This research is concerned with the mixed convection peristaltic flow of nanofluid in an inclined asymmetric channel. The fluid is conducting in the presence of inclined magnetic field. The governing equations are modelled.  Peristaltic motion is now an important research topic due to its immense applications in engineering and physiology. This type of rhythmic contraction is the basis of peristaltic pumps that move fluids through tubes without direct contact with pump components. This is a particular advantage in biological/medical applications where the pumped material need not to contact any surface except the interior of the tube. The word “peristalsis” comes from a Greek word “Peristaltikos”which means clasping and compressing. The peristaltic flow has specific involvement in the transport of urine from kidney to the bladder, chyme movement in gastrointestinal tract, movement of ovum in the female fallopian tubes, blood circulation in the small blood vessels, roller and finger pumps, sanitary fluid transport and many others. Latham Heat transfer in cooling processes is quite popular area of research in industry and medical science. Conventional methods for increasing cooling rates include the extended surfaces such as fins and enhancing flow rates. These conventional methods have their own limitations such as undesirable increase in the thermal management system's size and increasing pumping power respectively. The thermal conductivity characteristics of ordinary heat transfer fluids like oil, water and ethylene glycol mixture are not adequate to meet today's requirements. The thermal conductivity of these fluids have key role in heat transfer coefficient between the heat transfer medium and heat transfer surface. Hence many techniques have been proposed for improvement in thermal conductivity of ordinary fluids by suspending nano particles in liquids. The term “nano” introduced by Choi The aim of present study is to venture further in the regime of peristalsis for fluids with nanoparticles. Therefore we examine here the mixed convective peristaltic transport of nanofluid in an inclined asymmetric channel in the presence of inclined magnetic field. Channel asymmetry is produced by peristaltic waves of different amplitude and phases. Mathematical modelling involves the consideration of Brownian motion and thermophorsis effects. Numerical solution of nonlinear problem is obtained using shooting method. Limiting case for nanofluid in symmetric channel is also analyzed. Detailed analysis for the quantities of interest is seen.0 only. Let We consider mixed convective viscous nanofluid in an inclined asymmetric channel of width g the acceleration due to gravity, T the temperature, The equations governing the flow under consideration areThe transformations between fixed and wave frames are defined as follows:We now introduceF in the wave frame is related to the dimensionless time mean flow rate Employing transformation (8), dimensionless variables (9) and long wavelength and low Reynolds number u), temperature (Our main interest in this section is to examine the velocity (This subsection illustrates the behavior of emerging parameters u is decreasing function of M near the upper half of channel. The variations of Effect of heat transfer on peristalsis is shown in the Influence of mass transfer on peristalsis is shown in the Trapping phenomenon is shown in A detailed analysis is presented for magnetohydrodynamic peristaltic transport of nanofluid in an inclined asymmetric channel with heat and mass transfer. Numerical simulation is utilized for solution analysis. The critical cases from asymmetric to symmetric channel (


Understanding how the brain implements social behavior on one hand, and how social processes feedback on the brain to promote fine-tuning of behavioral output according to changes in the social environment is a major challenge in contemporary neuroscience. A critical step to take this challenge successfully is finding the appropriate level of analysis when relating social to biological phenomena. Given the enormous complexity of both the neural networks of the brain and social systems, the use of a cognitive level of analysis (in an information processing perspective) is proposed here as an explanatory interface between brain and behavior. A conceptual framework for a cognitive approach to comparative social neuroscience is proposed, consisting of the following steps to be taken across different species with varying social systems: (1) identification of the functional building blocks of social skills; (2) identification of the cognitive mechanisms underlying the previously identified social skills; and (3) mapping these information processing mechanisms onto the brain. Teleost fish are presented here as a group of choice to develop this approach, given the diversity of social systems present in closely related species that allows for planned phylogenetic comparisons, and the availability of neurogenetic tools that allows the visualization and manipulation of selected neural circuits in model species such as the zebrafish. Finally, the state-of-the art of zebrafish social cognition and of the tools available to map social cognitive abilities to neural circuits in zebrafish are reviewed. In social species animals interact frequently with their conspecifics and have to adjust the expression of their social behavior according to previous social experience and to social context. This behavioral flexibility in the social domain  differ from those involved in the interactions of the organism with its physical environment, and therefore the term social cognition has been created to refer specifically to cognitive processes involved in social interactions e.g., . Social In this paper, I propose a conceptual framework for comparative social neuroscience based on: (1) the identification of the functional building blocks of social behavior and the underlying cognitive mechanisms across different species with varying social systems, and (2) how these information processing mechanisms are inbuilt in the brain, which is viewed as an information processing organ. Following Krogh’s principle, that “for many problems there is an animal on which it can be most conveniently studied” , teleostTable 1 and Figure 1 for summary and selected examples in teleost fish, respectively).The first step of the conceptual framework proposed here is to identify the information processing problems posed by the social domain of the environment in order to identify the cognitive abilities underlying social skills. For instance, what are the mechanisms required for an individual to tolerate the presence of conspecifics, to recognized different classes of conspecifics and assess their behavior, to use public information available in social environments and to choose the appropriate responses from the available behavioral repertoire? Once we identify these building blocks of social competence we can investigate their phylogenetic distribution and how they map onto neural networks underlying behavior. The putative building blocks of social competence are identified and discussed below  and salience (on a low to high continuum) to social agents , such thGiven the wide array of social signals conveyed in multiple sensory modalities it is postulated that a general appraisal mechanism that assesses the valence and salience of social stimuli across different sensory modalities and functional domains must operate. According to this view the evaluation of valence and salience of social information is not just a result of direct effects of perceptual information , but rather a function of what that perceptual information means to the organism at that moment in time  and its reef fish clients, cleaners feed against their preference (ectoparasites instead clients’ mucus) in order to secure the possibility for numerous future interactions . This behavioral synchronization and coordination of individuals within social groups has lead to the emergence of collective patterns that can be impressive, such as the aerial movements of bird flocks, or the spatial behavior of insect swarms, fish schools, ungulate herds, and even human crowds. In most of these cases complex collective patterns can be explained by individual decision-making rules and by the way information flows between group members . For exaMore complex social systems are predicted to impose a higher cognitive demand, hence recruiting quantitatively more resources of the abovementioned social skills or promoting qualitative progress of new social skills  and sheep . Functional evidence for the presence of the social behavior network is difficult to obtain since it requires the simultaneous recording of neural activity in multiple brain regions. Given the difficulty of obtaining large-scale electrophysiological recordings indirect measures of neural activity, such as the expression of immediate early genes  or the activity of cytochrome oxidase, in relation to the expression of different social behaviors, have been used to test this hypothesis. In recent years this type of studies has been accumulating evidence in favor of the social brain network hypothesis. In the African cichlid Astatotilapia burtoni subordinate males given the opportunity to rise in social rank show higher expression of immediate early genes in all nodes of the social behavior network when compared either to stable subordinate or dominant males (Anolis carolinensis) repeated exposure to video-playbacks of aggressive displays of conspecific males induced changes in functional connectivity within the network .A successful comparative research program in cognitive social neuroscience has two key requirements: (1) the possibility for cladistic research on the evolution of social behavior and cognition aiming to uncover how pre-existing cognitive modules may evolve quantitatively  and how networks may be reconfigured leading to the emergence of qualitatively new solutions to adaptive problems; and (2) the possibility for reductionist research on the mapping of cognitive function into neural networks, which requires model organisms with appropriate social behavior and with an available “tool box” for the analysis of neural circuits. Therefore, the combination of comparative behavioral work on selected species in naturalistic settings covering the expected diversity in cognitive abilities with neuroethological research on a phylogenetically related model organism is a promising approach. Teleost fish fulfill both requirements and therefore they offer an excellent opportunity to fulfill such a research program on comparative cognitive social neuroscience.Labroides dimidiatus) on the context of cleaning mutualism  for which neurobiological and genetic tools are becoming increasingly available. Among the current teleost model organisms zebrafish offers the best conditions for research in social neuroscience due to a combination of relevant social behavior with availability of relevant tools for studying brain function in relation to behavior.Zebrafish are highly social animals that live in groups with structured social relationships including shoaling, dominance hierarchies, and territoriality . FurtherThe sight of conspecifics has rewarding value in zebrafish and can be used as a reinforcer in an associative learning task . Given tAlthough conspecifics act as social rewards zebrafish are not equally attracted to all conspecifics, exhibiting shoaling preferences that emerge during the juvenile phase . These sAs mentioned before a prerequisite for individuals to express social preferences is the ability to recognize individuals or classes of individuals. Zebrafish use both visual and olfactory cues in social recognition. Studies on zebrafish reared in social isolation and on cross-reared intra-specific phenotypes showed that visually mediated species recognition is based on a mechanism of phenotype matching against a learned template early in life . OlfactiCognitive appraisal and cognitive bias are recent research areas that only now are starting to be explored in zebrafish. In our lab we have collected preliminary evidence suggesting that in dyadic agonistic interactions it is the perception that the individual has of the event rather than its objective structure that triggers the physiological and genomic responses differentially observed in winners and losers . These results are in accordance with previous work on cichlid fish that showed that ambiguous agonistic interactions between fish and their own image on a mirror  failed to elicit the physiological responses observed in winners and losers of real opponent fights .So far the use of public information in zebrafish has been documented mainly in the context of response to aversive stimuli. A first suggestion of social learning in zebrafish comes from data showing that groups of zebrafish learn an avoidance response to an electric shock faster than single individuals . HoweverTemporal discounting has not been studied in fish so far. However, spatial discounting  for social rewards has been recently demonstrated in guppies . Both tyDanio aequipinnatus). The average distance among zebrafish shoal mates is approximately of 20 cm, and it responds to environmental factors, increasing in the presence of food and predators to over 30 cm  commonly used as a criterion for shoal membership in cyprinid species; er 30 cm . Consideer 30 cm , 2011. Aer 30 cm , only reer 30 cm , therefoOreochromis mossambicus: Lates calcarifer: A significant number of genetic and neuroanatomy tools and resources are becoming available for zebrafish, making it a tractable species to study brain behavior relationships. Detailed brain atlases are now available for adult zebrafish , and homThe functional study of neural circuits in zebrafish has benefited from the development of optogenetic and transgenic techniques that together allow the close monitoring of activity in neural networks and experimental gain and loss of function manipulations to assess causal relationships between specific neural patterns and specific behaviors . Imagingin vivo in the juvenile phase. On the other hand, the repertoire of social behavior is very limited in larvae, whose ethogram is limited to locomotor action patterns involved in swimming and in prey capture The creation of a common cognitive lexicon and taxonomy so that clear concepts are shared – the occurrence of complex social behaviors does not necessarily request complex cognitive abilities; therefore functionally similar cognitive abilities that rely on different underlying mechanisms should be recognized .(2)Poecilia reticulata) that had an impact on cognitive skills within two generations  and easy to breed in the lab, can be successfully used in the future to address this question using experimental evolution paradigms, as suggested by a recent study on artificial selection for larger brains in guppies (erations .(3)The distributed nature of information processing in neural networks should be taken into account when trying to map cognitive processes onto brain activity; therefore comparative analyses should move beyond the comparison of brain sizes and focus on inter-specific convergence/divergence in functional connectivity in the social decision making neural network.In answering all these questions I foresee a relevant role for species that offer the possibility to integrate imaging of brain activity with relevant behavioral tasks, as is the case of zebrafish.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Insect and sting allergy in immunocompetent populations. A comparison.Observation made in diferent subsets of population who had insect and sting allergy .1) Immunocompetent population in the developing world engaged in farming and related activities regularly exposed to all gradient of allergens like dust molds, dander, pets, etc and when they are exposed to insect and mosquito bites, bees and wasps stings even scorpion bites they suffer to a lesser extent.2) Immunocompromised population in the developed world far away from natural gradient of exposure of nearly all the allergens and when they are exposed to scorpion bite or bees and wasp stings there are reports of fatal reactions and even mosquito and insect bites causes serious wheal and flare reaction, this observation was made specially on the second generation of children from parents of Indian origin now living in USA and other affluent countries, where there is minimal exposure to all the allergens.Based on the observation made on nearly 2 lakh patients it was observed that there is a direct relationship of levels of exposure to all the natural allergens and the immunotolerance achieved by this natural exposure or natural immunotherapy.After above mentioned observations we reached to the conclusion that exposure to natural gradient of allergens, insect bites mosquito bites is troublesome for the immunocompromised populations who follow avoidance of exposure to allergens as a rule and this is a disaster for them there are many deaths reported due to the above mantioned exposure, at the same time the immunotolerant population which is exposed to all sorts of allergens insect bites mosquito bites bees and wasps stings suffers to a lesser extent.


