Exploring the presence of markers of decidualization in the fallopian tubes: a systematic review.

The fallopian tubes (FTs) are part of the female upper genital tract. The healthy FT provides the biological environment for successful fertilization and facilitates the subsequent movement of the conceptus to the endometrial cavity. However, when the FT is damaged, as with salpingitis, pyosalpinx, and hydrosalpinx, it may increase the risk of an ectopic pregnancy, a life-threatening condition. Decidualization refers to a multifactorial process by which the endometrium changes to permit blastocyst implantation. The decidualization reaction is vital for endometrial receptivity during the window of implantation. To date, no comprehensive review that collates evidence on decidualization in the human FT has been conducted. Therefore, the aim of this review is to compile the current evidence on cellular decidualization occurring in the healthy and pathological FT in women of reproductive age. A literature search was conducted using five databases and identified 746 articles, 24 of which were analyzed based on inclusion and exclusion criteria. The available evidence indicates that the FT are able to undergo decidual changes under specific circumstances; however, the exact mechanism by which this occurs is poorly understood. Further research is needed to elucidate the mechanism by which decidualization can occur in the FT.

Brief report of virtual clinician research tools for tobacco dependence or dyslipidemia.

Health avatars were created to deliver previously tested live interventions for tobacco dependence and cholesterol management. The exploratory aims were to develop and test whether the avatar can be reliably assessed for autonomy supportiveness using the Health Care Climate Questionnaire and estimate the mean changes in motivation variables and correlate the avatars' autonomy supportiveness with the motivation variables and health outcomes. The avatars were found to be reliably assessed for autonomy supportiveness on the Health Care Climate Questionnaire. Autonomy support was positively correlated with the change in motivations and reduction in low-density lipoprotein. These findings suggest that health avatars may be tested in clinical trials.

Life histories of two deep-water Australian endemic elasmobranchs: Argus skate Dipturus polyommata and eastern spotted gummy shark Mustelus walkeri.

Two Australian endemic elasmobranchs, the Argus skate Dipturus polyommata and the eastern spotted gummy shark Mustelus walkeri, were collected from the by-catch of a prawn Melicertus plebejus trawl fishery off Queensland. Age and growth parameters were estimated from growth band counts in vertebral sections of 220 D. polyommata and 44 M. walkeri. Dipturus polyommata males and females had an observed maximum age of 10 years and reached maximum sizes of 369 and 371 mm total length (LT ), respectively. Mustelus walkeri lived longer, with the oldest female aged 16 years and measuring 1050 mm stretched total length (LST ), and oldest male aged 9 years and 805 mm LST . Dipturus polyommata grew relatively fast with a von Bertalanffy growth completion parameter of k = 0·208 year(-1) with males reaching maturity at 4·0 years (c. 278 mm LT ) and females at 5·1 years (c. 305 mm LT ). Mustelus walkeri grew more slowly with k = 0·033 year(-1) with males estimated to mature at 7-9 years (670-805 mm LST ) and females at 10-14 years (833-1012 mm LST ). Length at birth inferred from neonate D. polyommata was 89-111 mm LT while for M. walkeri it was estimated to be 273 LST based on the value of L0 from the von Bertalanffy growth model. Both species appeared to have continuous reproductive cycles and low fecundity with an average ovarian fecundity of eight follicles for D. polyommata and a litter size of five to seven pups for M. walkeri. Based on these life-history traits, D. polyommata is more resilient to fishing pressure than M. walkeri.

Effects of an evidence-based computerized virtual clinician on low-density lipoprotein and non-high-density lipoprotein cholesterol in adults without cardiovascular disease: The Interactive Cholesterol Advisory Tool.

There is a lack of research on the use of electronic tools that guide patients toward reducing their cardiovascular disease risk. We conducted a 9-month clinical trial in which participants who were at low (n = 100) and moderate (n = 23) cardiovascular disease risk-based on the National Cholesterol Education Program III's 10-year risk estimator-were randomized to usual care or to usual care plus use of an Interactive Cholesterol Advisory Tool during the first 8 weeks of the study. In the moderate-risk category, an interaction between treatment condition and Framingham risk estimate on low-density lipoprotein and non-high-density lipoprotein cholesterol was observed, such that participants in the virtual clinician treatment condition had a larger reduction in low-density lipoprotein and non-high-density lipoprotein cholesterol as their Framingham risk estimate increased. Perceptions of the Interactive Cholesterol Advisory Tool were positive. Evidence-based information about cardiovascular disease risk and its management was accessible to participants without major technical challenges.

