Spatially-dense 3D facial asymmetry assessment in both typical and disordered growth

Mild facial asymmetries are common in typical growth patterns. Therefore, detection of disordered facial growth patterns in individuals characterized by asymmetries is preferably accomplished by reference to the typical variation found in the general population rather than to some ideal of perfect symmetry, which rarely exists. This presents a challenge in developing an asymmetry assessment tool that is applicable, without modification, to detect both mild and severe facial asymmetries. In this paper we use concepts from geometric morphometrics to obtain robust and spatially-dense asymmetry assessments using a superimposition protocol for comparison of a face with its mirror image. Spatially-dense localization of asymmetries was achieved using an anthropometric mask consisting of uniformly sampled quasi-landmarks that were automatically indicated on 3D facial images. Robustness, in the sense of an unbiased analysis under increasing asymmetry, was ensured by an adaptive, robust, least-squares superimposition. The degree of overall asymmetry in an individual was scored using a root-mean-squared-error, and the proportion was scored using a novel relative significant asymmetry percentage. This protocol was applied to a database of 3D facial images from 359 young healthy individuals and three individuals with disordered facial growth. Typical asymmetry statistics were derived and were mainly located on, but not limited to, the lower two-thirds of the face in males and females. The asymmetry in males was more extensive and of a greater magnitude than in females. This protocol and proposed scoring of asymmetry with accompanying reference statistics will be useful for the detection and quantification of facial asymmetry in future studies.     

Assessment of a motivational interviewing curriculum for year 3 medical students using a standardized patient case

Objective

We sought to evaluate a year 3 motivational interviewing (MI) curriculum using a standardized patient case.

Methods

The 2-h small group MI curriculum included a didactic presentation followed by interactive role plays. During a clinical skills assessment at the end of year 3 the MI skills of 80 students who had participated in the curriculum were compared with those of 19 students who had not participated.

Results

The standardized patient reliably rated the students on their performance of 8 items. Students who had participated in the MI curriculum were significantly more proficient than nonparticipating students in the performance of 2 strategic MI skills, importance and confidence rulers (ps < .006). The groups did not differ in their use of patient-centered counseling skills or collaborative change planning commonly used in MI.

Conclusions

Third year medical students can learn to use MI skills that specifically aim to enhance patients’ motivations for change.

Practice implications

Medical schools should consider providing students with MI training and MI skill assessments using standardized patient cases to help students prepare to counsel patients for behavior change.     

Motivation-based intervention to promote colonoscopy screening: an integration of a fear management model and motivational interviewing

Colorectal cancer (CRC) screening rates have been low despite effectiveness of screening in reducing CRC mortality. This article outlines the theoretical background and development of an innovative, telephone-based risk communication designed to promote screening among individuals at increased risk for familial CRC. This ongoing intervention integrates the Extended Parallel Process Model of fear management and the motivational interviewing counselling style. Tailoring and implementation intentions are incorporated. The primary outcome is self-reported colonoscopy within nine months following intervention. If proven effective, the remote intervention could be broadly disseminated to individuals at increased familial CRC risk, especially those in geographically underserved areas.     

The effects of water and microstructure on the mechanical properties of bighorn sheep (Ovis canadensis) horn keratin

The function of the bighorn sheep horn prompted quantification of the various parametric effects important to the microstructure and mechanical property relationships of this horn. These parameters included analysis of the stress-state dependence with the horn keratin tested under tension and compression, the anisotropy of the material structure and mechanical behavior, the spatial location along the horn, and the wet-dry horn behavior. The mechanical properties of interest were the elastic moduli, yield strength, ultimate strength, failure strain and hardness. The results showed that water has a more significant effect on the mechanical behavior of ram horn more than the anisotropy, location along the horn and the type of loading state. All of these parametric effects showed that the horn microstructure and mechanical properties were similar to those of long-fiber composites. In the ambient dry condition (10 wt.% water), the longitudinal elastic modulus, yield strength and failure strain were measured to be 4.0 G Pa, 62 MPa and 4%, respectively, and the transverse elastic modulus, yield strength and failure strain were 2.9 GPa, 37 MPa and 2%, respectively. In the wet condition (35 wt.% water), horn behaves more like an isotropic material; the elastic modulus, yield strength and failure strain were determined to be 0.6G Pa, 10 MPa and 60%, respectively.     

Expression of recombinant enterotoxigenic Escherichia coli colonization factor antigen I by Salmonella typhimurium elicits a biphasic T helper cell response