Medication adherence has a cumulative effect on people’s health and wellbeing and reduces the reliance on health and social care services. This paper reviews the London Borough of Lambeth’s assistive technology service, which is occupational therapy led and includes the use of electronic medication dispensers as part of innovative intervention in support of medication adherence.The paper gives an appraisal of the key-factors in the successful implementation of medication adherence aids in social care settings and is supported by observational records that originate in practice and by a review of the current evidence base for the use of assistive technologies in medicines management. Key factors include interdisciplinary working as well as having needs-led and outcome focussed services.In the current economic climate there is increased pressure on local government to deliver services more efficiently and cost-effectively. The paper examines several case studies, which demonstrate how the use of assistive technology can support medication adherence, resulting in cost savings and cost avoidances. A guiding framework with practical recommendations for best practice in implementing medication compliance aids in social care settings is then offered.There is a need for health and social care workers and others to engage with medication adherence more widely. There is a large and growing new variety of strategies, interventions, technologies and services available which have the potential to aid, facilitate and motivate clients to adhere to their prescribed medications. The paper gives an overview of their practical application and outcomes.


The NHMRC Partnership Project “Evidence based targeting of state wide strategies for preventing falls among community dwelling older people in Victoria” is a five component project examining the uptake of falls prevention strategies to better understand issues that might impact on the health and well-being of older adults in our community. From this data, information regarding drivers of footwear selection was determined and that is the focus of this study.Cross-sectional population based telephone survey of 394 men and women 70 years and over living in the community in Victoria. The survey was conducted over December 2010 to January 2011 and in a second wave between January 2012 to March 2012. Questions were asked regarding footwear worn indoors and outdoors and the reasons for this selection.The choice of footwear worn indoors was overwhelmingly enclosed slippers with comfort as the reason for this selection. The outdoor footwear of choice was walking shoes with comfort once again the main driver for selection.Understanding footwear selection of the elderly may assist health care providers when recommending falls strategies for this at risk population.


