Decision-making on colorectal cancer screening in Curaçao - interviews with the target population

BACKGROUND

During the first year of the population based colorectal cancer (CRC) screening program on Curaçao, about 20% of invitees participated. This study explored the target population's perceptions and awareness on CRC (screening), beliefs on the program provision, their preferences and information needs for informed decision-making.

METHODS

Semi-structured interviews with 23 individuals, who were not yet invited for CRC screening, were recorded, transcribed, coded and analyzed.

RESULTS

CRC (screening) was discussed in the context of personal health, where own responsibility and food were important. Cancer was perceived as an unpredictable disease that causes suffering and leads to death and was also associated with fear. Despite being aware of the program, most respondents were not familiar with the screening procedure. Provision of the screening program was regarded positively and as an opportunity to contribute to health improvement. This seemed related to the expressed trust in the Caribbean Prevention Center (program organizer). Respondents preferred to make independent decisions about CRC screening participation. A personal approach, visual aids and media were the preferred sources of information.

CONCLUSION

The results of our interviews suggest that it may be beneficial to provide information on CRC screening in Curaçao within the context of personal health. While including sensitivity to fears and respect for the autonomy of the target population. Finally, electronic media maybe useful in supporting informed decision-making.

Intracranial hemorrhages in infants of diabetic mothers: A national cohort study

OBJECTIVE

To assess the association of maternal diabetes mellitus (DM) with intraventricular hemorrhage (IVH) and other intracranial hemorrhages (ICH) in newborns.

STUDY DESIGN

We analyzed the National Inpatient Sample dataset and compared prevalence of IVH and other subtypes of ICH in infants of diabetic mothers (IDMs) vs. those born to mothers without DM. Regression models were used to control for demographic and clinical confounding variables.

RESULT

A total of 11,318,691 infants were included. Compared to controls, IDMs had increased prevalence of IVH (aOR = 1.18, CI: 1.12-1.23, p < 0.001) and other ICH (aOR = 1.18, CI: 1.07-1.31, p = 0.001). Severe IVH (grades 3 & 4) was encountered less frequently in IDMs (aOR = 0.75, CI: 0.66-0.85, p < 0.001) than controls. Gestational DM was not associated with increased IVH after controlling for the demographic, clinical and perinatal confounders in the logistic regression model (aOR = 1.04, CI: 0.98-1.11, p = 0.22).

CONCLUSION

Chronic maternal DM is associated with increased neonatal IVH and other ICH but not severe IVH. This association needs to be confirmed in further studies.

Ralstonia solanacearum - A soil borne hidden enemy of plants: Research development in management strategies, their action mechanism and challenges

Plant pathogens present in soil cause severe losses to plants every year. Among them, Ralstonia solanacearum, because of its destructive nature, is the world's second most damaging bacterial phytopathogen. Over 310 species of plants belonging to 42 plant families are infected by this deadly pathogen. Around the world, the bacterial wilt (BW) disease causes yield losses that range from 20 to 100%. Control measures for managing this pathogen comprises several diverse approaches. Regardless of whether several control methods are developed to manage the BW disease, efficient management strategies with eco-friendly effects and the desired level of effective control is still awaited and there is need to developed effective management methods to eliminate this fetal disease in several crops under field conditions. An analysis of development in the management strategies will provide an effective way to search and develop control methods with desirable level of effectiveness. In this review, we discussed and analyzed the information reported on the development of various management strategies for the management of R. solanacearum along with the comprehensive presentation on action mechanism of these management strategies. We have also made an effort to summarize the challenges that make hurdle in the effective management of this deadly pathogen. The analysis of the information in this review article will assist in future implications of management strategies and help in developing effective control measures with more efficacy.

Parthenium hysterophorus alleviates wilt stress in tomato plants caused by Ralstonia solanacearum through direct antibacterial effect and indirect upregulation of host resistance

