To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help.
An ...American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa.
The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform.
This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants.
The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.
► We evaluate a set of 288 wheat advanced lines Mexico, Iran, Sudan, Egypt and Bangladesh. ► Contrasting advanced lines for yield and physiological traits but with similar phenology were identified ...for future strategic trait-based crossing. ► Agronomic and physiological variables were able to predict on average 27% of yield variation and 34% under stress environments (34% of yield variation). ► If drought and heat adaptive traits are brought together in one genotype, yields can be further increased particularly in low yielding environments.
Genetic progress in yield will increase if more traits conferring better agronomic and physiological performance are brought together in the same variety through full exploitation of genotyping and phenotyping techniques in breeding. A set of 288 spring wheat advanced lines was tested in different countries in North Africa, Western and South Asia, as well as in Mexico (total of 12 environments) to: identify high yielding germplasm adapted to the former regions; identify sources of variation for physiological traits; and test the ability of physiological traits to predict yield. A group of high yielding advanced lines has been selected in these environments, but significant genotype by environment interactions were observed and were significantly explained (21% of yield variation) by soil pH and air temperature. Associations between traits were dependent on the environment, specifically TKW was positively associated with yield in almost all environments however in Sudan, negative associations were observed. In contrast cooler CT was consistently associated with yield and the trait showed moderate heritability. Agronomic and physiological variables were able to predict 27% of yield variation across advanced lines (R2% by ridge regression) using means of all environments and this model became more significant under stress environments (explaining around 34% of yield variation). Results suggested that if drought and heat adaptive traits are brought together in one genotype, yields can be further increased particularly in low yielding environments.
Silicon (Si) is known to have numerous beneficial effects on plants, alleviating diverse forms of abiotic and biotic stress. Research on this topic has accelerated in recent years and revealed ...multiple effects of Si in a range of plant species. Available information regarding the impact of Si on plant defence, growth and development is fragmented, discipline-specific, and usually focused on downstream, distal phenomena rather than underlying effects. Accordingly, there is a growing need for studies that address fundamental metabolic and regulatory processes, thereby allowing greater unification and focus of current research across disciplines.
Silicon is often regarded as a plant nutritional 'non-entity'. A suite of factors associated with Si have been recently identified, relating to plant chemistry, physiology, gene regulation and interactions with other organisms. Research to date has typically focused on the impact of Si application upon plant stress responses. However, the fundamental, underlying mechanisms that account for the manifold effects of Si in plant biology remain undefined. Here, the known effects of Si in higher plants relating to alleviation of both abiotic and biotic stress are briefly reviewed and the potential importance of Si in plant primary metabolism is discussed, highlighting the need for a unifying research framework targeting common underlying mechanisms. The traditional approach of discipline-specific work on single stressors in individual plant species is currently inadequate. Thus, a holistic and comparative approach is proposed to assess the mode of action of Si between plant trait types (e.g. C3, C4 and CAM; Si accumulators and non-accumulators) and between biotic and abiotic stressors (pathogens, herbivores, drought, salt), considering potential pathways (i.e. primary metabolic processes) highlighted by recent empirical evidence. Utilizing genomic, transcriptomic, proteomic and metabolomic approaches in such comparative studies will pave the way for unification of the field and a deeper understanding of the role of Si in plants.
Fifty-three Quarter Horses were put into race-training at 18 mo of age. Changes in the third metacarpal were monitored by radiographic densitometry initially at 83 days prior to the commencement of ...training and at days 0, 62, 104 and 244 of training. A normal increase in density of the third metacarpal due to growth and mineralization was seen from the first set of radiographs until the horses began training at day 0 (P<.001). Bone density then decreased to day 62 (P<.001), remained low through day 104 before it began to increase to day 244 (P<.005). Differences in the most optically dense portion of each cortex of the third metacarpal were compared in horses completing the study without injury and those sustaining a bone-related injury. Horses experienced fewer injuries when they had greater cortical mass in the lateral (P<.05) and medial (P<.1) aspects of the third metacarpal, relative to the palmar aspect, at the commencement of training.
We compared cycling injury risks of 14 route types and other route infrastructure features.
We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover ...design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip.
Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio OR = 0.11; 95% confidence interval CI = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9).
The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling.