The Program for Disordered Eating run at Headspace Gold Coast is a new intervention developed in September 2012 in response to an identified unmet need for a service for young people with eating issues. This program aims to provide screening, assessment and early intervention for those who are suffering from disordered eating at a distressing level but who do not meet the criteria for local public health eating disorder services. Headspace is an ideal organisation as it targets young people between 12 and 25 and the two peak risk periods for the onset of eating disorders are early adolescence and late teens . Funded under ATAPS a young person can access 12 individual sessions and 12 groups per calendar year.The paper will present the background and rationale for the program, an outline of the evidence based approaches offered and the preliminary data gathered which demonstrates the effectiveness of the interventions.Disordered Eating – Characteristics & Treatment stream of the 2013 ANZAED Conference.This abstract was presented in the


Ontologies encode the knowledge of human experts in order to allow computers to automate common tasks in a domain. They are hierarchically organised and backed by computational logic which allows automated inferences of the implicit consequences of explicitly stated knowledge. ChEBI is a database and ontology of chemical entities of biological interest . Within


Numerous amperometric biosensors have been developed for the fast analysis of neurotoxic insecticides based on inhibition of cholinesterase (AChE). The analytical signal is quantified by the oxidation of the thiocholine that is produced enzymatically by the hydrolysis of the acetylthiocholine pseudosubstrate. The pseudosubstrate is a cation and it is associated with chloride or iodide as corresponding anion to form a salt. The iodide salt is cheaper, but it is electrochemically active and consequently more difficult to use in electrochemical analytical devices. We investigate the possibility of using acetylthiocholine iodide as pseudosubstrate for amperometric detection. Our investigation demonstrates that operational conditions for any amperometric biosensor that use acetylthiocholine iodide must be thoroughly optimized to avoid false analytical signals or a reduced sensitivity. The working overpotential determined for different screen-printed electrodes was: carbon-nanotubes (360 mV), platinum (560 mV), gold  or cobalt phthalocyanine . It is interesting to note that this potentiometric method needs an electroactive compound in the solution [Acetylthiocholine iodide was used as substrate for biosensors based on AChE immobilized on platinum electrodes poised at 410 mV  . A potensolution  and, in 3.5.The difference between the potential of the oxidation peak of thiocholine at 110 mV and iodide at 675 mV is important  and suggDifferent potentials were reported in literature for the quantification of the analytical signals of biosensors developed by the immobilization of AChE on electrodes modified with cobalt phthalocyanine when acetylthiocholine iodide was used as substrate. A wide oxidation peak attributed by the authors to the overlap of the peaks of unknown species was obtained by differential pulse voltammetry recorded from 100 to 1,000 mV. An oxidation peak attributed to the thiocholine with maximum at 370 mV with a height approximately equal with one third of the previous wide peak was obtained when the differential pulse voltammetry was carried out in a narrower potential range between 100 and 500 mV. The optimum potential for amperometric measurements chosen by authors was 370 mV, but the enzymatic inhibition may be determined between 300 and 400 mV . The thi3.6.The experiments described above are useful to predict the behavior of biosensors constructed by the immobilization of AChE on the surface of similar electrodes. Nevertheless, the electrode surface is modified in the case biosensors and in consequence the electrochemical propertied may be modified. We have verified our results using biosensors obtain by the immobilization of AChE by reticulation with glutaraldehyde on the surface of platinum and cobalt phthalocyanine screen-printed electrodes and the analytical signals were recorded for the injection of 1 mM acetylthiocholine chloride and iodide, respectively. The biosensors based on platinum screen-printed electrodes were tested at 560 mV and 700 mV. The response measured at 560 mV was 132 nA for both chloride and iodide substrates. The response obtained at 700 mV was 531 nA using acetylthiocholine iodide much higher in comparison with 148 nA that were recorded for acetylthiocholine chloride. The immobilized enzyme was completely denatured by incubation for 3 min in a 1:1 water-methanol solution and the residual response was recorded in order to test the interferences. At 560 mV it was not measured any significant signal for the injection of both chloride and iodide, but at 700 mV the response measured for acetylthiocholine iodide is 389 nA while for acetylthiocholine iodide the signal is still insignificant. For the biosensors based on cobalt phthalocyanine screen-printed electrodes it was obtained at 110 mV an analytical signal of 156 nA for acetylthiocholine chloride that is statistically higher than 118 nA recorded for acetylthiocholine chloride. All these results confirm the conclusions reached using bare electrodes, but tests with chloride and iodide substrate must be carried out for every particular developed biosensor in order to avoid false signals.4.Our study demonstrates that it is possible to use acetylthiocholine iodide as pseudosubstrate for the quantification of the analytical signals of amperometric biosensors based on AChE only after a careful investigation of the electrochemical behavior of the electrode towards thiocholine in the presence of iodide. Iodide anions may interfere with the measurements in two different ways: (i) by the modification of the measurement sensibility of the thiocholine and/or (ii) by producing false analytical signal due to the oxidation. The influence of the iodide on the measurements and optimum potential must be determined experimentally for every developed biosensor because each layer deposed on the electrode surface modifies the overall electrochemical behavior.


Plasmodium falciparum on the north coast of PNG are genetically isolated. If this fragmented population structure is found throughout PNG it will provide a unique opportunity for planning malaria control strategies and focusing efforts on regions where they are likely to have the greatest impact. We are working towards defining a high-resolution population genomic map of parasite networks and migration patterns throughout PNG using single nucleotide polymorphisms. Our approach, preliminary data and the practical implications of this research will be discussed in context with the national malaria control program.Malaria is being controlled in Papua New Guinea (PNG) where the epidemiology of the disease ranges from highly endemic in low-lying regions to epidemics in the highlands. Analyses of microsatellite haplotypes have revealed that populations of


BRCA1 make a significant contribution to the molecular pathology of familial breast and ovarian cancer and are potentially detectable by the CGH or SNP microarrays in common use.The use of microarray based molecular karyotyping for diagnostic testing is now common in clinical practice. A feature of this technology is an increased capacity to uncover genetic abnormalities unrelated to the original indication for the test. These incidental findings can involve the unexpected diagnosis of well recognised Mendelian genetic disorders through the rearrangement of a known disease genes. Large scale genomic rearrangements of BRCA1 gene locus. Analysis showed that the copy number variant resulted in the deletion of exons 2-17 and would be classified as a pathogenic mutation. Following discussion with a clinical geneticist the result was reported to the family by the pediatrician who facilitated their referral them to a familial cancer centre for further discussion.We describe the case of a 5 year old boy seen at the Peter MacCallum Familial Cancer Centre. The index case and his twin brother originally presented to their pediatrician for investigation of a history of an autistic spectrum disorder and a molecular karyotype was ordered. This array revealed an unexpected finding of a deletion on chromosome 17q21 involving the A detailed pedigree revealed no significant cancer history with only a single case of breast cancer in the wider family. The parents of the index described being surprised by the result but grateful for the information. Both parents elected to proceed with predictive testing to clarify the origin of the mutation and the potential cancer risks for them and their family in the future.The rapid expansion of genetic testing capacity through new technologies such as microarray testing or next-Generation-Sequencing are certain to be associated with increasing numbers of unexpected findings including familial cancer syndromes. Although an approach to this type of finding needs to be developed, the current case demonstrates that whilst unanticipated, this information can be welcomed by families.


Our findings regarding the Breast Cancer and Environment Research Centers (BCERCs) in which Wolff and Barlow are involved represent a broad overview of all four centers and are meant to portray several dimensions of the collaborative aspects of the work. In our article , we aimeThe findings reported in our article  show a nOur analysis  does notOur research  providedOur article  and reco


Endogenous opioid peptides have been aligned with a diverse array of effects. Their activity is not only attributable to action the three main opioid receptors, mu (MOR), delta (DOR), and kappa (KOR) opioid receptors but their impacts appear to extend to activities at sodium channels, cytokine receptors  is one of the most prominent and is the prototypical endogenous peptide for the MOR class of opioid receptors and is found within the CNS and the immune system  are effective inhibitors for DPP IV, albeit di-isopropyl fluorophosphate has been shown to induce compensatory anticholinesterase activity producing tremors due to its irreversible nature. Spinorphin  (Sacerdote and Panerai, The search for the sites of action for the non-opioid effects of endogenous opioids has been largely focused on the immune system (Rittner et al., Increasing our understanding of the role of beta-endorphin and its biotransformation fragments provides an insight into the complexity of the endogenous opioid system. The current analgesics are targeted at the modulation of analgesia by directly binding to one or more of the opioid receptors, with the analgesic being predominantly designed as a MOP agonist. The above observations would suggest that this is solely one aspect of opioid pharmacology, albeit one that has been explored widely and utilized in therapy. Biotransformation is a process that produces an array of compounds having a plethora of specific actions which contribute to the body's and its biological systems response to disease or injury. Future therapeutic strategies should consider such actions in designing better treatments or disease modulators.


