Community-engaged healthcare model for currently under-served individuals involved in the healthcare system.

In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as 'high needs, high cost' (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with 'currently under-served'; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients.

The comparative landscape of duplications in Heliconius melpomene and Heliconius cydno.

Gene duplications can facilitate adaptation and may lead to interpopulation divergence, causing reproductive isolation. We used whole-genome resequencing data from 34 butterflies to detect duplications in two Heliconius species, Heliconius cydno and Heliconius melpomene. Taking advantage of three distinctive signals of duplication in short-read sequencing data, we identified 744 duplicated loci in H. cydno and H. melpomene and evaluated the accuracy of our approach using single-molecule sequencing. We have found that duplications overlap genes significantly less than expected at random in H. melpomene, consistent with the action of background selection against duplicates in functional regions of the genome. Duplicate loci that are highly differentiated between H. melpomene and H. cydno map to four different chromosomes. Four duplications were identified with a strong signal of divergent selection, including an odorant binding protein and another in close proximity with a known wing colour pattern locus that differs between the two species.

Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot.

Achilles tenotomy is a recognised step in the Ponseti technique for the correction of idiopathic congenital talipes equinovarus in most percutaneous cases. Its use has been limited in part by concern that the subsequent natural history of the tendon is unknown. In a study of 11 tendons in eight infants, eight tendons were shown to be clinically intact and ten had ultrasonographic evidence of continuity three weeks after tenotomy. At six weeks after tenotomy all tendons had both clinical and ultrasonographic evidence of continuity.

Management of congenital talipes equino varus in Scotland: a nationwide audit.

The Scottish Talipes Register is a record of all newly diagnosed cases of idiopathic congenital talipes equinovarus (CTEV) in Scotland over a four.year period. Two hundred and sixteen children were entered into the register, which recorded initial management and all subsequent interventions, both non-operative and operative. The data, therefore, represent a record of the different management regimens used within Scotland highlighting the variations in duration of conservative management and variations in surgical intervention following different methods of conservative management.

Control of flow direction in microfluidic devices with polyelectrolyte multilayers.

Electroosmotic flow (EOF) is commonly utilized in microfluidics. Because the direction of the EOF can be determined by the substrate surface charge, control of the surface chemical state offers the potential, in addition to voltage control, to direct the flow in microfluidic devices. We report the use of polyelectrolyte multilayers (PEMs) to alter the surface charge and control the direction of flow in polystyrene and acrylic microfluidic devices. Relatively complex flow patterns with simple arrangements of applied voltages are realized by derivatization of different arms of a single device with oppositely charged polyelectrolytes. In addition, flow in opposite directions in the same channel is possible. A positively derivatized plastic substrate with a negatively charged lid was used to achieve top-bottom opposite flows. Derivatization of the two sides of a plastic microchannel with oppositely charged polyelectrolytes was used to achieve side-by-side opposite flows. The flow is characterized using fluorescence imaging and particle velocimetry.

Cellular applications of a sensitive and selective fiber-optic nitric oxide biosensor based on a dye-labeled heme domain of soluble guanylate cyclase.

Nitric oxide-selective sensors have been prepared with the heme domain of soluble guanylate cyclase (sGC), the only known receptor for signal transduction involving nitric oxide. Expressed in and purified from E. coli, the heme domain contains a stoichiometric amount of heme that has electronic and resonance Raman spectra almost identical to those of heterodimeric (native) sGC purified from bovine lung. The small size of the heme domain, its inability to bind oxygen, and its high affinity for nitric oxide make it well-suited for sensor applications. The heme domain has been labeled with a fluorescent reporter dye and changes in this dye's intensity are observed based on the sGC heme domain's characteristic binding of nitric oxide. The current sensors are prepared with 100-microns optical fiber but could also be prepared using submicrometer fiber tips. These sensors have fast, linear, and reversible responses to nitric oxide and are unaffected by numerous common interferents, such as oxygen, nitrite and nitrate. The sensor limit of detection is 1 microM nitric oxide. Glutathione has been shown to decrease the sensitivity of the sensor; however, the sensor response remains linear and can be calibrated on the basis of the glutathione concentration present in the biological environment of interest. The sensors have been used to measure extracellular nitric oxide production by BALB/c mouse macrophages. Minimal nitric oxide was produced by untreated cells, while high levels of nitric oxide were released from activated cells, e.g., 111 +/- 2 microM in a given cell culture.

Ratiometric and fluorescence-lifetime-based biosensors incorporating cytochrome c' and the detection of extra- and intracellular macrophage nitric oxide.