Competence-impeding electronic games and players' aggressive feelings, thoughts, and behaviors.

[Correction Notice: An Erratum for this article was reported in Vol 106(3) of Journal of Personality and Social Psychology (see record 2014-07574-006). In the article, the name of author Edward Deci was missing his middle name initial and should have read as Edward L. Deci. In addition, an incorrect version of figure 1 was published.] Recent studies have examined whether electronic games foster aggression. At present, the extent to which games contribute to aggression and the mechanisms through which such links may exist are hotly debated points. In current research we tested a motivational hypothesis derived from self-determination theory-that gaming would be associated with indicators of human aggression to the degree that the interactive elements of games serve to impede players' fundamental psychological need for competence. Seven studies, using multiple methods to manipulate player competence and a range of approaches for evaluating aggression, indicated that competence-impeding play led to higher levels of aggressive feelings, easier access to aggressive thoughts, and a greater likelihood of enacting aggressive behavior. Results indicated that player perceived competence was positively related to gaming motivation, a factor that was, in turn, negatively associated with player aggression. Overall, this pattern of effects was found to be independent of the presence or absence of violent game contents. We discuss the results in respect to research focused on psychological need frustration and satisfaction and as they regard gaming-related aggression literature.

Mind, body, spirit: co-benefits for mental health from climate change adaptation and caring for country in remote Aboriginal Australian communities.

The evident and unresolved health disparity between Aboriginal and other Australians is testament to a history of systematic disenfranchisement. Stigma, lack of appropriate services and the expense of delivering services in remote settings make it impossible to adequately address mental health needs, including suicide, solely using a mainstream medical approach. Nor do mainstream approaches accommodate the relationship between Aboriginal health and connectedness to land, whether traditional or new land, remote or metropolitan. This review describes how caring-for-country projects on traditional lands in remote locations may provide a novel way to achieve the linked goals of climate change adaptation with co-benefits for social and emotional wellbeing.

Spectra of the triply charged ion CS(2)(3+) and selectivity in molecular Auger effects.

Spectra of triply charged carbon disulphide have been obtained by measuring, in coincidence, all three electrons ejected in its formation by photoionization. Measurements of the CS(2)(3+) ion in coincidence with the three electrons identify the energy range where stable trications are formed. A sharp peak in this energy range is identified as the (2)Pi ground state at 53.1+/-0.1 eV, which is the lowest electronic state according to ab initio molecular orbital calculations. Triple ionization by the double Auger effect is provisionally divided, on the basis of the pattern of energy sharing between the two Auger electrons into contributions from direct and cascade Auger processes. The spectra from the direct double Auger effect via S 2p, S 2s, and C 1s hole states contain several resolved features and show selectivity based on the initial charge localization and on the identity of the initial state. Triple ionization spectra from single Auger decay of S 2p-based core-valence states CS(2)(2+) show retention of the valence holes in this Auger process. Related ion-electron coincidence measurements give the triple ionization yields and the breakdown patterns in triple photoionization at selected photon energies from 90 eV to above the inner shell edges.

Having to versus wanting to play: background and consequences of harmonious versus obsessive engagement in video games.

The present research examined the background and consequences of different styles of engagement in video game play. Based on self-determination theory(1) and the dualistic model of passion,(2) the authors hypothesized that high levels of basic psychological need satisfaction would foster harmonious passion for video play, supporting the subjective sense that play is something one wants to do. It was also predicted that low levels of need satisfaction would promote obsessive passion for games and contribute to the feeling that game play is something one feels compelled to or has to do. It was expected, in turn, that passion for play would directly influence player outcomes closely tied to games, moderate links between play and well-being, and relate to overall levels of well-being as a function of basic need satisfaction. As expected, results showed that low levels of basic need satisfaction were associated with more obsessive passion, higher amounts of play, greater tension following play, and low game enjoyment, whereas high levels of need satisfaction did not predict hours of play but were associated with more harmonious passion, game enjoyment, and energy following play. Moderation analyses showed that high amounts of play related negatively to well-being only to the extent that players reported an obsessive passion and that the unique relations between passion and overall levels of player well-being were quite small once controlling for their basic need satisfaction in daily life. Discussion of the current findings focuses on their significance for understanding disordered play and the value of applying a theory-based approach to study motivation for virtual contexts.