We are describing a simple and innovative way of documenting tachycardia. This patient came with video recording of neck pulsation done with the help of mobile phone camera. No other documentation of this tachycardia was available as patient was living in a remote area away from even basic health facilities. It was during one of those bedside clinics, when one of my professors taught us that Wenckebach block was first diagnosed by Dr Karel F. Wenckebach in 1899 by observing jugular venous pulsation [In a country like India, where mobile phone industry has grown tremendously and made inroads into every nook and corners of the country, this kind of indigenous telemedicine is certainly a small filler in the big lacuna of health care.


A descriptive embedded multiple case study research design is planned to provide an intense focus on a single phenomenon (the audit cycle) within its real life context . The measures to be included in the case study have been identified by the Balanced Patient Safety Measurement Framework. These include: audit and peer review activity, provider attitudes to patient safety, safety learning, action and performance. A purposive sample of 6 to 8 surgeons  from 3 to 4 specialities (cases) will undergo semi-structured interview. This will investigate: current audit tools and processes; attitudes; and behaviours of surgeons to the audit cycle. Similarities in and differences between the units of analysis will indicate which identified measures function as barriers or enablers of the audit cycle. Reliability and validity  will be assessed using established methods for case studies. The descriptive embedded multiple case study will reveal how and why foot and ankle surgeons participate in the audit cycle. This will inform further research to improve the outcomes of foot and ankle surgery through development of an audit tool.The direct costs of managing adverse outcomes from Australian health care are estimated to be $2 billion. The audit cycle is considered an important tool to assist in the preventive management of adverse outcomes.Australian guidelines for audit cycle design allow for comparison of data sets derived from similar surgical specialities. However a lack of data set standardisation inhibits meaningful comparisons of foot and ankle surgical audits. This research will assist development of a best practice model for auditing foot and ankle surgery. Data derived from this model will improve the safety and quality of foot and ankle surgery. The preliminary phase of this process is to identify and understand the attitudes and behaviours of


The regulation of metabolism in fed and fasted states is governed by hormonal and nutrient-derived signals that are mediated in part by nuclear receptors. Just as insulin and glucagon help the body store and mobilize energy through their membrane receptors, nutrient-derived lipids activate their cognate nuclear receptors  to govern transcriptional programs involved in energy storage and utilization during times of nutrient excess and privation. Recent work has revealed that many of the actions of these nuclear receptors are mediated by two atypical fibroblast growth factors (FGF19 and FGF21) that function as endocrine-like hormones. The characterization of these pathways in normal and metabolic disease animal models has led to an understanding of their physiologic and pharmacologic mechanism of action.