Heavy damage to tomato crops due to wilt stress caused by the pathogenic bacterium Ralstonia solanacearum and the insufficient availability of management strategies with desired control levels urged the researchers to investigate more reliable control methods to manage this issue in tomato and other horticultural crops. In this study, Parthenium hysterophorus, a locally and freely available herbaceous plant, was successfully used to manage bacterial wilt of tomatoes. The significant growth reduction ability of P. hysterophorus leaf extract was recorded in an agar well diffusion test and its ability to severally damage the bacterial cells was confirmed in SEM analysis. In both greenhouse and field trials, soil amended with P. hysterophorus leaf powder at 25 g/kg soil was found to effectively suppress the pathogen population in soil and significantly reduce the wilt severity on tomato plants, resulting in increased growth and yield of tomato plants. P. hysterophorus leaf powder at concentrations greater than 25 g/kg soil caused phytotoxicity in tomato plants. The results showed that P. hysterophorus powder applied through the mixing of soil for a longer period of time before transplanting tomato plants was more effective than mulching application and a shorter period of transplantation. Finally, the indirect effect of P. hysterophorus powder in managing bacterial wilt stress was evaluated using expression analysis of two resistance-related genes, PR2 and TPX. The upregulation of these two resistance-related genes was recorded by the soil application of P. hysterophorus powder. The findings of this study revealed the direct and indirect action mechanisms of P. hysterophorus powder applied to the soil for the management of bacterial wilting stress in tomato plants and provided the basis for including this technique as a safe and effective management strategy in an integrated disease management package.

Performance appraisal of Trichoderma viride based novel tablet and powder formulations for management of Fusarium wilt disease in chickpea

In developing a Trichoderma viride-based biocontrol program for Fusarium wilt disease in chickpea, the choice of the quality formulation is imperative. In the present study, two types of formulations i.e. powder for seed treatment (TvP) and tablet for direct application (TvT), employing T. viride as the biocontrol agent, were evaluated for their ability to control chickpea wilt under field conditions at three dosages i.e. recommended (RD), double of recommended (DD) and half of recommended (1/2 RD). A screening study for the antagonistic fungi strains based on volatile and non-volatile bioassays revealed that T. viride ITCC 7764 has the most potential among the five strains tested (ITCC 6889, ITCC 7204, ITCC 7764, ITCC 7847, ITCC 8276), which was then used to develop the TvP and TvT formulations. Gas Chromatography-Mass Spectrometry (GC-MS) analysis of volatile organic compounds (VOCs) of T. viride strain confirmed the highest abundance of compositions comprising octan-3-one (13.92%), 3-octanol (10.57%), and 1-octen-3-ol (9.40%) in the most potential T. viride 7764. Further Physico-chemical characterization by standard Collaborative International Pesticides Analytical Council (CIPAC) methods revealed the optimized TvP formulation to be free flowing at pH 6.50, with a density of 0.732 g cm^-3. The TvT formulation showed a pH value of 7.16 and density of 0.0017 g cm^-3 for a complete disintegration time of 22.5 min. The biocontrol potential of TvP formulation was found to be superior to that of TvT formulation in terms of both seed germination and wilt incidence in chickpea under field conditions. However, both the developed formulations (TvP and TvT) expressed greater bioefficacy compared to the synthetic fungicide (Carbendazim 50% WP) and the conventional talc-based formulation. Further research should be carried out on the compatibility of the developed products with other agrochemicals of synthetic or natural origin to develop an integrated disease management (IDM) schedule in chickpea.

Neonatal Hypocalcemia in the Infant of a Diabetic Mother

Neonatal hypocalcemia (NHC) is one of the most common disorders of calcium metabolism in infants admitted to the NICU. Presentation can range from asymptomatic to generalized seizures or tetany. In this case study, an infant with NHC is presented along with an overview of the pathophysiology, prevalence, diagnosis, and management of NHC for neonatal clinicians.

Chemosensitizing micelles self-assembled from amphiphilic TPGS-indomethacin twin drug for significantly synergetic multidrug resistance reversal

Vitamin E d-ɑ-tocopheryl poly(ethylene glycol) 1000 succinate (TPGS) and indomethacin (IDM) can reverse multidrug resistance (MDR) via inhibiting P-glycoprotein (P-gp) and multidrug resistance associated protein 1 (MRP1) respectively, but their drawbacks in physicochemical properties limit their clinical application. To overcome these defects and enhance MDR reversal, the amphiphilic TPGS-IDM twin drug was successfully synthesized via esterification, and could self-assemble into free and paclitaxel-loaded (PTX-loaded) micelles. The micelles exhibited lower CMC values (5.2 × 10^-5mg/mL), long-term stability in PBS (pH 7.4) for 7 days and SDS solution (5 mg/mL) for 3 days, and effective drug release at esterase/pH 5.0. Moreover, the micelles could down-regulate ATP levels and promote ROS production in MCF-7/ADR via the mitochondrial impairment, therefore achieving MDR reversal and cell apoptosis. Additionally, the PTX-loaded micelles could significantly inhibit the cell proliferation and promote apoptosis for MCF-7/ADR via the synergistic chemosensitizing effect of TPGS and IDM, and synergistic cytotoxic effect of TPGS and PTX. Thus, the chemosensitizing micelles self-assembled from amphiphilic TPGS-indomethacin twin drug have the great potentials for reversing MDR in clinical cancer therapy.