Ratiometric and lifetime-based sensors have been designed for cellular detection of nitric oxide. These sensors incorporate cytochrome c', a hemoprotein known to bind nitric oxide selectively. The cytochrome c' is labeled with a fluorescent reporter dye, and changes in this dye's intensity or fluorescence lifetime are observed as the protein binds nitric oxide. The ratiometric sensors are composed of dye-labeled cytochrome c' attached to the optical fiber via colloidal gold, along with fluorescent microspheres as intensity standards. These ratiometric sensors exhibit linear response, have fast response times (< or = 0.25 s), and are completely reversible. The sensors are selective over numerous common interferents such as nitrite, nitrate, and oxygen species, and the limit of detection is 8 microM nitric oxide. The lifetime-based measurements are made using free, dye-labeled cytochrome c' in solution and have a limit of detection of 30 microM nitric oxide. The use of these two techniques has allowed measurement of intra- and extracellular macrophage nitric oxide. Employing the ratiometric fiber sensors gave a multicell culture average extracellular nitric oxide concentration of 210 +/- 90 microM for activated macrophages, while an average intracellular concentration of 160 +/- 10 microM was determined from the lifetime-based measurements of dye-labeled cytochrome c' in the macrophage cytosol. Microscopic adaptation of the lifetime-based methods described here would allow direct correlation of intracellular nitric oxide levels with specific cellular activities, such as phagocytosis.

Development and cellular applications of fiber optic nitric oxide sensors based on a gold-adsorbed fluorophore.

A new design for optochemical sensors has been applied to the development of a nitric oxide selective fiber optic sensor. This sensor is composed of a fluorescein derivative dye attached to colloidal gold. The fluorescein dye rearranges as nitric oxide adsorbs onto the gold, inducing a decrease in the fluorescence intensity of the dye. This mechanism has allowed preparation of fiber optic dye-based nitric oxide sensors, which have been made ratio-metric by addition of reference dye microspheres. Previously developed fast, selective optical sensors for detection of aqueous nitric oxide involved a protein, such as cytochrome c'. The new fluorescein derivative chemical sensors have characteristics similar to those of the protein-based biosensors, including fast response times, excellent selectivity, and complete reversibility. In addition, the chemical sensors have advantages such as greater stability and commercially available components. These sensors were utilized to measure nitric oxide production by BALB/c mouse macrophages.

Predictive value of human footprints in a forensic context.

Previous work from the United States has shown close correlation between an individual's size and weight and predetermined measurements taken from his or her footprints. This study investigated the situation in a group of United Kingdom subjects, for which there is at present little data. Walking and standing footprints, fleshed foot measurements and stature were obtained from 105 adult volunteers from the staff and students of the United Medical and Dental Schools of Guy's and St Thomas' Hospitals, London. The footprints were measured using predetermined landmarks and the results analysed to investigate the significance of the parameters in a forensic context. Inter-observer and intra-observer errors were within acceptable limits. Regression equations were calculated for foot length from various parameters measured on a footprint. Topinard's finding that foot length represents between 14.9%-18.1% of stature in a given individual was confirmed. Footprint length showed a normal distribution in both sexes but male footprint length was greater than female footprint length for any given height. This study provides a quantitative method that could be used both with partial footprints and in the absence of dermatoglyphics to assist in the identification of an individual in a forensic context.

Fiber-optic nitric oxide-selective biosensors and nanosensors.

Fiber-optic biosensors that are selective for nitric oxide and do not respond to most potential interferents have been prepared with cytochromes c'. Both micro- and nanosensors have been prepared, and their response is fast (< 1 s), reversible, and linear up to 1 mM nitric oxide. The detection limit is 20 microM, making the sensor useful for some biological samples, such as the macrophages studied here. While sensors have been prepared based on the fluorescence of the cytochromes c', optodes with greatly enhanced signal-to-noise ratios have been made by labeling the cytochrome c' with a fluorescent dye. Comparisons of cytochromes c' from three species of bacteria as well as of two matrixes were performed and the optimum sensor configuration is described.

Nitrite- and chloride-selective fluorescent nano-optodes and in vitro application to rat conceptuses.

Nitrite- and chloride-selective, ion correlation-based, nano-optodes have been prepared for application in vitro. These fluorescent, liquid polymer based sensors have theoretically predictable responses to anion activities and good selectivity. The nitrite sensor, prepared with a vitamin B12 derivative ionophore, would be useful for determination of oxidized nitric oxide. Chloride nano-optodes, as well as micro-optodes, prepared with an indium porphyrin ionophore, were utilized to determine chloride levels both on the surface and inside the visceral yolk sac of organogenesis-stage rat conceptuses.