The motivating role of violence in video games.

Six studies, two survey based and four experimental, explored the relations between violent content and people's motivation and enjoyment of video game play. Based on self-determination theory, the authors hypothesized that violence adds little to enjoyment or motivation for typical players once autonomy and competence need satisfactions are considered. As predicted, results from all studies showed that enjoyment, value, and desire for future play were robustly associated with the experience of autonomy and competence in gameplay. Violent content added little unique variance in accounting for these outcomes and was also largely unrelated to need satisfactions. The studies also showed that players high in trait aggression were more likely to prefer or value games with violent contents, even though violent contents did not reliably enhance their game enjoyment or immersion. Discussion focuses on the significance of the current findings for individuals and the understanding of motivation in virtual environments.

Suggestions in maternal and child health for the National Technology Assessment Programme: a consideration of consumer and professional priorities.

In North Staffordshire, the Achieving Sustainable Quality in Maternity (ASQUAM) meetings provide the programme for clinical guidelines and audit over the following year. The ASQUAM clinical effectiveness programme has attempted to address a number of the issues identified as obstacles to informed democratic prioritization. For example, it became clear that a number of topics raised were actually research questions. The organizers therefore decided to split the fourth ASQUAM day into an 'audit' morning and a 'research' afternoon. The meeting organized by RJ, CR and PJ in partnership with the Midwives Information and Resource Service and the National Childbirth Trust, was timed to allow the research ideas to feed into the national Health Technology Assessment (HTA) programme. This meeting was designed to increase the profile of ASQUAM amongst consumers and to increase their representation at the meeting. Objectives were to choose a new set of research priorities for the year 2000, and to ascertain the voting pattern of comparison to health professionals. There was overall agreement in terms of priorities, with the consumer group prioritizing 8 of the 10 topics chosen by the professionals (or 10 of the 11). No significant differences between the proportions of voted cast for each topic by professionals and consumers were found apart from topic 20. The numbers of consumers were small which does limit the number the validity of statistical comparisons. Nevertheless, it is clear that voting patterns were similar. Overall the process suggests that democratic prioritization is a viable option and one that may become essential within the framework of clinical and research governance.

Caesarean section by choice could fulfil the inverse care law.

We have assessed knowledge about caesarean sections in a group of North Staffordshire Hospital professionals and patients. Those who were more interested in having a caesarean section without medical indication were the nulliparous health professionals, the majority of whom thought they should be able to choose this option. Paradoxically, this was also the group who were most likely to consider that caesarean section is more expensive and dangerous. The explanation may be that they also felt it to be an easier, less painful and more convenient option.

Reducing risk by improving standards of intrapartum fetal care.

Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward--guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality of care was assessed by use of the CESDI system in all babies born with an Apgar score of 4 or less at 1 min and/or 7 or less at 5 min. 540 babies (4.3%) had low Apgar scores, and neither the percentage nor gestational age differed significantly between audit periods. In the baseline audit, care was judged suboptimal (grade II/III) in 14 (74%) of 19 cases, and in the next four periods it was 23%, 27%, 27% and 32%. In the latest audit period, after further educational interventions, it was 9%. Many of the failures to recognize or act on abnormal events were related to CTG interpretation. After the interventions there was a significant increase in cord blood pH measurement. There were no differences between audit periods in the proportion of babies with cord pH < 7.2. These results indicate that substantial improvements in quality of intrapartum care can be achieved by a programme of clinical risk management.

Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome.

