Rheumatic fever (RF) and rheumatic heart disease (RHD) are significant causes of World Health Organization (WHO) and International Society and Federation of Cardiology (ISFC) initiated an ...International Programme for Prevention of RF/RHD in 16 developing countries, including Jamaica. The Jamaican RF/RHD National Control Programme began in July 1985.
The Control Programme promotes the primary prevention of RF/RHD through the appropriate treatment of streptococcal throat infections. Secondary prevention has been the main focus of the Control Programme by administration of benzathine penicillin injections every four weeks to RF/RHD patients. Case finding activities have included two retrospective surveys of case records of RF/RHD patients admitted to the major hospitals in Kingston and St Andrew in the period 1975-1985 (Survey A) and 1989-1995 (Survey B). These surveys provided clinical and laboratory data on RF/RHD in Jamaican patients which were documented and analysed.
Records of 1079 patients were reviewed in Survey A and records of 512 patients were reviewed in Survey B. Seventy-seven per cent of 524 patients were aged 5-15 years in initial attacks of RF in Survey A and in Survey B, 82% of 119 patients were between 5 and 15 years in initial attacks. There was no significant sex difference in RF in Survey A and Survey B. A diagnosis of RF had been made in 54% of records in Survey A and 55% of records in Survey B. Diagnosis conformed to the Modified Jones criteria. Carditis occurred in 41% and 70% of RF patients, respectively in survey A and B. Polyarthritis occurred in 73% in Survey A and 74% in Survey B. Chorea occurred in 3% of RF patients in both surveys. Erythema marginatum and subcutaneous nodules occurred rarely in both surveys. Evidence of recent streptococcal infections in RF was found in 74% and 64% in Survey A and B, respectively. Severe carditis occurred in 7% of initial attacks of RF in A and 26% in B. In RHD, mitral incompetence was the commonest valvular lesion, occurring in 82% and 68% in A and B, respectively Rheumatic fever and rheumatic heart disease have relatively long and expensive hospital stays which are preventable by careful adherence to prevention programmes.
The National Control Programme for RF/RHD in Jamaica began in 1985 and deserves careful monitoring and support to reduce the burden of RF/RHD. Analysis of clinical and laboratory data obtained in the retrospective surveys conducted for case finding provides important data on RF/RHD in Jamaica.
Although microRNAs (miRNA) have been broadly studied in cancer, comparatively less is understood about their role in progression. Here we report that miR-153 has a dual role during progression of ...colorectal cancer by enhancing cellular invasiveness and platinum-based chemotherapy resistance. miRNA profiling revealed that miR-153 was highly expressed in a cellular model of advanced stage colorectal cancer. Its upregulation was also noted in primary human colorectal cancer compared with normal colonic epithelium and in more advanced colorectal cancer stages compared with early stage disease. In colorectal cancer patients followed for 50 months, 21 of 30 patients with high levels of miR-153 had disease progression compared with others in this group with low levels of miR-153. Functional studies revealed that miR-153 upregulation increased colorectal cancer invasiveness and resistance to oxaliplatin and cisplatin both in vitro and in vivo. Mechanistic investigations indicated that miR-153 promoted invasiveness indirectly by inducing matrix metalloprotease enzyme 9 production, whereas drug resistance was mediated directly by inhibiting the Forkhead transcription factor Forkhead box O3a (FOXO3a). In support of the latter finding, we found that levels of miR-153 and FOXO3a were inversely correlated in matched human colorectal cancer specimens. Our findings establish key roles for miR-153 overexpression in colorectal cancer progression, rationalizing therapeutic strategies to target expression of this miRNA for colorectal cancer treatment.
A neural model of voluntary movement and proprioception is developed that offers an integrated interpretation of the functional roles of diverse cell types in movement-related areas of primate ...cortex. The model circuit maintains accurate proprioception while controlling voluntary reaches to spatial targets, exertion of force against obstacles, posture maintenance despite perturbations, compliance with an imposed movement, and static and inertial load compensations. Computer simulations show that properties of model elements correspond to the properties of many known cells types in areas 4 and 5. Among these properties are delay period activation, response profiles during movement, kinematic and kinetic sensitivities, and latency of activity onset. In particular, area 4 phasic and tonic cells, respectively, compute velocity and position commands that are capable of activating alpha and gamma motor neurons, thereby shifting the mechanical equilibrium point. Anterior area 5 cells compute the position of the limb using corollary discharges from area 4 and feedback from muscle spindles. Posterior area 5 neurons use the position perception signal and a target position signal to compute a desired movement vector. The cortical loop is closed by a volition-gated projection of this movement vector to the area 4 phasic cells. An auxiliary circuit allows phasic-tonic cells in area 4 to incorporate force command components needed to compensate for static and inertial loads. After reporting simulations of prior experimental results, predictions are made for both motor and parietal cell types under novel experimental protocols.