Portal vein thrombosis (PVT) not associated with hepatocellular carcinoma is considered a frequent complication of liver cirrhosis but, unlike PVT occurring in non-cirrhotic patients, very few data are available on its natural history and management. The reduced portal blood flow velocity is the main determinant of PVT but, as in other venous thromboses, multiple factors local and systemic, inherited or acquired often can concur with. PVT has a variety of clinical presentations ranging from asymptomatic to life-threatening diseases like gastroesophageal bleeding or acute intestinal ischemia. It is usually diagnosed by Doppler ultrasound but computed tomography and magnetic resonance imaging are useful to study the extent of thrombosis and the involvement of the abdominal organs. The risk of bleeding mainly determined by the presence of gastroesophageal varices and clotting alterations causes concern for the treatment of PVT in cirrhotic patients. To date, anticoagulant therapy seems to be indicated only in patients awaiting liver transplantation. This review focuses on the definition of the subgroups of patients with cirrhosis that might benefit from treatment of PVT and examines the pros and cons of the available treatments in terms of efficacy, monitoring and safety, providing also perspectives for future studies. Liver cirrhosis is the most frequent underlying disease in patients with non-neoplastic thrombosis occurring in the portal vein (PVT). In a large autopsy series of patients with PVT, neoplasia was present in 67%, cirrhosis in 28% and in only 5% of patients PVT was considered primitiveHepatocellular carcinoma (HCC) is the most frequent cause of PVT in cirrhosis, being present in up to 44% of casesThis review deals with PVT occurring in patients with liver cirrhosis without HCC focusing on the necessity and/or the opportunity of management of this specific complication of liver disease.The occurrence of PVT in cirrhotic patients has been increasingly reported in recent years. This stems from the different procedures utilized for diagnosis and the different settings of cirrhotic patients studied. The presence of PVT was 0.6% when evaluated by old angiographic studiesMoreover, the prevalence of PVT increases with the age and severity of liver disease reaching 15% in patients awaiting liver transplantationFew studies have focused on the incidence of PVT. The de novo thrombosis within one year, in patients with liver cirrhosis, ranges from 7.4% to 16%It is generally thought that liver cirrhosis leads to a progressive bleeding tendency because of the complex alteration of the clotting system induced by liver failure but recent studies have demonstrated that liver cirrhosis, causing a reduced synthesis of either pro-coagulant or anticoagulant proteins is still associated with a balanced equilibrium of the clotting system set at a lower levelEpidemiological studies show a prevalence of venous thrombosis of 0.5% - 1%As in all venous thrombosisIn patients with cirrhosis the derangement of liver architecture leads to increased intrahepatic vascular resistance, development of porto-systemic collateral circulation and splanchnic vasodilatation and ultimately to a stagnation of the portal flow, which is considered the main predisposing factor to thrombosis.Zocco et al have recently demonstrated that the portal flow velocity, measured by Doppler ultrasound, is inversely correlated with the risk of PVTThe age, sex of the patient and etiology of liver disease have not resulted as risk factors for PVT in patients with cirrhosis, even if a lower prevalence of PVT was reported in PSC and PBC candidates for liver transplantationLocal risk factors may trigger thrombosis via endothelial damage as abdominal inflammatory diseases like diverticulitis, pancreatitis, cholangitis. Abdominal surgical interventions, particularly portal-caval shunts and splenectomy, are associated with PVTPrevious bleeding episodes from gastroesophageal varicesLocal ablative therapies, percutaneous ethanol injection and thermotherapy for HCC may induce thrombosis of portal branches close to the tumorOdds ratio of 5.9The G20210A mutation of the prothrombin is the main inherited clotting abnormality that has been associated with PVT development in liver cirrhosis with a prevalence ranging from 21.4% to 29% and an The contribution of FVL, and antiphospho-lipid antibodies to the pathogenesis of PVT in cirrhosis remains controversial. MTHFRTT677 mutation in the absence of hyperhomocysteinemia is not considered a risk factor of venous thromboembolismIn rare cases of PVT associated with recurrent venous thrombosis, or severe presentation with intestinal infarction an underlying myeloproliferative disorder can be suspectedIs it worthwhile performing a complete thrombophilic work-up in the presence of PVT in a cirrhotic patient?The identification of one or more thrombophilic risk factors in a single patient is interesting for research purposes and it useful in the clinical setting to plan the length of anticoagulant therapy. In fact in patients with “strong” and persistent risk factors anticoagulation has to be prescribed lifelong. In the subgroups of patients with cirrhosis and PVT in which anticoagulation is indicated (see below) the presence of thrombophilia justifies a protracted therapy.From a patho-physiologic standpoint, PVT aggravates portal hypertension with increasing blood flow through collateral veins, which in turn favours bleeding from the esophageal and gastric veins. Even if thrombosis mostly occurs in the main portal trunk it may extend to its intrahepatic branches, splenic vein and into the superior mesenteric vein, leading to mesenteric ischemia or infarction, often lethal in these patientsMoreover, thrombosis of the smaller branches of hepatic and portal veins, frequently found in autopsy samples of cirrhotic livers, may induce hepatocyte apoptosis, contributing to the further deterioration of liver diseaseWhereas theoretically the occurrence of PVT may worsen either liver function or portal hypertensionIn clinical practice the influence of PVT has been evaluated only in the setting of liver transplantation where, even if PVT is not considered an absolute contraindication, it represents a complex challenge for the hepatic surgeon and is the cause of increased post-transplantation morbidity and mortalityPVT can have a variable clinical onset. In a study of 79 cirrhotic patients, PVT caused gastrointestinal bleeding in 39% and abdominal pain in 18%; seventy per cent of patients, admitted for acute abdominal pain, presented intestinal infarction due to the involvement of mesenteric vein .In 43% of cases PVT was a fortuitous finding during the scheduled ultrasound examination for the screening of hepatocellular carcinomaIn the previous studyThis is probably due to the earlier diagnosis of PVT and the less pronounced thrombophilic state in patients with cirrhosis.Nonetheless, the complete occlusion of the mesenteric vein is invariably associated with intestinal ischemia or infarction and the presence of a splanchnic vein thrombosis has to be investigated in cirrhotic patients with acute abdominal pain.PVT is usually diagnosed by abdominal ultrasound with pulsed and color Doppler examination but this procedure has sensitivity and specificity in detecting the thrombus variable from 66% to 100%, because it is affected both by operator expertise and patient characteristicsOverall in the presence of new diagnosis of PVT, the extent of the thrombosis and the clinical features of the patient have to be investigated for a correct evaluation of the prognosis and of the treatment.Studies in numerous series of patients with non-cirrhotic PVT have demonstrated that anticoagulation is safe and effective and represents the therapy of choiceDespite the high frequency of PVT in patients with liver cirrhosis, there are very few data on the treatment in this settingThe main concerns for anticoagulation in cirrhotics arise from the presence of a bleeding risk in these patients and the lack of evidence of a real clinical benefit from the therapy in patients with an advanced liver disease.In stable conditions the bleeding risk arises mainly from the presence of portal hypertension, in fact more than 50% of these patients have gastroesophageal varicesThe utility of the PVT treatment has been assessed only in patients awaiting liver transplantation in whom the presence of a partial PVT represents a cause of increased morbidity and mortality, while a complete thrombosis is a definitive contraindication to transplantation.In a preliminary study Francoz et al.These data, even if necessitating confirmation in larger series of patients, indicated that PVT arising in patients listed for liver transplantation is an indication for anticoagulation therapy.Since data available are not sufficient to make recommendation on PVT treatment, the following suggestions should be considered advice that can help in clinical practice. The choice of the best management should be evaluated case by case, at least to date.The presence of acute abdominal pain, due to intestinal ischemia for progression of thrombosis to the mesenteric vein, represents an absolute indication to anticoagulation in the attempt to prevent intestinal infarction. However, there remains to be evaluated whether the presence of mesenteric vein involvement in asymptomatic patients is an indication for treatment. Considering the likelihood of progression of the thrombotic process and the life threatening consequences of the complete mesenteric vein occlusion, treatment is advisable.- asymptomatic patients with a compensated liver diseaseIt is useful, for clinical purpose, to identify other specific groups of patients in whom PVT treatment needs to be evaluated:This group of patients should be treated according to the criteria of non-cirrhotic PVT either to prevent long term complications of the thrombosis or not to preclude a future liver transplantation option. Moreover, a complete assessment of risk factors is suggested in these patients since a thrombophilic state other than cirrhosis per se is likely.- patients presented with bleeding from portal hypertensionThe clinical onset with gastroesophageal bleeding of PVT should not be considered a contraindication to an anticoagulant therapy since the thrombosis may have triggered the bleeding by worsening portal hypertension. Preliminary data show that in these patients anticoagulation therapy is safe if they are adequately treated for bleeding recurrence by medical and endoscopic prophylaxisIn these patients an intrahepatic shunt (TIPS) could be considered as second line treatment because it can achieve the repermeation of the vessel and concomitant treatment of portal hypertensive complications when endoscopic therapies have failedLastly, the treatment of PVT is not to be recommended in patients with advanced liver disease, unsuitable for liver transplantation, since the improvement of survival is unlikely in this setting. Nor it is recommended in the presence of a well established cavernomatous transformation of portal vein in the absence of well defined risk factors.Studies addressing the issue in patients with PVTare lacking and it is currently advisable to apply to this group of patients the guidelines for the primary prophylaxis of bleeding followed for patients without PVTAs in non-cirrhotic PVT, anticoagulation therapy is the first line therapeutic strategy in patients with liver cirrhosis. Two main groups of drugs are available to this purpose Vitamin K antagonists (VKA), acenocoumarol and warfarin, and heparins.Francoz et al.Amitrano et al.The number of platelets did not change significantly in any patient during anticoagulation treatment and only two patients complained of mild anemia due to portal hypertensive gastropathy.-VKAs administered by mouth are more acceptable by the patients but they need periodical dose-adjustments by INR monitoring; in patients with advanced liver disease the INR value is often spontaneously close to or above 2.0 considered a therapeutic range for anticoagulation. Thus INR value as currently measured is inadequate to monitor anticoagulation for patients with severe liver disease- LMWHs have completely replaced unfractionated heparins since they have the same efficacy and do not necessitate monitoring for dose adjustmentIn absence of comparative studies, the choice of the anticoagulant therapy has to rely on the following considerations:These disadvantages of both anticoagulation strategies may be overcome by the new oral anticoagulant drugs such as thrombin inhibitors and anti factor XaCurrently VKAs may represent a therapeutic option in patients with compensated liver disease who require long term anticoagulation. LMWHs should be given to patients awaiting liver transplantation and to patients with a more severe liver disease.- patients who achieved a complete recanalisation can stop anticoagulant therapy in the absence of previous thrombotic events, or thrombopilic risk factors. They should be followed periodically for PVT recurrence.- patients with partial recanalisation or with a stable partial thrombosis should continue anticoagulant therapy if candidates for or suitable for future OLT in order to prevent a complete portal vein occlusion.- patients who failed to achieve any recanalisation of occlusive PVT should stop anticoagulant therapy. Nevertheless, in patients with deep vein thrombosis of the limbs, residual or persistent thrombosis is considered as a risk factor for recurrence requiring long-life anticoagulation- patients with recurrence of PVT should be considered for long-life anticoagulant therapy.The current guidelines for the treatment of venous thromboembolismLocal and systemic thrombolysis has been utilized in the setting of non-cirrhotic venous thrombosis and only rarely in cirrhosis as rescue therapy but high rate of major complications including bleeding has been reportedSo this therapeutic approach in a cirrhotic patient with PVT should be reserved only in the case of patients with ongoing intestinal infarction not responsive to anticoagulation therapy.Transjugular intrahepatic porto systemic shunt (TIPS) can be considered a second line treatment of PVT in patients with portal hypertensive complications not controlled by the common therapeutic approach particularly in patients awaiting liver transplantation. In preliminary experience Senzolo et al. reported a successful TIPS placement in a 69% of 13 cirrhotic patients with PVTPortal vein thrombosis is recognized as one of the complications of liver cirrhosis but many aspects still remain to be elucidated. The first is the impact of PVT on the natural history of liver cirrhosis and prospective studies addressing this issue are warranted and to identify subgroups of patients who could benefit from PVT treatment.The best treatment option in terms of efficacy and safety has also to be established. Furthermore, which anticoagulant treatment, the duration of therapy and the modality of monitoring need to be evaluated in future controlled trials.


