Quantitative ultrasound criteria for risk stratification in clinical practice: a comparative assessment

This study aimed to compare two different classifications of the risk of fracture/osteoporosis (OP) based on quantitative ultrasound (QUS). Analyses were based on data from the Epidemiological Study on the Prevalence of Osteoporosis, a cross-sectional study conducted in 2000 aimed at assessing the risk of OP in a representative sample of the Italian population. Subjects were classified into 5 groups considering the cross-classification found in previous studies; logistic regression models were defined separately for women and men to study the fracture risk attributable to groups defined by the cross-classification, adjusting for traditional risk factors. Eight-thousand six-hundred eighty-one subjects were considered in the analyses. Logistic regression models revealed that the two classifications seem to be able to identify a common core of individuals at low and at high risk of fractures, and the importance of a multidimensional assessment in older patients to evaluate clinical risk factors together with a simple, inexpensive, radiation-free device such as QUS.     

An ecological perspective on medication adherence

Adherence to a prescribed medication regimen is influenced not only by characteristics of the individual patient, but also by factors within the patient's environment, or so-called system level factors. Until now, however, health care system factors have received relatively little attention in explaining medication nonadherence. Ecological models might serve as a framework to help explain the influence of health care system factors on patient behavior (e.g., adherence). In an ecological model, different levels of factors influence patients' behavior, i.e. factors at the patient-level, micro- (provider and social support), meso- (health care organization), and macro (health policy) -levels. In order to understand medication adherence and implement interventions to improve medication adherence, factors at these different levels should be taking into consideration. This paper describes an ecological model compromised of the most important factors at the patient-, micro-, meso- and macro-levels.     

Dynamics and association of different acute stress markers with performance during a simulated resuscitation

Aim

Whether mental stress negatively impacts team performance during cardio-pulmonary resuscitation (CPR) remains controversial; this may partly be explained by differences in stress measures used in previous studies. Our aim was to compare self-reported, biochemical and physiological stress measures in regard to CPR performance.

Methods

This prospective, observational study was conducted at the simulator center of the University Hospital Basel, Switzerland. Self-reported (feeling stressed and overwhelmed [stress/overload]), biochemical (plasma cortisol) and physiological (heart rate, heart rate variability) stress measures were assessed in 28 residents (teams of 2) before, during and after resuscitation. Team performance was defined as time to start CPR and hands-on time during the first 180 s.

Results

At baseline, significant negative correlations of heart rate variability with stress/overload and heart rate, as well as positive correlations of heart rate and cortisol were found. During resuscitation, self-reported, biochemical and physiological stress measures did not correlate significantly. There was no association of baseline stress measures with performance. During CPR, stress/overload was significantly associated with time to start CPR (regression coefficient 12.01 (95% CI 0.65, 23.36), p = 0.04), while heart rate was negatively associated with time to start CPR (regression coefficient −0.78 (95% CI −1.44, −0.11), p = 0.027) and positively with hands-on time (regression coefficient 2.22 (95% CI 0.53, 3.92), p = 0.015).

Conclusions

Self-reported stress (stress/overload) was the only predictor for low CPR performance. Biochemical measures showed no association, and physiological measures (heart rate) showed an inverse association, which may be due to physical activity, limiting its value as a mental stress marker in this acute setting.     

Nanoparticles in oncology: the new theragnostic molecules

Cancer nanotherapeutics have shown promise in resolving some of the limitations of conventional drug delivery systems such as nonspecific biodistribution and targeting, lack of water solubility, low therapeutic indices, and poor oral bioavailability. Moreover, cancer nanotechnology has the potential of improving current approaches to cancer detection, diagnosis, and imaging. Recently, nanotechnology and molecular imaging have been combined to generate nanoparticles that simultaneously facilitate cancer therapy and diagnosis, the so called theragnostic nanoparticles. The aim of our review is to highlight recent developments within the context of the current knowledge of nanotechnology, to recall the experimental steps that have brought to the clinical development and application of nanoparticles, and explain the biological rationale for their use with oncologic patients. In particular, we summarize recent findings with respect to possible new applications for therapy and diagnosis, and their specific properties. Moreover, we report the more recent prospects in gene therapy, the possibility of using new drug delivery methods, the action of nanoparticles on the immune system and apoptosis, and the concrete possibility of detecting and characterizing circulating tumor cells or of developing new technologies in drug discovery.     

Identification of NVP-BKM120 as a Potent,Selective, Orally Bioavailable Class I PI3 Kinase Inhibitor for Treating Cancer

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Human rights and reproductive health: political realities and pragmatic choices for married adolescent women living in urban slums,Bangladesh

Background

In Bangladesh, particularly in urban slums, married adolescent women’s human rights to life, health, and reproductive and sexual health remain adversely affected because of the structural inequalities and political economic, social and cultural conditions which shape how rights are understood, negotiated and lived.

Methods

The focus of the research and methods was anthropological. An initial survey of 153 married adolescent women was carried out and from this group, 50 in-depth interviews were conducted with selected participants and, from the in-depth interviews, a further eight case studies of women and their families were selected for in-depth repeated interviews and case histories.

Results

This paper speaks of the unanticipated complexities when writing on reproductive rights for poor adolescent women living in the slums, where the discourses on ‘universal human rights’ are often removed from the reality of adolescent women’s everyday lives. Married adolescent women and their families remain extremely vulnerable in the unpredictable, crime-prone and insecure urban slum landscape because of their age, gender and poverty. Adolescent women’s understanding of their rights such as the decision to marry early, have children, terminate pregnancies and engage in risky sexual behaviour, are different from the widely accepted discourse on rights globally, which assumes a particular kind of individual thinking and discourse on rights and a certain autonomy women have over their bodies and their lives. This does not necessarily exist in urban slum populations.

Conclusions

The lived experiences and decisions made pertaining to sexual and reproductive health and ‘rights’ exercised by married adolescent women, their families and slum communities, allow us to reflect on the disconnect between the international legal human rights frameworks as applied to sexual and reproductive health rights, and how these are played out on the ground. These notions are far more complex in environments where married adolescent women and their families live in conditions of poverty and socioeconomic deprivation.

     

PAH concentrations in the moss species Hylocomium splendens (Hedw.) B.S.G. and Pleurozium schreberi (Brid.) Mitt. from the Kielce area (south-central Poland)

Forty eight samples of mosses Hylocomium splendens and Pleurozium schreberi from the Kielce area (south-central Poland) were analyzed for seventeen polycyclic aromatic hydrocarbons. The PAH concentrations varied from 558.00 μg/kg (ppb) to 4457.00 μg/kg in H. splendens and from 643.00 to 3086.00 μg/kg in P. schreberi. In both moss species phenanthrene (75.00-732.00 μg/kg), fluoranthene (101.00-577.00 μg/kg) and pyrene (68.00-568.00 μg/kg) predominated, but H. splendens accumulated more PAHs than P. schreberi at eighteen different sites. The highest PAH concentrations were noted at sites located close to the housing estates (sites 1-10) and potential emission sources (e.g. heat and power generating plant “Kielce S.A.”) (sites 19-21). The moss samples displayed the diverse ring sequence, but the most prevalent was four>five>three>six. The diagnostic ratios (three+four ring/total PAHs, Flu/Py, Phen/Ant, Phen/Phen+Ant, Flu/Flu+Py, IndPy/IndPy+BghiPe and BaA/BaA+Chr) indicated that coal and petroleum combustion was a principal PAH source in the study area.