Summary
Outer membrane vesicles (OMVs) are asymmetrical single bilayer membranous nanostructures produced by Gram‐negative bacteria important for bacterial interaction with the environment. ...Porphyromonas gingivalis, a keystone pathogen associated with chronic periodontitis, produces OMVs that act as a virulence factor secretion system contributing to its pathogenicity. Despite their biological importance, the mechanisms of OMV biogenesis have not been fully elucidated. The ~14 times more curvature of the OMV membrane than cell outer membrane (OM) indicates that OMV biogenesis requires energy expenditure for significant curvature of the OMV membrane. In P. gingivalis, we propose that this may be achieved by upregulating the production of certain inner or outer leaflet lipids, which causes localized outward curvature of the OM. This results in selection of anionic lipopolysaccharide (A‐LPS) and associated C‐terminal domain (CTD) ‐family proteins on the outer surface due to their ability to accommodate the curvature. Deacylation of A‐LPS may further enable increased curvature leading to OMV formation. Porphyromonas gingivalis OMVs that are selectively enriched in CTD‐family proteins, largely the gingipains, can support bacterial coaggregation, promote biofilm development and act as an intercessor for the transport of non‐motile bacteria by motile bacteria. The P. gingivalis OMVs are also believed to contribute to host interaction and colonization, evasion of immune defense mechanisms, and destruction of periodontal tissues. They may be crucial for both micro‐ and macronutrient capture, especially heme and probably other assimilable compounds for its own benefit and that of the wider biofilm community.
Background
During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric ...surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based “enhanced” perioperative protocol.
Methods
The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation.
Results
Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials.
Conclusions
A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
Abstract Study question Does paternal pre-conception consumption of caloric or non-caloric sweeteners (NCS) coupled with high fat diets (HFD) predispose offspring to early puberty onset in mice? ...Summary answer Paternal prenatal consumption of the NCS Rebaudioside A(RebA) resulted in early puberty onset in female offspring only compared to water and caloric sweetener groups. What is known already A growing body of evidence suggests that the paternal diet also influences health and disease onset in offspring. Early puberty onset is associated with metabolic syndrome, type 2 diabetes, and cardiovascular disease later in adulthood. NCS are often promoted as heathier alternatives to caloric sweeteners. Evidence examining the impact of NCS on male reproductive function and offspring health outcomes, including pubertal timing are lacking. Few studies have shown maternal HFD can contribute to early puberty onset in female offspring however to our knowledge this is the first study to investigate paternal diet and offspring reproductive outcomes. Study design, size, duration 32 6-week-old C57/BL6 male mice were randomly assigned to receive a control diet (CD) or HF plus water (Con), fructose (Fr), Acesulfame K (Ak) or RebA). After 8 weeks, mice were mated. Litters were standardised to 2 males and 2 females per group and fed a standard laboratory diet. Participants/materials, setting, methods Puberty onset was measured in females by vaginal opening (from postnatal day (PN28) and in males by preputial separation (from PN35). Oral glucose tolerance tests were carried out at PN70. Mice were culled from PN80. Data were analysed by repeated measures or 2-way ANOVA. Main results and the role of chance There were no significant differences in birth weight, sex ratio or organ weights across groups. There was an overall effect of paternal NCS on male but not female offspring weightCR1 at cull(p < 0.05), with male CDRebA offspring having increased BW (29.52g±1.5) compared with CDAk at PN80 (26.4g±3; p < 0.05). Females from paternal HF and CD RebA group CR2 entered puberty significantly earlier (31.8d±1) than Fr (34d±1;p<0.01) and Con (34±1;p<0.05) groups. Male offspring from HFAk had lower glucose AUC (913±31) compared with CDCon (1289±48;p<0.001). Female offspring from CDRebA (1263±84) and CDFr (1273±67) groups had lower glucose AUC compared with CDCon group (1445±56;p<0.05). Limitations, reasons for caution This study was carried out on mice therefore direct translatability to humans is limited. examining the impact of paternal NCS intakes on molecular pathways in the ovary and testes to assess offspring reproductive health later in life and to evaluate pregnancy success following mating would essential for providing further insight. Wider implications of the findings The present study adds to the experimental evidence to date suggesting that NCS may not be beneficial alternatives to sugar-sweetened products consumed preconceptionally on the health of the offspring. This study also highlights the importance of including paternal diet in research when looking at transgenerational effects. Trial registration number not applicable
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