BACKGROUND: The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder. OBJECTIVE: To determine whether bowel symptom severity and psychological symptoms directly influence health-related quality of life and health care costs. DESIGN: Cross-sectional survey. SETTING: Secondary and tertiary gastroenterology clinics. PATIENTS: 257 patients with severe IBS who did not respond to usual treatments and were recruited for a trial of psychological treatment. MEASUREMENTS: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability to work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores), and health care and productivity costs. Predictor and outcome measures were compared by using multiple regression and logistic regression analyses. RESULTS: Abdominal pain occurred on average 24 days per month and activities were restricted on 145 days of the previous 12 months. The mean (+/-SD) Hamilton depression score was 11.3 +/- 6.1. The SF-36 physical component summary score was low (37.7 +/- 10.6), and the patients had incurred high health care costs ($1743 +/- $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, and Hamilton depression scores independently contributed to the physical component score of the SF-36 (adjusted R(2) = 35.2%), but only psychological scores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted R(2) = 9.3%). History of sexual abuse was not an independent predictor of outcome. CONCLUSIONS: Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.

Democratic prioritization of maternity care: a rational basis for planning a clinical effectiveness programme.

BACKGROUND: The aim of the study was to evaluate the use of a democratic process for prioritizing the ASQUAM (Achieving Sustainable Quality in Maternity) clinical effectiveness programme. METHODS: Twenty-two improvements in the standards of maternity care were chosen as top-topic priorities at the 1996 and 1997 ASQUAM meetings. We wished to assess the relative priorities of local and national delegates, by comparing their voting patterns at the two meetings. The setting was North Staffordshire ASQUAM prioritization days, and the subjects were all the delegates at the 1996 and 1997 ASQUAM meetings. Main outcome measures were comparison of numbers of votes cast by local and national delegates for each of the 20 topics presented at the two ASQUAM meetings, and proportions of the 11 top-topics decided at each meeting that were chosen by local and national delegates. RESULTS: In 1996, significantly more local than national delegates voted for two topics related to maternal mortality or morbidity (incontinence and hypertensive diseases of pregnancy), but there were no statistically significant differences between the proportions of votes cast for any of the other 18 topics presented on the day. Indeed, local delegates had prioritized 11/11 of the final top-topics, and only one was omitted by the national delegates (10/11). In 1997, significantly more national than local delegates voted for three topics relating to professional stress levels, user involvement in working groups and antibiotic prophylaxis, but there were no statistically significant differences between the proportions of votes cast for any of the other 17 topics presented on the day. Again, local delegates had prioritized 11/11 of the final topics, with only one being omitted by the national delegates (10/11). CONCLUSION: There appeared to be a remarkable concordance between local and national delegates at both meetings, suggesting an underlying rationality to decision making. We believe this to be a reflection of the process of careful evaluation of outcome and intervention supported by the protection of a secret ballot, allowing free expression of individual's values.

Improving the standards of care for women having caesarean sections.

Improvement in the uptake of prophylactic antibiotics at caesarean section was chosen as a priority at the 1994 ASQUAM (Achieving Sustainable Quality in Maternity) meeting. The interventions used were guidelines, cyclical audit of cases and a patient-specific reminder stamp in the notes. A more detailed qualitative assessment of standards of communication and outcome was undertaken on a smaller cohort of women. Data on antibiotic prophylaxis were obtained from an audit record completed for every caesarean section undertaken at North Staffordshire Hospital from 1996 to 1998. Information on morbidity following caesarean section and on counselling was obtained from a review of the case records of a consecutive series of 75 caesarean sections and from a telephone call. In the baseline audit, 75% of women had received antibiotics; this increased to 92% in the remainder of 1996, 95% in 1997 and 98% in 1998. Fifty-eight of the 75 women were contactable by telephone (77%); of these 16 (28%) had a 'wound infection', 12 of which developed after discharge from hospital. Only 25 women (43%) remembered being counselled about the caesarean section. It is possible to achieve significant improvements in the quality of care for women having caesarean sections through the use of local guidelines, cyclical audit and reminder stamps. However, this audit, with community follow-up, raises questions about the adequacy of single dose prophylaxis. It also suggests the need for improved compliance with RCOG communication following caesarean section guidelines.

Prospective audit of surgery for varicose veins.

BACKGROUND: Recent reports have demonstrated a high recurrence rate following varicose vein surgery. It has been suggested that this is due to inadequate surgery. This has been assessed by a prospective surgical audit. METHODS: Fifty limbs in 33 patients awaiting varicose vein surgery were examined before operation and 6 weeks after operation. A duplex scanner was used to detect sites of venous incompetence. RESULTS: Eighteen operations were performed for recurrent disease, 38 limbs had an incompetent connection between the long saphenous vein or another superficial vein and the common femoral vein in the groin, and 11 limbs had saphenopopliteal incompetence. Following surgery, persisting incompetence existed in seven limbs in the groin and eight limbs in the popliteal fossa; this was due to inadequate surgery in 13 of 15 cases. Thirty-four operations were performed by trainees who were responsible for 14 of the 15 cases of persisting incompetence in the groin or popliteal fossa. CONCLUSION: Improved surgical technique and training is required to reduce recurrence following varicose vein surgery.