A key problem in neuroscience is understanding how the brain makes decisions under uncertainty. Important insights have been gained using tasks such as the random dots motion discrimination task in which the subject makes decisions based on noisy stimuli. A descriptive model known as the drift diffusion model has previously been used to explain psychometric and reaction time data from such tasks but to fully explain the data, one is forced to make ad-hoc assumptions such as a time-dependent collapsing decision boundary. We show that such assumptions are unnecessary when decision making is viewed within the framework of partially observable Markov decision processes (POMDPs). We propose an alternative model for decision making based on POMDPs. We show that the motion discrimination task reduces to the problems of (1) computing beliefs (posterior distributions) over the unknown direction and motion strength from noisy observations in a Bayesian manner, and (2) selecting actions based on these beliefs to maximize the expected sum of future rewards. The resulting optimal policy (belief-to-action mapping) is shown to be equivalent to a collapsing decision threshold that governs the switch from evidence accumulation to a discrimination decision. We show that the model accounts for both accuracy and reaction time as a function of stimulus strength as well as different speed-accuracy conditions in the random dots task. Animals are constantly confronted with the problem of making decisions given noisy sensory measurements and incomplete knowledge of their environment. Making decisions under such circumstances is difficult because it requires (1) inferring hidden states in the environment that are generating the noisy sensory observations, and (2) determining if one decision (or action) is better than another based on uncertain and delayed reinforcement. Experimental and theoretical studies In this paper, we derive from first principles a POMDP model for the well-known random dots motion discrimination task hidden state, belief (posterior probability distribution) over the set of possible states given the sensory observations seen so far: optimal policyWe model the random dots motion discrimination task as a POMDP. The POMDP framework assumes that at any particular time step, the environment is in a particular We now describe how the general framework of POMDPs can be applied to the random dots motion discrimination task as shown in In a given trial, neither the direction It can be shown Given the framework above, the task of deciding the direction of motion of the coherently moving dots is equivalent to the task of deciding whether The animal updates its belief after receiving the current observation Recall that a belief state A policy belief MDP, we need to define the transition probabilities One standard way Given the time-independent belief state transition Before we proceed to results from the model, we note that the one-step belief transition probability matrix We summarize the model variables as well as their statistical relationships in The optimal policy We compare predictions of the model based on the learned policy The performance on the task using the optimal policy The sequence of random variables Let The probabilities of making rightward or leftward eye movement are the marginal probabilities summing over all possible crossing times: The left panel of The right panel of There is essentially one parameter in our model needed to fit the experimental accuracy data, namely, the reward ratio From The above model makes two testable predictions about neural responses in LIP. The first is that the neural response to The second prediction concerns the buildup rate  Another advantage of a POMDP model is that the model parameters have direct physical interpretations and can be easily manipulated by the experimenter. Our analysis shows that the optimal policy is fully determined by the reward parameters The proposed model demonstrates how the monkey's choices in the random dots task can be interpreted as being optimal under the hypothesis of reward maximization. The reward maximization hypothesis has previously been used to explain behavioral data from conditioning experiments We showed through analytical derivations and numerical simulation that the optimal threshold for selecting overt actions is a declining function of time. Such a collapsing decision bound has previously been obtained for decision making under a deadline Instead of traditional dynamic programming techniques, the optimal policy


This includes maintaining skin integrity wherever possible, promoting healing in the non-healing wound and provision of expertise and specialist equipment to complex acute and chronic wounds.○ The Podiatry Wound Care Service is a team of experienced podiatrists highly skilled to manage the high risk foot. The team works across both primary and secondary care forming a seamless service between the two working closely with all disciplines to provide a holistic approach to treatment and care planning.○ The Lower Limb Service is run by experienced nurses who are proficient in the management of cellulitis, tissue viability and skin care related to the lower limb. Patients are provided with a variety of health education, clinical treatment and advice in different settings including community clinics, domiciliary visits and groups within the wider community.Each service has a different view of the patient and their wound.Working within an integrated team allows us to fast track urgent referrals and arrange joint visits between the disciplines with ease so wound care plans can be devised and implemented immediately. The 3 services complement each other well, each bringing a different skill mix to the treatment but with us all having the same goalJust as we view the patient holistically but assess individual systems, so the Integrated Wound Care Team is able to take a different view of the wound but collaborate together to provide high quality care which benefits the patient as a whole.


Previous vaccine development has been driven mainly by policies and concerns around childhood, with the aim of preventing premature death amongst young children from infectious disease and stopping them from acting as carriers. Whilst this is important, the face of the world has changed recently and the problem has now to be extended to include the protection of a vulnerable aging population. Here we present the case for a need to develop a prophylactic regimen for older individuals which features vaccination at the center of a portfolio of treatments.Advances in medical, social, and economic conditions have resulted in human population growth and an ever-extending life expectancy such that for the first time in our history the world population will soon have more people over the age of 65 than under the age of 5. The development of antibiotic therapy, progresses in vaccine technology combined with mass vaccination programs and government schemes to improve economic and social well-being mean that the majority of individuals over the age of 65 are currently physically more active than their counterparts a few decades ago . Influenza is commonly thought to be a disease of limited duration, but in older individuals it may lead to a period of prolonged bed rest. Because long periods of bed rest are associated with a loss of aerobic capacity (1% per week whilst bedridden), a loss of muscle capacity (5% per week), and a loss of bone density (∼1% per week) this may leave a previously healthy older individual as a weak frail person dependent on assistance from others for their normal activities of daily living  is recommended for all adults over the age of 60–65 to combat transmission (Michel et al., The poor performance of the TIV in providing protection in older individuals has been known for some time, but to date there has been no satisfactory resolution of the issue. Several studies have been undertaken on possible reasons for this problem and these have produced a number of studies on age-associated changes in immunity which have identified problems with Langerhans cells (Shaw et al., One of the major challenges for vaccine development in this population is associated with identifying measureable surrogate markers which are acceptable readouts of immune protection (Lang et al., In a complex system such as the immune system with its multiple component overlaps, predicting individual responsiveness to influenza vaccination using a single method able to distinguish between a healthy and an immunosenescent state, would be very challenging. Especially as the ability of the immune system to respond to vaccination is further impinged upon by the impact of non-immune factors such as nutritional and metabolic status, and comorbidities from which adults increasingly suffer from as they age (Collerton et al., The presence of these multiple issues associated with vaccine ineffectiveness underlines the degree of diversity which exists amongst older individuals, which in turn is somewhat expected since aging is neither regulated nor programed. Although each individual ages differently and in a way, which in part is dependent on lifestyle choices and environmental factors, there are common threads (Murabito et al., Since there are currently no tests associated with defining an individual's ability or inability to produce a protective response to vaccination, a more valuable approach would be to measure several aspects of the immune response following vaccination within an individual and compare these not only with known benchmark levels but also to confront these with validated biological and clinical outcomes. This would entail some degree of classification of older individuals into specific trends of aging on the basis of defined characteristics or their absence. In the past efforts have been made to achieve this and define an immune risk phenotype which includes T cell phenotypes, subset numbers, function, CMV status, and cognitive impairment (Wikby et al., Such a move from the existing immunization menu toward a greater degree of personalized medicine could contribute to accelerating the development of new vaccines with higher efficacy and of specific combined therapeutic approaches than those currently available.


In 2007, Kangan Institute commenced inclusion of Allied Health Assistant Certificate 4 - Podiatry Units delivered by a podiatrist. Different models have been delivered including external placement with private podiatrists, service specific units on site and external work based programs. Since then, a number of TAFE based AHA courses have been commenced including those at Swinburne and Gippsland. With National Registration, the recognised qualification for podiatry assistants is the Certificate III or IV Allied Health Assistant qualification that includes Podiatry Units.Clarification of the required training for podiatry assistants has offered TAFE services the opportunity to consider the way in which services are offered, and to review the barriers and enablers: (i) to podiatrists using AHA trained podiatry assistants in the work setting and (ii) to acceptance of AHA students for podiatry based clinical placements. This presentation will discuss these issues and present some of the current strategies used in the TAFE sector to enhance the enablers and reduce barriers to the benefit of the profession and its podiatry assistants. It will also discuss methods to expand the training in the future to benefit the podiatry industry.