This study probes femto- and picosecond excited-state dynamics of a series of N-heterocyclic carbene (NHC) ligand-containing platinum(II) complexes of the type trans-(NHC)2PtII(CC-Ar)2, where CC-Ar ...is an arylacetylide. By using femtosecond transient absorption spectroscopy, two dynamic processes are observed: an ultrafast singlet → triplet intersystem crossing (<0.3 ps), followed by geometric/electronic relaxation that takes place on a 2–10 ps time scale. The geometric/electronic relaxation is attributed to ligand torsional modes, mainly arising from twisting of the aryl units relative to the square-planar PtL4 unit. The dynamics of this relaxation process depend somewhat on steric constraints induced by substituent groups attached to the (benz)imidazole and phenyl ligands. The geometric relaxation dynamics slow with increasing solvent viscosity. The experimental studies also reveal that the different conformers can be photoselected by varying the excitation at different near-UV wavelengths. To corroborate the experimental findings, density functional theory calculations were conducted to probe the effects of geometry and steric hindrance on the ground-state energy surface. The calculations suggest that the barrier for torsion of the CC-Ar units increases as N-substituents on the NHC ligands increase in the order CH3 < cyclohexyl < n-butyl and as the CC-Ar units are substituted in the 3 and 5 positions with tert-butyl groups.
Introduction
The aim of undergraduate dental education is to provide competent dentists to serve societal needs and improve population oral healthcare. Competency‐based education has influenced the ...development of dental education for decades but this term is problematic. This article explores components of competency‐based undergraduate health professional education in order to help the dental profession have a better understanding of the context and purposes of undergraduate dental education.
Methods
This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on competency‐based undergraduate education.
Results and Discussion
Competence comprises an integration of knowledge, skills and attitudes indicating a capability to perform professional tasks safely and ethically. The process of becoming a competent practitioner is complex. Four characteristics of competency‐based education are: curriculum components and content shaped by societal needs; focused on student‐centred learning; learning achievement; and limited attention to time‐based training and numerical targets. Alongside a competency‐based approach, undergraduate dental education can be influenced by institutional features and external factors but these receive little consideration in the literature.
Conclusion
Understanding competence, competency‐based education, and institutional and external factors will help to improve educational quality, define roles and professional development for the dental educator, and inform further research.
This study aimed to investigate the incidence of cystoid macular edema and anterior uveitis associated with the use of latanoprost.
A retrospective review of patients treated with latanoprost in the ...authors' practice between September 1, 1996, and August 1, 1997, was performed.
Ninety-four patients and 163 eyes were studied.
Patients presenting with signs and symptoms of ocular inflammation while receiving latanoprost were noted, and their response to the discontinuation of the drug was recorded.
The presence and degree of anterior uveitis and cystoid macular edema were measured.
Six (6.4%) of 94 patients (8 4.9% of 163 eyes) had anterior uveitis develop, and 2 (2.1%) of 94 patients (2 1.2% of 163 eyes) had cystoid macular edema develop while being treated with latanoprost.
Although latanoprost is an effective ocular-hypotensive agent, the authors' experience with the drug has shown a significant incidence of anterior uveitis and cystoid macular edema. To the authors' knowledge, this is the first study to report the incidence of both cystoid macular edema and anterior uveitis associated with latanoprost therapy. Treating physicians should be aware of these potential complicating side effects of latanoprost.
•Limited information is known about treatment outcomes for squamous cell carcinoma of the bladder (SqCC).•Treatment for SqCC is extrapolated from urothelial carcinoma.•Outcomes of chemoRT for SqCC ...are very limited.•Following chemoRT, patients with SqCC do worse than counterparts with urothelial carcinoma.
