Improved Detection of Tuberculosis and Multidrug-Resistant Tuberculosis among Tibetan Refugees, India.

The incidence of tuberculosis (TB) among Tibetan refugees in India is 431 cases/100,000 persons, compared with 181 cases/100,000 persons overall in India in 2010. More than half of TB cases in these refugees occur among students, monks, and nuns in congregate settings. We sought to increase TB case detection rates for this population through active case finding and rapid molecular diagnostics. We screened 27,714 persons for symptoms of TB and tested 3,830 symptomatic persons by using an algorithm incorporating chest radiography, sputum smear microscopy, culture, and a rapid diagnostic test; 96 (2.5%) cases of TB were detected (prevalence 346 cases/100,000 persons). Of these cases, 5% were multidrug-resistant TB. Use of the rapid diagnostic test and active case finding enabled rapid detection of undiagnosed TB cases in congregate living settings, which would not have otherwise been identified. The burden of TB in the Tibetan exile population in India is extremely high and requires urgent attention.

What does it feel like to live here? Exploring sensory ethnography as a collaborative methodology for investigating social determinants of health in place.

This paper introduces sensory ethnography as a methodology for studying residents' daily lived experience of social determinants of health (SDOH) in place. Sensory ethnography is an expansive option for SDOH research because it encourages participating researchers and residents to "turn up" their senses to identify how previously ignored or "invisible" sensory experiences shape local health and wellbeing. Sensory ethnography creates a richer and deeper understanding of the relationships between place and health than existing research methods that focus on things that are more readily observable or quantifiable. To highlight the methodology in use we outline our research activities and learnings from the Sensory Ethnography of Logan-Beaudesert (SELB) pilot study. We discuss theory, data collection methods, preliminary outcomes, and methodological learnings that will be relevant to researchers who wish to use sensory ethnography or develop deeper understandings of place and health generally.

Day case laparoscopic nephrectomy: initial experience.

RATIONALE: Laparoscopic nephrectomy tends to become the new gold standard surgical technique in a selected population (non-functioning kidney, localised renal cell carcinoma). Day surgery is a popular pathway of care and, procedures of ever-increasing complexity are being considered. OBJECTIVE: The aim of the study was to report the postoperative complications of day case laparoscopic nephrectomy, according to the Clavien system, and, to assess the feasibility of the procedure performed as a day case. MATERIAL AND RESULTS: This study included all the patients considered for day case transperitoneal laparoscopic nephrectomy between May 2008 and November 2009. Sixteen consecutive patients were enrolled in this retrospective study. There were ten procedures on the left hand-side and six on the right hand-side. Age ranges from 22 to 77 years old. Male to female ratio was 9:7. The preoperative diagnosis was non-functioning kidney in 9 cases and kidney tumour in the other 7 cases. All but two patients have been discharged in the same day (87.5%). The readmission rate was of 12.5%. One wheel-chair bonded patient was readmitted four days after the procedure, because of adynamic ileus, and another one three days later because of wound infection. There were two grade I and one grade IV complications (Clavien system). The patient readmitted with grade IV complication, wheel-chair bonded because of cerebral palsy, was not a typical day surgery patient. DISCUSSION: The vast majority of complications were minor and resulted in no residual disability. In our small series, the day case laparoscopic nephrectomy was feasible and safe.

An elevated PSA, which normalizes, does not exclude the presence of prostate cancer.

The purpose of this study was to determine the incidence of prostate cancer in patients who have an elevated referral prostate-specific antigen (PSA), which subsequently falls to within their normal age-specific reference range prior to prostate biopsy. The study demonstrated that of the 160 patients recruited, 21 (13%) had a repeat PSA level which had fallen back to within their normal range. Five of these 21 patients (24%) were diagnosed with prostate cancer following biopsy, two of whom had a benign prostate examination. The study, therefore, demonstrates that normalisation of the PSA level prior to biopsy does not exclude the presence of prostate cancer even when the prostate feels benign.

Introduction to the DAPPLE Air Pollution Project.

The Dispersion of Air Pollution and its Penetration into the Local Environment (DAPPLE) project brings together a multidisciplinary research group that is undertaking field measurements, wind tunnel modelling and computer simulations in order to provide better understanding of the physical processes affecting street and neighbourhood-scale flow of air, traffic and people, and their corresponding interactions with the dispersion of pollutants at street canyon intersections. The street canyon intersection is of interest as it provides the basic case study to demonstrate most of the factors that will apply in a wide range of urban situations. The aims of this paper are to introduce the background of the DAPPLE project, the study design and methodology for data collection, some preliminary results from the first field campaign in central London (28 April-24 May 2003) and the future for this work. Updated information and contact details are available on the web site at http://www.dapple.org.uk.