Hypoglycemia in High-Risk Infants Within the Immediate Postnatal Period

The incidence of hypoglycemia in the immediate postnatal period is rising because of the increasing rate of preterm births, maternal diabetes, and maternal obesity. Severe hypoglycemia has been considered a risk factor for neuronal cell death and adverse neurodevelopmental outcomes. The American Academy of Pediatrics (AAP) suggests a goal of ≥45 mg/dL (≥2.5 mmol/L) for infants who are asymptomatic within the first 48 hours. The Pediatric Endocrine Society (PES) suggests that infants who are unable to maintain their blood glucose >50 mg/dL (>2.77 mmol/L) within the first 48 hours or >60 mg/dL (>3.33 mmol/L) after the first 48 hours are at risk for persistent hypoglycemia. While there is disagreement for target glucose levels within the first 48 hours, both the AAP and the PES suggest further investigation for persistent hypoglycemia beyond 48-72 hours, which is beyond the scope of this article. However, in the immediate postnatal period, much can be gained with familiarization of the two guidelines, as well as current management techniques. This article presents current definitions and treatment modalities for management of hypoglycemia in infants considered at high risk in the immediate postnatal period.

Sustainable and Ecofriendly Approach of Managing Soil Born Bacterium Ralstonia solanacearum (Smith) Using Dried Powder of Conyza canadensis

Bacterial wilt disease caused by Ralstonia solanacearum is a devastating plant disease that inflicts heavy losses to the large number of economic host plants it infects. The potential of dried powder of the Conyza canadensis to control bacterial wilt (BW) of tomato was explored in vitro and in planta. Three application times (16 days before transplanting (DBT), 8 DBT and 0 DBT), three plastic-mulch durations (10 days plastic mulching (DPM), 5DPM and 0DPM) and four doses viz. 0 g, 8 g, 16 g and 24 g of the plant powder were evaluated. SEM analysis was also conducted to observe the change in bacterial cell morphology. Ethanol extract of dried C. canadensis in different concentrations inhibited the in vitro growth of R. solanacearum by as much as 98% of that produced by ampicillin. As evident from the scanning electron micrograph, the highest concentration produced severe morphologic changes, such as rupture of the bacterial cell walls and cell contents leaked out. Results from application time and dose experiment demonstrated that the highest powder dose viz. 24 g kg⁻¹ mixed with infested soil 16 DBT gave maximum root length (34.0 ± 2.5 cm), plant height (74.3 ± 4.7 cm), fresh biomass (58.3 ± 4.3 g), reduction in bacterial population (1.52 log10) and resulted in lowest AUDPC value (1156.6). In case of mulching duration and dose experiment the maximum root length (39.6 ± 3.2 cm), plant height (78.3 ± 5.8 cm), fresh biomass (65.6 ± 4.9 g) reduction in bacterial population (1.59 log10) and lowest AUDPC value (1251.6) was achieved through the application of highest powder dose viz. 24 g kg⁻¹ and longest plastic mulching duration of 10 DPM. The better results of highest dose and longer application time can be explained on the basis of higher amounts of anti-microbial plant bio-active compounds in highest dose and the longer exposure time of the pathogen to these chemicals. The better results of longer mulching duration are due to faster and more complete decomposition (because of 10-days-long plastic-mulch-provided increased solar heat) of the dried powder which produced more amounts of volatile and non-volatile bactericidal compounds. Our results clearly suggest that the use of 24 g kg⁻¹ dried plant powder of C. canadensis plastic-mulched for two weeks could be used as a reliable component of the integrated disease management program against BW.

A novel synthetic carbon and oxygen doped stalactite-like g-C3N4 for broad-spectrum-driven indometacin degradation

Achieving efficient solar utilization is a primary goal in the field of photocatalytic degradation of PPCPs. For this study, a broad-spectrum carbon and oxygen doped, porous g-C₃N₄ (COCN) was synthesized via a simple co-pyrolysis of dicyandiamide and methylamine hydroiodide (CH₅N·HI). The 0.3COCN demonstrated an excellent photocatalytic degradation of indometacin (IDM), which was 5.9 times higher than bulk g-C₃N₄. The enhanced photocatalytic activity could be ascribed to the broad-spectrum utilization of solar light and improved charge separation efficiency. Reactive species (RSs) scavenging experiments have shown that O₂^·- and ¹O₂ were the dominant active species. Further, the 0.3COCN exhibits excellent yield of hydroxyl radicals which was confirmed by electron spin resonance (ESR) spectra. Meanwhile, the degradation pathways of IDM were proposed according the HRAM LC-MS/MS and total organic carbon (TOC). This research provided a new strategy for a broad-spectrum photocatalyst, and a promising strategy for environmental remediation.