Atypical presentation of Crohn's disease: severe, recurrent iron deficiency anemia dependent on blood transfusions.

We report an unusual case of Crohn's disease. Our subject, a 43-yr-old lady, presented with severe iron deficiency anemia, hypoproteinemia and lymphocytopenia, but without any clinical manifestations of Crohn's disease either at presentation or during follow-up. She had recurrent episodes of severe iron deficiency anemia, repeatedly requiring blood transfusions (28 units in 20 months). She was found to have a short stricture with ulceration in the ileum due to Crohn's disease, and a blind loop with bacterial overgrowth above it. Resection of the affected area prevented further recurrence of anemia and corrected hypoproteinemia. We postulate that her anemia and hypoproteinemia were due to blood and protein (lymph) loss from the ulcerated area in the ileum. Such a presentation has not been described before.

Properties and partial genetic characterization of Nepean phage and other lytic phages of Brucella species.

Nepean (Np), a new brucellaphage, was associated with atypical Brucella abortus strains from Ontario cattle. Carriage of Np was associated with loss of smooth lipopolysaccharide, changes in some protein bands in acrylamide gel electrophoresis profiles, increased susceptibility to colistin, and increased resistance to ultraviolet killing. Nepean (Np) was compared with brucellaphages Tb, Fi, Wb, Iz and R/C. All were morphologically identical, with icosahedral capsids (50-65 nm diameter) and short tails (15-25 nm long), but Np had a more restricted host range, replicating only in smooth strains of B. abortus. All six brucellaphages were generally similar in resistance to chemical and physical agents. Brucellaphage DNA was double stranded and unmethylated; its molecular size was 38 kilobase pairs. The DNAs of Tb, Fi, Wb, Iz and R/C could not be differentiated by restriction endonuclease digest profiles produced by BgII, EcoRI, HindIII or PvuII. Nepean (Np) DNA was very similar to that of the other brucellaphages, but with every enzyme used its profile differed in the number and/or position of at least one fragment. However, there was complete cross-hybridization of Tb and Np DNAs. Hybridization techniques failed to detect Brucella DNA in Dp or Tb phages, or phage DNA in Brucella cells. Extrachromosomal plasmid DNA was not detected.

Plasmid transfer and plasmid-mediated genetic exchange in Brucella abortus.

Naturally-occurring plasmids and gene transfer mechanisms have not yet been reported in brucellae. Here we show that Brucella abortus is capable of maintaining and transferring the broad-host-range plasmids pTH10 (IncP), pSa (IncW) and R751 (IncP), and describe pTH10-mediated transfer of B. abortus chromosomal genes to Escherichia coli. All three plasmids transferred by conjugation from E. coli to B. abortus S19, and from B. abortus S19 to B. abortus 292 (biovar 4). They were stably maintained with no effect on biotyping characteristics. Plasmid pTH10 is a Tn1-containing derivative of RP4. It confers temperature-sensitive resistance to kanamycin, tetracycline and ampicillin to E. coli, but its tetracycline resistance and temperature sensitivity were poorly expressed in B. abortus. Plasmids pTH10 and pSa both transferred from B. abortus to E. coli DP50, a strain that is auxotrophic for diaminopimelic acid (DAP) Plasmid pTH10 (but not pSa) mobilized Brucella chromosomal gene(s) for DAP synthesis to DP50, yielding non-DAP-requiring (NDR) transconjugants. Neither plasmid transferred the NDR marker from their original E. coli host strains, nor did pTH10 transfer it from NDR transconjugants. Escherichia coli NDR transconjugant EP8.11 was cured of pTH10 by passage at the nonpermissive temperature, but retained the NDR marker and the Tn1-encoded resistance to ampicillin, indicating Tn1-mediated integration of Brucella chromosomal DNA into the E. coli chromosome.