savings and a decrease in the need for surgery in some patients. But the risk-benefit ratio of steroid treatment is unclear. There is some evidence that NSAIDs may decrease otalgia associated with AOM, but no proof that NSAIDs reduce or prevent inflammatory changes in the middle ear associated with AOM and OME.

The Drosophila protein Wunen repels migrating germ cells.

In Drosophila, germ cells migrate in embryonic development from the lumen of the developing gut towards the overlying mesoderm, where they enter the gonads. The gene wunen is responsible for guiding the germ cells early in this process. Here we report that the protein Wunen has two properties that allow it to use repulsion to guide the germ cells. Wunen can transform a permissive cellular environment into a repulsive one, and is expressed in the gut in a pattern that guides germ cells towards the mesoderm. Wunen shows strong similarity to the enzyme type 2 phosphatidic acid phophatase (PAP2)4, suggesting that it is involved in lipid metabolism.

The NOTCH receptor and its ligands.

An intricate interplay of signalling pathways dictates the acquisition of specific cell fates during development. The NOTCH receptor is the central element in a cell-interaction mechanism that controls the fate of a very broad spectrum of precursor cells. Conservation across species implies that signalling through this receptor is a tool frequently used by metazoans to modulate the fate of precursor cells. This article describes recent advances in the genetic and molecular dissection of this developmentally fundamental pathway that have provided new insights into the mechanism by which extracellular signals act through the NOTCH receptor to determine or alter cellular fate.

Analysis of dominant enhancers and suppressors of activated Notch in Drosophila.

The Notch receptor controls cell fate decisions throughout Drosophila development. Truncated, ligand-independent forms of this protein delay or block differentiation. We have previously shown that expression of the intracellular domain of the receptor under the control of the sevenless enhancer/promoter induces a rough eye phenotype in the adult fly. Analysis of the resultant cellular transformations suggested that this form of Notch acts as a constitutively activated receptor. To identify gene products that interact with Notch, a second-site mutagenesis screen was performed to isolate enhancers and suppressors of the eye phenotype caused by expression of these activated Notch molecules. We screened 137,000 mutagenized flies and recovered 290 dominant modifiers. Many new alleles of previously identified genes were isolated, as were mutations defining novel loci that may function in the Notch signaling pathway. We discuss the data with respect to known features of Notch receptor signaling and Drosophila eye development.