By living in a “world of water” fishes are exposed to major osmotic challenges that are opposite in nature in the freshwater and marine environments. In both cases, obligatory water fluxes primarily due to osmotic gradients across respiratory surfaces are threatening to the internal milieu and must be compensated by bulk flows of water in the opposite direction. While the ionoregulatory mechanisms that generate the osmotic driving force for such water flows have been known for decades, the molecular pathways of compensatory water fluxes are still largely unravelled. Current models suggest that water passes hydrophobic epithelia by para- and/or transcellular pathways, the former being defined by the characteristics of tight junctions, the latter determined by the serial permeability of apical and basolateral cellular membranes. Transcellular water transport may occur by simple diffusion through lipid bilayers or become markedly improved by the insertion of integral channel proteins (aquaporins) in the plasma membrane. Thus, aquaporins can truly be conceived as the plumbing system of cells.In mammals, 13 aquaporin subfamilies are present and several of these have been investigated structurally and functionally in >6600 publications since their discovery in 1992 by Agre and colleagues. The first paper on aquaporins in fishes appeared in Cutler and Cramb  but surpAquaporins most certainly play distinct roles in fishes as they do in mammals—both at the cellular, organ and organismal level. However, there is a considerable lack of information from the fish world on this topic, with only ca. 50 papers addressing aquaporins in fishes at the time of the call of this Research Topic in 2010. Most of these describe tissue expression patterns in various Teleosts, while Aqnathans and Chondrichthyes and the functionality of fish aquaporins have received very little focus. This ebook presents a collection of papers addressing the evolution and role of aquaporins during gametogenesis and embryonic development as well as for water transport across adult gill, kidney and intestinal epithelia using bony and cartilagenous fishes as models. Our aim is to stimulate new original research in this area as well as bringing together new collaborations across fields.


Sir,We appreciate the keen interest in our cMycobacterium tuberculosis from kidney transplant recipients because the recipients may belong to diverse geographic locations where the prevalence of drug resistance may vary. Identifying drug susceptibility is all the more important in transplant recipients in view of the limited drug options available for them due to significant interaction of rifamycins with calcinurin inhibitors (CNIs) and mTOR inhibitors. The current recommendation for treatment of tuberculosis in kidney transplant recipient is to use the same treatment regimen as used in local general population who require therapy.[The KDIGO clinical practice guidelines for the care of kidney transplant recipients recommen therapy. Rifampic therapy.5 The duret al.[et al.[Aguado et al. has repol.[et al. reportedl.[et al. durationThe prostatic abscess in our patient was asymptomatic and was picked up only on imaging; he had no evidence of bladder outlet obstruction. Hence, an intervention for draining the same was not considered necessary. A repeat CT scan after 3 months of antitubercular chemotherapy showed complete resolution of the abscess.


Simon Hay and colleagues discuss the potential and challenges of producing continually updated infectious disease risk maps using diverse and large volume data sources such as social media. Systems to provide static spatially continuous maps of infectious disease risk and continually updated reports of infectious disease occurrence exist but to-date the two have never been combined.Novel online data sources, such as social media, combined with epidemiologically relevant environmental information are valuable new data sources that can assist the “real-time” updating of spatial maps.Advances in machine learning and the use of crowd sourcing open up the possibility of developing a continually updated atlas of infectious diseases.Freely available dynamic infectious disease risk maps would be valuable to a wide range of health professionals from policy makers prioritizing limited resources to individual clinicians.It is perhaps surprising to state that we have an extremely poor knowledge of the global distribution of the vast majority of infectious diseases Here we argue that this information gulf has serious implications for global public health surveillance and that too little attention is given to spatial epidemiology in international preparedness planning. Stated simply, how can we gauge the risk posed by new infectious disease outbreaks if we have only the crudest understanding of their natural geographical range? Additionally, how do we prioritise useful intelligence in the growing deluge of Big Data To explore the factors hindering progress, we need to consider how traditional methods are used to map disease. We illustrate this in To complete the process illustrated in Canonically, the output risk surface is where the mapping process ends, which further compounds the problem of the paucity of infectious disease mapping. This is in part due to the very labour intensive nature of assembling  provides continually updated disease occurrence points but not continuous spatial data. Can we conceive of spatially continuous risk maps being updated in “real-time”—as frequently as new occurrence data are assimilated? The conceptual bridge of imagining spatial modelling as a continuous process in time is achieved simply by linking the output risk map back to the data inputs to create a feedback loop. This is important as it facilitates the novel step of spatial triage of new occurrence information (see below) and critically, the potential for multiple iterations of the map with continuous improvement by adding a machine learning element. This conceptual shift towards evolving maps, in combination with the increased availability of novel digital data sources The process described above provides a continuous risk map in space that is static in time. Conversely HealthMap , frequency of update (velocity), or diversity (variety) It is well established that a huge amount of novel data are being generated that will make important contributions to temporal public health surveillance In the era of satellite sensors, a diversity of epidemiologically relevant environmental information can be sourced globally at daily intervals Perhaps the most important development in relation to Big Data is the conceptual move from static to improving and evolving risk maps. Taking further our example of dengue mapping , the firThe biggest obstacles to incorporating a continuous spatial mapping component to routine biosurveillance will be demonstrating the feasibility and sustainability of this undertaking and engaging the audience. We have focussed here on applications for biosurveillance but it is important to emphasise the wider audiences. First, one should never underestimate the value of risk maps in helping to illustrate the extent of a public health problem www.flunearyou.org) and Influenzanet in the EU (www.influenzanet.eu), which now boast nearly 100,000 volunteers combined. From the outset all infectious disease data and derived maps should be made freely available to ensure engagement. This will also facilitate the uptake of new resources and their consideration by policy makers. Once the primary investment in the software platform is complete, and the community established, sustainability increases because demands for user inputs decrease as the software learns and the mapped outputs become increasingly stable. The ultimate vision is to democratise the platform by providing the code to all interested authorities.We have already argued that this mapping ambition is made tractable by automating many of the laborious steps in primary data acquisition and positioning. The Big Data revolution is already underway and harnessing the useful information in these new data sources will involve collaborations with computer scientists at the forefront of machine learning and with those who have had success in engaging communities


The potential to discover unanticipated clinically significant genetic variants during the course of research has stimulated much debate about the obligations of researchers to communicate such findings to study participants. Published guidelines suggest that researchers have an obligation to communicate valid and significant results, especially if they are clinically actionable. I will present data on the practices and perspectives of investigators conducting genome-wide association studies (GWAS) and will caution against the establishment of a general obligation to return results in research. I will compare the role-specific responsibilities of researchers with those of clinicians and discuss emerging standards for genomic analysis and communication of test results in the clinical setting.


Mediterranean Journal of Hematology and Infectious Diseases (MJHID) is a new open access, peer-reviewed, online journal, which encompasses different aspects of clinical and translational research providing an insight into the relationship between acute and chronic infections and hematological diseases. MJHID will be a topical journal on subjects of current importance in clinical haematology and infectious diseases. Every issue should have, beside the editor in chief, a guest editor. Both editor in chief and guest editor provide to invite experts in the selected topic to performe a complete update of the arguments readily available for practising phisicians. The journal will have also a section devoted to original papers, case reports and letters to editor and Editorial comment mostly focusing on the arguments treated in the previous topical issues. Reciprocal interdependence between infectious and haematologic diseases  is well known.27Splenectomy frequently performed autoimmune diseases as well in lymphoproliferative diseases is a further cause of immunodeficiency.28helicobacter pylori and B lymphoproliferative diseases are well known65Nevertheless, the main cause of immunodeficiency at present is due to HIV infection in developed as well in developing countries.Urgent pragmatic and efficient measures are needed both at international and national levels. Most of the peoples affected by neglected infectious diseases live in Central Africa, South Asia This should be possible bridging the health system gap between the south and the north borders sides of Mediterranean Sea while improving scientific collaboration.Case report should have educational character. Clinical trials of hematologic and infectious diseases present of Mediterranean area will have their natural home in this Journal. Also case studies relative to important health care intervention in developing countries of south Mediterranean areas will be accepted. All that should contribute to disseminate updated informations among physicians of developing countries on the more frequent diseases of the Mediterranean area.The results of relevant studies in the field should be made available to scientists and clinicians, in particular those in developing countries where the fight against pathogen related cancers is of the utmost importance.Every accepted manuscript will be available for reading on its date of acceptance by any person who has access to the web in web-friendly XML. Considering that every issue will be devoted to a topic, when all articles of the same topic will be available they will be formatted and the typeset PDF version will be available. The first issue of the MJHID has been dedicated to “Update in Diagnosis and Treatment of Thalassemia and related Disorders” Guest Editor Prof. Maria Domenica Cappellini.