Intra-individual variation of serum prostate specific antigen levels in men with benign prostate biopsies.

OBJECTIVE: To determine the intra-individual (physiological) variation of prostate-specific antigen (PSA) measurements in men after a benign prostatic biopsy. PATIENTS AND METHODS: Sixty-four men were prospectively assessed, all of whom had a benign prostatic biopsy within the preceding 13 months. The degree of intra-individual variability was established by calculating the coefficient of variation on four PSA levels obtained from each patient weekly over a month. RESULTS: Six patients were subsequently diagnosed with prostate cancer and their data are presented separately. In the remaining 58 patients the median (range) individual mean PSA value was 6.3 (0.5-34.1) ng/mL. The median (range) coefficient of variation within the group was 9.5 (2.4-76.1)%. There was a clear linear relationship between mean PSA level and the standard deviation. CONCLUSION: In 48 of the 63 patients analysed, the coefficient of variation for serum PSA values in the group as a whole was greater than the variation claimed for the assay technique. The significance of the linear relationship between PSA and the standard deviation is discussed, with particular reference to those men who had a benign prostate biopsy.

The developmental sequelae of nonorganic failure to thrive.

The developmental sequelae of infant failure to thrive (FTT) were examined in an unreferred group of 6-year-olds with a history of severe nonorganic growth retardation, sampled from a 1-year birth cohort in an inner-city area of South London. Children who failed to thrive in infancy (weight below the third centile for at least 3 months) and their pairwise matched comparisons were originally studied at 15 months, and 42 cases and 42 controls (89.5% of the sample) were followed up. At 6 years, previously growth-retarded children were considerably smaller than matched comparisons, in terms of body mass index (BMI), and height and weight for age Z scores. History of FTT explained substantial variance in weight and BMI at 6 years, with maternal height also contributing to variation in height for age. Child cognitive functioning at 6 years was examined using the McCarthy Scales: cases had more limited quantitative and memory skills than comparisons, but there was no intergroup variation in general cognitive performance. In contrast to analyses of physical development, failure to thrive did not account for cognitive functioning; maternal IQ was the sole significant predictor of performance on all indices of child cognitive abilities. At 15 months, earlier growth faltering was linked to limitations in mental development, but these findings were not confirmed by the follow-up data: the timing of FTT was not related to cognitive abilities at 6 years. Results correspond to past research indicating that nonorganic failure to thrive is associated with persistent limitations in physical stature. There was little evidence of cognitive disadvantage for case group children at school age, suggesting that the adverse effects of early malnutrition on cognitive functioning appear to diminish over time.

Is salivary flow related to personality?

Studies conducted in the 1960s proposed that stimulated salivary flow was negatively correlated with the personality trait of introversion-extraversion such that introverted individuals were supposed to salivate more strongly to lemon-juice stimulation than were extraverts. The relationship was re-examined in the present study in light of more recent but inconsistent findings. A sample of 36 male and female volunteers showed no significant relationship between stimulated salivary flow and extraversion. Nor was flow related to State or Trait anxiety according to Spielberger's anxiety inventory, or to CNS activation as assessed by an objective electronic test. It was concluded that there was no evidence to relate stimulated salivary flow rates to personality in volunteers selected from a non-psychiatric population.

An ethnography of caring and control in an acute psychiatric unit.

The setting for this study was a 19 bed general hospital psychiatric ward serving a heterogeneous population. The objective of the study was to generate thick description of the cultural knowledge patients and nurses used to organise their behaviour and interpret their experience in an acute psychiatric unit. Further aims were to describe the nature of the service provided, and more specifically to identify relationships between caring and controlling in this social context, and the outcomes for patients of caring and controlling interventions by nurses.

The benefits of physiological psychology.

This article asserts that physiological psychology offers specific benefits to theoretical psychology and the real world and also contributes in a more diffuse manner to an integrated perspective of the nature of man. Theoretical topics covered are: perception, with particular reference to pattern recognition; parallel distributed processing; subconscious perception. Real-world problems addressed are: the role of stress in illness; personality, learning and proneness to psychological disorder; the mechanisms of depression and anxiety. There is a brief discussion of eating disorders, sex, aggression, neuropsychology and the role of perceptual variety in brain development. It is argued that conversation between the physiological and psychological levels of explanation benefits theorizing at both levels.

PHA-induced interferon in multiple sclerosis: association between gamma interferon and clinical and genetical variables.