Neonatal Hypoglycemia: Is There a Sweet Spot?

Hypoglycemia is one of the most common neonatal problems. Despite increasing evidence that hypoglycemia is linked to neurologic impairment, knowledge regarding the specific value or duration of hypoglycemia that results in injury to the brain remains unclear. Current published statements/guidelines focused on preventing clinically significant hypoglycemia are conflicting and continue to be based on low evidence. This article reviews transitional events leading to extrauterine euglycemia, risk factors contributing to transient or persistent hypoglycemia, and common treatment approaches. Current information related to neurodevelopmental outcomes and screening strategies to prevent significant hypoglycemia with early treatment is described.

Exendin-4 prevented pancreatic beta cells from apoptosis in (Type I) diabetic mouse via keap1-Nrf2 signaling

IMPACT STATEMENT

Nrf2 is an essential part of the defense mechanism of vertebrates and protects them from surrounding stress via participation in stimulated expression of detoxification as well as antioxidant enzymes. It also exerts a role in defending hosts from different stress in the environment, including reactive oxygen species. Our study investigates the role of exendin-4 on Nrf2 pathway as well as cell death in pancreatic β-cell and in non-obese diabetic mice. Result of study indicates exendin-4 mediates activation of Keap1-Nrf2-ARE pathway and may serve as a potential agent to treat type I diabetes mellitus. In our research, we observed excessive reactive oxygen species production, low level of cell death, and PKC phosphorylation on exendine-4 treatment. Nrf2 knockdown led to suppression of reactive oxygen species generation as well as increasing apoptosis. Moreover, siRNA-mediated Nrf2 down-regulation attenuated the suppressive effect of exendin-4 in pancreatic β-cell viability, via modulating apoptosis promoting- and counteracting-proteins, Bax, and Bcl-2.

A COMMENTARY ON CLASSIFICATION OF DIABETES: LATENT AUTOIMMUNE DIABETES IN ADULTS (LADA) OR INTERMEDIARY DIABETES MELLITUS (IDM)?

Diabetes Mellitus is a huge syndrome which can be detected from the first day of life until the last year of life of a centenarian. In the current classification of diabetes among the so-called "idiopathic phenotypes", apart Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) has been included provisionally term "Latent Autoimmune Diabetes in Adults" (LADA). This has unclear characterization regarding the age at onset, the presence of anti-β-cell antibodies and the level of insulin secretory function, in conformity with C-peptide levels. According to several recent publications, there are no specific biochemical or genetic markers for Latent Autoimmune Diabetes in Adults (LADA), but only a gradual transition from T1D to T2D. In addition, the word "latent" in the construction of "LADA" term is inaccurate because in this phenotype nothing is latent: both the autoimmunity and diabetes are present and are even parts of the diagnosis. So that, the best term should be what in reality this sub-phenotype is: an Intermediary Diabetes Mellitus (IDM). Some recent genetic data strongly support this designation.

Evaluation of the impacts of cooperative adaptive cruise control on reducing rear-end collision risks on freeways

Although plenty of studies have been conducted recently about the impacts of cooperative adaptive cruise control (CACC) system on traffic efficiency, there are few researches analyzing the safety effects of this advanced driving-assistant system. Thus, the primary objective of this study is to evaluate the impacts of the CACC system on reducing rear-end collision risks on freeways. The CACC model is firstly developed, which is based on the Intelligent Driver Model (IDM). Then, two surrogated safety measures, derived from the time-to-collision (TTC), denoting time exposed time-to-collision (TET) and time integrated time-to-collision (TIT), are introduced for quantifying the collision risks. And the safety effects are analyzed both theoretically and experimentally, by the linear stability analysis and simulations. The theoretical and simulation results conformably indicate that the CACC system brings dramatic benefits for reducing rear-end collision risks (TET and TIT are reduced more than 90%, respectively), when the desired time headway and time delay are set properly. The sensitivity analysis indicates there are few differences among different values of the threshold of TTC and the length of a CACC platoon. The results also show that the safety improvements weaken with the decrease of the penetration rates of CACC on the market and the increase of time delay between platoons. We also evaluate the traffic efficiency of the CACC system with different desired time headway.