Meniscal regeneration in the long-term after total meniscectomy?

A cohort of 39 patients (28 male, 11 female) that had undergone total meniscectomy as adolescents (mean age 16 years) underwent FISP 3D Magnetic Resonance Imaging at a mean follow up of 30 years. The presence of meniscal tissue was assessed by two independent observers blinded to the operation details. The volume of any meniscal tissue present was calculated. A posterior horn remnant was seen in 57% of medial and 45% of lateral meniscectomy cases. The mean volume of an operated medial meniscal remnant was 0.29 mL compared with a mean volume of 1.15 mL for an intact medial meniscus. The mean volume of an operated lateral meniscal remnant was 0.30 mL compared with 1.07 mL for an intact lateral meniscus. We have shown that the incidence of incomplete excision of the posterior horn is more common after total medial meniscectomy, and that at a mean follow up of 30 years there is no convincing in vivo MRI evidence of long-term meniscal regeneration.

Utilization of lipophilic ionic additives in liquid polymer film optodes for selective anion activity measurements.

Lipophilic anionic and cationic additives are investigated as components for use in liquid polymer film-based optodes. These ionic additives are known to strongly influence the selectivity behavior of anion-selective electrodes. They also make it possible to construct ion coextraction optodes that can measure anion activities. Theoretical, thermodynamic anion-optode equilibria formalisms were derived to help understand the influence these additives have on the overall optode response and on the selectivity behavior. Neutral and charged anion carrier film configurations are described and tested for two anion ionophores with known modes of action, ruthenium(II) octaethylporphyrin and a vitamin B12 derivative (cyanoaquacobyrinic acid heptakis(2-phenylethyl ester)). These film configurations were further tested using a less well-understood ionophore, indium(III) octaethylporphyrin. Notable is the indium(III) octaethylporphyrin optode, which has a dynamic range appropriate for physiological measurements of chloride at neutral pH values. Also of interest is the optode with the vitamin B12 derivative ionophore, which has a dynamic range appropriate for some physiological measurements of nitrite at neutral pH values.

[Occupational risks in childhood and adolescence: a review]. / Riscos ocupacionais na infância e na adolescência: uma revisão.

The authors present a brief bibliographic review of the health risks to which children and youth are often exposed in the workplace. The concern regarding these risk factors is justified based on the fact that children and youth comprise a large portion of the work force and begin working at early ages. At the same time these children and youth are undergoing profound biological, psychological and social changes and therefore are susceptible to occupational illnesses. With this in mind, the article seeks to alert health professionals regarding possible occupational health risks to children and youth in the workplace.

Consumer satisfaction with services provided to head-injured patients and their families.

In the context of a broader survey of adjustment after head injury, both victims and their families rated satisfaction with professional health care services. Included were ratings of quality care, and of perceived helpfulness (to the victim and to the family) of select professional groups. Quality of service inquiries concentrated on patient/familial education about the consequences of head injury, aftercare, referral sources and prognosis. Many respondents indicated inadequate information was provided in these areas. Areas of greatest informational deficit included post-hospitalisation resources and expectations for outcome. Highest ratings of helpfulness were attributed, by both victims and their families, to professional groups that provided tangible, 'hands-on' services, e.g. nursing. Significantly lower ratings were observed for social service professions, e.g. psychology. Limited contact with psychologists/neuropsychologists was targeted as an area of concern. Ratings of all professional groups were discussed with reference to staff/family dynamics. The importance of a multifaceted patient/family education programme was stressed.

Return to work (RTW) after head injury.

This study explored return to work (RTW) after head injury from survey data on 177 cases of head injury. Although 45% of the sample study did engage in some work-related activity only 19% were in competitive employment positions. Factors which were related to RTW after head injury were: age when injured, sex, length of loss of consciousness and Likert ratings of learning, motor and ambulation impairment. Many of those who did return to competitive employment did so in less demanding positions than held pre-injury. Limitations of the current study and suggestions for future research are ventured.

The financial trauma of head injury.

One hundred parents and 50 spouses of head-injured persons responded to a survey on adjustment issues after head injury. The information they provided on financial matters is presented. Medical costs, legal fees, and other expenses are reported, both in total costs since the insult and in current yearly costs. Percentages of parents and spouses having to find employment, borrow money, lose possessions, and declare bankruptcy are also presented. Financial benefits such as Worker's Compensation and legal settlements are considered. Finally, mean reduction of income for the head-injured person and for the family is examined. The financial impact of head injury is varied in both source and in amount, though for many the cost is overwhelming.