Squamous cell carcinoma (SqCC) is the second most common histology of primary bladder cancer, but still very limited information is known about its treatment outcomes. Most bladder cancer trials have excluded SqCC, and the current treatment paradigm for localized SqCC is extrapolated from results in urothelial carcinoma (UC). In particular, there is limited data on the efficacy of definitive chemo-radiotherapy (CRT). In this study, we compare overall survival outcomes between SqCC and UC patients treated with definitive CRT.
We queried the National Cancer Database (NCDB) for muscle-invasive (cT2-T4 N0 M0) bladder cancer patients diagnosed from 2004 to 2013 who underwent concurrent CRT. Propensity matching was performed to match patients with SqCC to those with UC. OS was analyzed using the Kaplan-Meier survival method, and the log-rank test and Cox regression were used for analyses.
3332 patients met inclusion criteria of which 79 (2.3%) had SqCC. 73.4% of SqCC patients had clinical T2 disease compared to 82.5% of UC patients. Unadjusted median OS for SqCC patients was 15.6 months (95% CI, 11.7–19.6) versus 29.1 months (95% CI, 27.5–30.7) for those with UC (P < 0.0001). On multivariable analysis, factors associated with worse OS included: SqCC histology HR: 1.53 (95% CI, 1.19–1.97); P = 0.001, increasing age HR: 1.02 (95% CI, 1.02–1.03); P < 0.0001, increasing clinical T-stage HR: 1.21 (95% CI, 1.13–1.29); P < 0.0001, and Charlson-Deyo comorbidity index HR: 1.26 (95% CI, 1.18–1.33); P < 0.0001. Seventy-seven SqCC patients were included in the propensity-matched analysis (154 total patients) with a median OS for SqCC patients of 15.1 months (95% CI, 11.1–18.9) vs. 30.4 months (95% CI, 19.4–41.4) for patients with UC (P = 0.013).
This is the largest study to-date assessing survival outcomes for SqCC of the bladder treated with CRT. In this study, SqCC had worse overall survival compared to UC patients. Histology had a greater impact on survival than increasing T-stage, suggesting that histology should be an important factor when determining a patient’s treatment strategy and that treatment intensification in this subgroup may be warranted.
We present a 169-km wide-angle velocity model across the Goban Spur rifted margin, southwest of the UK. A 120-km-wide intermediate region is identified between the first clear seafloor spreading ...magnetic anomaly (anomaly 34r) and thinned continental crust, where velocities increase from 4.5 km s−1 to 6.8 km s−1 in the top 4 km beneath acoustic basement. At depth it can be divided into a region where a 1.5-km-thick high-velocity layer (7.2-7.6 km s−1) exists and a region where this layer is absent but velocities of ∼7 km s−1 are present. Wide-angle PmP arrivals are observed across the whole of the intermediate region but a normal incidence reflection Moho is not present. Based on these velocities and combined with seismic reflection, gravity and magnetic modelling along this transect we interpret the intermediate region to consist of a 70 km wide zone of exhumed mantle with high Poisson's ratio at top basement (>0.34), an extremely low topographic expression and a high-velocity deep layer. Empirical relationships between velocity and degree of serpentinization suggest that serpentinite content decreases with depth from 100 per cent at top basement to <25 per cent from 5-7 km into basement. The observed magnetic anomaly is best fit by a thin magnetized layer (1 km) of magnetization 2-3 A m−1. The intense magnetization may be due to magnetite formation during a prolonged interaction of serpentinite with sea water. Between this exhumed mantle and anomaly 34r is a 50-km-wide region raised 400 m above the adjacent exhumed mantle, consisting of a series of basement ridges. Poisson's ratio is not well defined in this region, which may be composed of anomalous oceanic crust or exhumed mantle.
Abstract Hyla Bristow Stallard was one of the greatest middle-distance runners in British athletic history. While an English medical student, he won the bronze medal in the 1500-meter run at the 1924 ...Paris Olympics, immortalized in the critically acclaimed 1981 epic British film, Chariots of Fire . He later became one of the most famous ophthalmologists in the world for his pioneering work in radiation therapy of malignant eye disease. He was an inspiring role model for both athletes and physicians. As a gifted individual who enjoyed two international careers, he is worthy of great admiration and emulation.
In this study we applied discriminant analysis and geostatistics to create soil drainage maps using topographical and soil electrical conductivity (EC) data as auxiliary information. Drainage classes ...were determined on 107 soil cores collected from a 20-ha field in Illinois.
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