Investigating the Relationship between Insulin-like Growth Factor-1 (IGF-1) in diabetic mother's breast milk and the blood serum of their babies

Introduction

Since research investigating IGF-1 levels in breast milk are few, the goal of this study was to analyze the IGF-1 levels in the breast milk of diabetic mothers as well as in the serum of their newborn babies and to identify what relationship exists between blood serum and IGF-1 milk levels through patient measurement of mothers and their babies.

Methods

This case control study was undertaken under the auspices of the Clinic of Neonatology at Al Minia University Pediatric Hospital over May 2012 through May 2013. With a total of 30 diabetic mothers and their babies forming the experimental group and the control group consisting of 15 non-diabetic mothers and their babies. A detailed medical history, anthropometric assessments, as well as the measurement of the baby’s serum IGF-1 and their mother’s breast milk IGF-1 levels were taken from all participants using ELSIA. The resulting data were analyzed via Statistical Package for the Social Sciences (SPSS) version 16 and measurements of descriptive statistics, t-test, Chi-square test, as well as the Pearson Correlation Coefficient.

Results

The Infants born to Diabetic Mothers (IDMs) demonstrated significantly greater anthropometric measurement. Both the serum levels and the milk IGF-1 levels as well as all of the physical measurements taken were found to have a positive correlation between the level of IGF-1 in mother’s milk and all of the anthropometric measurements studied with the exception of delivered baby’s length.

Conclusion

Higher levels of IGF-1 are present in the milk of diabetic mothers and the blood serum of their babies and this characteristic could be used as a prenatal biomarker for macrosomia.

Innovations in air sampling to detect plant pathogens

Many innovations in the development and use of air sampling devices have occurred in plant pathology since the first description of the Hirst spore trap. These include improvements in capture efficiency at relatively high air-volume collection rates, methods to enhance the ease of sample processing with downstream diagnostic methods and even full automation of sampling, diagnosis and wireless reporting of results. Other innovations have been to mount air samplers on mobile platforms such as UAVs and ground vehicles to allow sampling at different altitudes and locations in a short space of time to identify potential sources and population structure. Geographical Information Systems and the application to a network of samplers can allow a greater prediction of airborne inoculum and dispersal dynamics. This field of technology is now developing quickly as novel diagnostic methods allow increasingly rapid and accurate quantifications of airborne species and genetic traits. Sampling and interpretation of results, particularly action-thresholds, is improved by understanding components of air dispersal and dilution processes and can add greater precision in the application of crop protection products as part of integrated pest and disease management decisions. The applications of air samplers are likely to increase, with much greater adoption by growers or industry support workers to aid in crop protection decisions. The same devices are likely to improve information available for detection of allergens causing hay fever and asthma or provide valuable metadata for regional plant disease dynamics.

Infants of diabetic mothers

Infants of diabetic mothers (IDMs) can present with various symptoms and disorders. The neonatal nurse must be able to assess the infant for glucose control and other anomalies.

Effects of Oral Stimulus Frequency Spectra on the Development of Non-nutritive Suck in Preterm Infants with Respiratory Distress Syndrome or Chronic Lung Disease, and Preterm Infants of Diabetic Mothers

The precocial nature of orofacial sensorimotor control underscores the biological importance of establishing ororythmic activity in human infants. The purpose of this study was to assess the effects of comparable doses of three forms of orosensory experience, including a low-velocity spectrally reduced orocutaneous stimulus (NT1), a high-velocity broad spectrum orocutaneous stimulus (NT2), and a SHAM stimulus consisting of a blind pacifier. Each orosensory experience condition was paired with gavage feedings 3x/day for 10 days in the neonatal intensive care unit (NICU). Four groups of preterm infants (N=214), including those with respiratory distress syndrome (RDS), chronic lung disease (CLD), infants of diabetic mothers (IDM), and healthy controls (HI) were randomized to the type of orosensory condition. Mixed modeling, adjusted for gender, gestational age, postmenstrual age, and birth weight, demonstrated the most significant gains in non-nutritive suck (NNS) development among CLD infants who were treated with the NT2 stimulus, with smaller gains realized among RDS and IDM infants. The broader spectrum of the NT2 stimulus maps closely to known response properties of mechanoreceptors in lip, tongue, and oral mucosa and is more effective in promoting NNS development among preterm infants with impaired oromotor function compared to the low-velocity, spectrally reduced NT1 orosensory stimulus.