Protective immunity to enterotoxigenic Escherichia coli (ETEC) is antibody (Ab) dependent; however, oral immunization with purified ETEC fimbriae fails to elicit protective immunity as a consequence of antigenic alteration by the gastrointestinal (GI) tract. Unless unaltered ETEC fimbriae can reach the inductive lymphoid tissues of the GI tract, immunity to ETEC cannot be induced. To produce immunity, live vectors, such as Salmonella typhimurium, can effectively target passenger antigens to the inductive lymphoid tissues of the GI tract. By convention, oral immunizations with Salmonella vectors induce CD4(+) T helper (Th) cell responses by gamma interferon (IFN-gamma)-dominated pathways both to the vector and passenger antigen, resulting in serum immunoglobulin G2a (IgG2a) and modest mucosal IgA Ab responses. In the present study, mice orally immunized with a Salmonella vector engineered to stably express ETEC colonization factor antigen I (CFA/I) showed initially elevated serum IgG1 and mucosal IgA anti-CFA/I Ab responses. As expected, mice orally immunized with an E. coli-CFA/I construct elicited poor anti-CFA/I Ab responses. In fact, the addition of cholera toxin during oral E. coli-CFA/I immunization failed to greatly enhance mucosal IgA Ab responses. Seven days after immunization with the Salmonella-CFA/I construct, cytokine-specific ELISPOT showed induction of predominant Th2-type responses in both mucosal and systemic immune compartments supporting the early IgG1 and IgA anti-CFA/I Abs. By 4 weeks, the Th cell response became Th1 cell dominant from the earlier Th2-type responses, as evidenced by increased mucosal and systemic IFN-gamma-producing T cells and a concomitant elevation of serum IgG2a Ab responses. This biphasic response offers an alternative strategy for directing Salmonella vector-induced host immunity along a Th2 cell-dependent pathway, allowing for early promotion of mucosal and systemic Abs.     

Alkaline conditions accelerate polymorphonuclear leukocyte apoptosis in vitro

Apoptosis was monitored in polymorphonuclear leukocytes (PMNs) cultured under mildly acidic, neutral, and alkaline conditions. Within 3 h, 9.0% of the PMNs underwent apoptosis at pH 6.7, as did 12% at pH 7.2, 38% at pH 7.7, and 60% at pH 8.2. Inhibitors of serine proteases, caspase-1, or caspase-3 significantly inhibited PMN apoptosis at pH 8.2, suggesting an involvement by these enzymes.     

Prevalence and residential determinants of fungi within homes in Melbourne, Australia

BACKGROUND: Recent epidemiological studies suggest that the adverse respiratory health effects caused by the inhalation of fungal propagules are substantial. Knowledge of the prevalence and environmental determinants of indoor fungal levels is essential in designing effective avoidance measures. AIM: To investigate the prevalence of fungi and the influence of residential characteristics on levels of fungi within homes in Melbourne, Australia. METHODS: Floor dust and air samples were collected from bedrooms in 485 houses over 1 year. The dust was analysed for ergosterol, a marker of cumulative fungal biomass exposure. Total and genera-specific fungal propagules were identified in air samples. Details of the relevant residential characteristics were documented using a questionnaire. Independent predictors (P < 0.05) of ergosterol and total fungal propagules were identified by multiple linear regression. RESULTS: Fifty-five percent of the houses had viable fungal propagules exceeding 500 CFU/m3. Cladosporium and Penicillium were identified as the most prevalent and abundant fungal genera in indoor air. The median ergosterol level in bedroom floor was 3.8 microg/g of dust. Multivariate analysis showed that total fungal propagules in indoor air were lower in bedrooms with a ceiling fan, without visible mould, and those that were more frequently vacuumed, had a solid fuel fire, had windows closed at the time of the sampling or lacked pets. The presence of more than one cat had the greatest effect on total fungal propagules. Ergosterol levels were significantly lower in homes without old fitted carpets, visible mould or pets and those with frequent airing and regular use of an extractor fan in the kitchen. Old wall-to-wall carpets had the greatest effect on ergosterol. CONCLUSIONS: High indoor fungal exposures were associated with infrequent ventilation or vacuuming, presence of pets, visible mould and old carpets.     

Asymmetry in the emotional content of lateralised multimodal hallucinations following right thalamic stroke

The thalamus has been described as a "relay station" for sensory information from most sensory modalities projecting to cortical areas. Therefore injury to the thalamus may result in multimodal sensory and motor deficits. In the present study, a 61-year-old woman suffered a right thalamic cerebral vascular accident (CVA; as evidenced by a computerised tomography [CT] scan). Secondary to this incident, she complained of altered sensations across multiple sensory modalities, including olfactory, visual, auditory, tactile, temperature, and pain sensation. Interestingly, during recovery from the thalamic CVA, the patient reported hallucinations in all the modalities cited above. Multimodal dysaethesias (odd sensations) and hallucinations showed reliable laterality in the affective valence across modalities with positive associations within right hemispace and negative associations within left hemispace. Overall, the results support multimodal role of the thalamus and provide evidence for lateralisation of positive and negative affect within the right and left hemispheres respectively.     

Analysis of mid-trimester corticotrophin-releasing hormone and alpha-fetoprotein concentrations for predicting pre-eclampsia

The aims of this study were firstly to examine if corticotrophin-releasing hormone (CRH) concentrations in maternal plasma were significantly elevated in Chinese pregnancies complicated by pre-eclampsia, secondly to assess if this elevation could be detected in the mid-trimester before onset of clinical signs of the disease, and thirdly to evaluate the performance of using maternal CRH and/or alpha-fetoprotein (AFP) concentrations in the mid-trimester for prediction of pre-eclampsia. The first part of this study was tested in a cohort of 39 subjects. The CRH concentrations were significantly elevated in pregnant women complicated by pre-eclampsia. The second and third parts of the study involved a different cohort of 1021 subjects. Both CRH and AFP concentrations in the mid-trimester were significantly elevated in those who subsequently developed pre-eclampsia. However, when used for prediction of pre-eclampsia, neither the CRH nor AFP concentrations alone in the mid-trimester had strong predictive value. Although the combination of both tests improved the detection rate compared to the use of CRH alone, the small increase in the likelihood ratio from 1.9 to 2.6 did not suggest that the combination would be of great clinical value.