Gamma interferon (INF-gamma) production, after PHA stimulation of peripheral blood mononuclear cells, from multiple sclerosis (MS) patients with the acute remitting and chronic progressive forms, in attack and remission phases, and from normal controls, was studied by immunoradiometric assay. MS patients in all these 4 clinical states of disease produced less INF-gamma (log value range from 2.55 to 2.65). MNC from the total MS patients produced significantly low levels of INF-gamma compared to the control group (log values 2.60 vs. 2.82; P = 0.001). No association between the interferon production and antigens at any HLA locus (A, B, C, Dw and Bf) was found. There was no correlation between IFN-gamma production and age, sex, duration of disease, or disability index. However there was a slight tendency to negative correlation with the progression index of the disease. The results suggest that this lower IFN-gamma production in MS may be secondary to the disease, and the primary defect may be a severe reduction of the essential lymphocyte populations required for an effective lymphokine cascade to produce the normal immune response against infection.

Development of the cerebellum with particular reference to cellular differentiation in the external granular layer.

Immunocytochemical evidence of differentiation in developing human cerebellum is presented in this study. Antibodies to neuron specific enolase, neurofilament protein, glial fibrillary acidic protein, vimentin, cytokeratin, epithelial membrane antigen and lymphoid markers, DLC and Leu 7 were used. The external granular layer showed positivity with neuronal markers between 27 weeks gestation and 4 months postnatal, but was negative for all other markers including glial fibrillary acidic protein. Characteristic staining reactions were noted in the other cerebellar layers. Monoclonal antibodies, UJ13A (pan-neuroectodermal marker) and G10 (localising microtubule-associated protein MAP1x) were also used in a limited number of cryostat sections and were positive and negative, respectively, in the external granular layer. The results of this study are discussed in relation to the theory that the external granular layer may be one source of medulloblastomas.

Association between Bell's palsy and lymphoid malignancies.

Eight cases of lymphoid malignancy preceded by Bell's palsy are reported. There was a disproportionate number of ALL cases, two of which were of T-cell type. The possible pathogenic association of these conditions is discussed.

Evoked potentials and the dynamics of language processing.

It is observed, in a brief review of studies of evoked potentials and language processing, that for the most part only global and rather static aspects have been investigated. It is argued that the important topic of the dynamics of work recognition has been neglected. The evolution of 'spreading activation' models of semantic processing is briefly traced. These postulate pre-conscious word recognition in a semantic network where radiation of excitation between semantically related 'nodes' or 'logogens' account for important context effects on word recognition. It is suggested that evoked potential studies could be used to test and elaborate this model. An experiment is described in which discrimination between positive and negative instances of primed categories by enhancement of the N1-P2 (N130-P212) amplitude measure supports the notion of early and possibly pre-conscious attainment of work meaning and also indicates enhanced activation from word detection units sensitized by spread of activation from a category prime.

Brain potentials, perceptual mechanisms and semantic categorisation.

The behaviour of intermediate and long-latency evoked potential (EP) components were investigated in a semantic categorisation task. Visually presented 'narrow' and 'wide' priming category questions, intended to vary processing load, were followed, after 1.5 sec by a 100 msec presentation of a positive or negative instance for decision. Neither behavioural response latencies nor amplitudes of N1-P2 (130 and 212 msec mean latencies) differentiated between 'narrow' and 'wide' category decisions. However, response latencies were faster and N1-P2 amplitudes greater for positive than for negative instances of primed categories. This result is attributed to the priming effect, by 'spreading activation, of prior category questions on 'logogen-like' pre-conscious word detecting devices within the brain. Semantic discrimination by N1-P2 contradicts previous assertions that intermediate components only reflect selection based on crude stimulus characteristics. Comparison of N1-P2 amplitudes at lateral electrodes offered no evidence of hemispheric lateralisation of language function in the experimental task. There was no late wave unequivocally identifiable as P300 on morphological and scalp distribution criteria. A positive peak at mean latency 327 msec (called P3) was of low amplitude and stable latency and did not appear to index processing load as defined by the experimenters. However, the amplitude of N2-P3 was larger to positive instances of narrow categories than any of the other three conditions. This could be the sort of probability effect seen in P300 behaviour if it is assumed that the brain can discriminate between stimuli on the basis of the size of the subset from which they come.

Is amnesia caused by an activational deficit? A preliminary electrophysiological investigation of acquisition in amnesics.

Six alcoholic amnesics were compared with 6 matched controls in a task involving visual presentation of words under 'learn', 'repeat' and 'passive' instructions whilst their EEG was recorded from the vertex. Although the amnesics' N2-P3 component to word stimuli was similar to that of controls, their word-elicited N1-P2 component was of greater amplitude and their EEG showed an overall reduction in power in the period immediately following word offset. The group difference for N1-P2 was similar in all instructional conditions, but the EEG power difference was greater in the learn condition. It was argued that the N1-P2 enhancement may reflect an attempt by the amnesics to compensate for an unspecified activational impairment indicated by their reduced post-word EEG power.