Partnership between service users and researchers is a cornerstone of the current research and development strategy for England’s National Health Service and is considered by funders as essential throughout the entire research process. To promote and facilitate public involvement in the field of HCAI research, the HCAI Research Network (RN) formed a Service User Research Forum (SURF) to inform priorities and contribute to HCAI research. This paper shows how SURF is supported to develop its own research priorities into viable projects.The HCAI RN has developed a robust process with SURF to identify priorities and develop feasible research questions, facilitate interrogation to assess viability and ethics and ensure potential benefits are defined. This enables lay researchers to contribute to literature reviews and desk research; determine appropriate funding; work in partnership with academic/ clinical researchers and undertake research team roles. The HCAI RN provides training and support for this process.In 2010, SURF worked collaboratively with clinical and academic researchers to submit a proposal exploring patient experiences of MRSA screening for funding. The group is currently developing a user-led project evaluating health professional education in HCAI.Active service user involvement contributes diverse perspectives, ensures projects are relevant to patients and the public and empowers service users to make real contributions to the reduction of HCAI and drive change within healthcare settings. We continue to develop strategies to enable SURF involvement at all stages of research. Dedicated training and support ensures service users have the research skills and confidence to make their knowledge, experience and insights count in HCAI research.None declared.


Thyroid gland disease of autoimmune origin presents wide spectrum of pathologies, Graves’ disease from one side and chronic thyroiditis with fibrosis and atrophy of gland parenchyma from the other one. Among them the highest number of misunderstandings is observed in pathological reports of chronic thyroiditis in pre-operative cytological as well as in post operative histological examinations. There are numerous classifications of chronic thyroiditis, however they are not widely accepted. Histoclinical classification which correlates elements of microscopic examination with clinical course of the disease seems to be ideal but still does not exist. FNAB of thyroid gland is a method of the greatest importance in the diagnosis of chronic thyroiditis however that fact is not widely understood in every day routine of clinicians and pathologists.


The world of pharmaceutical statistics has taken adaptive designs to its heart - at least in theory. However despite the very large number of methodological publications and presentations at conferences there are still very few examples of adaptive designs in the medical literature. In this talk I will discuss why this might be the case and will suggest areas where these approaches are likely to be of greatest value in the future.


To the Editor: Recent articles in the professional literature (Neisseria gonorrhoeae (QRNG) is much more common in Asia  . Those partners who were identified were either not located or did not agree to speak with the disease intervention specialist.Sexual behaviors associated with travel can change the level of risks for STD transmission (Neisseria gonorrhoeae should serve as a model for STD prevention planning and programming. It highlights the importance of retaining the laboratory capacity to monitor antimicrobial susceptibilities of bacterial STD isolates. Treatment protocols should be adjusted in light of the prevalence of resistant strains of sexually transmitted pathogens. In cases in which symptoms associated with a bacterial STD persist after what is usually considered appropriate treatment, clinicians should obtain cultures and perform susceptibility tests on isolates. Nucleic acid amplification technologies do not provide critical antibiotic susceptibility information. In this situation, the public health STD program or laboratory should be contacted for guidance. Determining the sensitivity pattern of the pathogen in an expeditious fashion will ensure that appropriate and timely therapy can be initiated for the infected patient as well as enable more effective follow-up and treatment to sexual contacts. Asking patients who seek treatment for a possible STD about their own and their partner’s travel histories is important to broaden the differential diagnosis (This experience with antimicrobial resistance of


Malaria is one of the major public health problems for low income countries, a major global health priority, one that carries a dramatic economic impact. Funding and consequently coverage of both preventive interventions and of case management for malaria control have been rising and both international donors and governments of malaria endemic countries need the tools and evidence to assess which are the best and most efficient strategies. To aid with these decisions we developed an open access malaria costing database that effectively summarizes an extensive body of literature on costing and effectiveness of malaria preventive interventions and case management. The database comprises 150 publications spanning from 1985 through 2012 from a total of 42 countries. We collected costs, detailed site and intervention data on insecticide residual spraying campaigns, insecticide treated net distribution and re-treatment campaigns, delivery of intermittent preventive treatment, and treatment of uncomplicated and severe malaria. Unit costs and other intervention data were coded into standardized categories and expressed in common 2008 international dollars allowing us to compare economic outlays across sites and interventions. We discuss findings from these descriptive analyses and illustrate how these data can be used to extrapolate costs to other countries.


A poster presentation will be prepared to disseminate the result of research conducted to investigate the potential for the Health Belief Model as a tool to understand the factors affecting compliance with the use of prescribed footwear in diabetic foot disease.A self-completion postal questionnaire was developed and applied in a South Wales Valley community to investigate the health beliefs of 72 individuals provided with prescription footwear for advanced diabetic foot disease and to investigate the impact of these beliefs on their compliance with prescription footwear.46.6% of respondents were found to be compliant with their use of prescribed footwear at the 9.6 hours per day threshold. Prior history of ulceration was found to be associated with increased likelihood of compliance , which contests the finding of McFarlane & Jensen(2003). Recollection of advice to wear the prescribed footwear indoors was also significantly associated with compliance . Patients who perceived prescribed footwear as beneficial used them for a greater number of hours per day . Patients who perceived diabetic foot ulceration as serious were more likely to perceive prescribed footwear as beneficial  and patients who perceived prescribed footwear as beneficial were less likely to rate barriers to compliance as high . The correlation between the summary health belief scale and reported daily hours of prescription footwear was not significant . An improved health belief model has been constructed to enhance understanding of the factors affecting compliance in this context.It is recommended that the NHS provision of prescription footwear should be focused toward patients with a previous history of ulceration and those for whom ulceration is imminent. Patients with pre-ulcerative diabetic foot disease should be counseled to wear protective commercial footwear indoors as well as when walking outside.


Being able to induce therapeutic tolerance for the treatment of immunological diseases was once considered by many to be an unattainable dream, but recent developments in our understanding of immune regulation and tolerance-compatible immunosuppressive drugs may be turning that dream into reality. Tolerance induction in many rodent models of autoimmune disease and graft rejection is now almost trivial, and the problem has become not how to achieve tolerance experimentally but how to translate this knowledge to real clinical applications in human disease. This volume brings together 17 articles that highlight some of the different approaches being investigated for translating potentially tolerogenic therapies to the clinic and the barriers that still need to be overcome.The first two articles review the current status of clinical trials that result from large networks of basic laboratories and clinical consortia coordinated by the International Tolerance Network  o et al.  discuss o et al.  focuses o et al.  make a cThe following six articles consider various novel approaches to tolerance induction. Becker et al.  argue thThe final six articles discuss in more detail some of the barriers that remain to clinical translation of tolerogenic therapies to the clinic. Pasquet et al.  questionIn summary, we have made considerable progress toward translating potentially tolerogenic therapies from rodent models into the clinic, to the point where we now have a much clearer understanding of the barriers that remain and how we may yet overcome them.


Previous research has overwhelmingly established a relationship between sport participation and the development of positive body image (BI) (Richman & Schaffer (2000), Shaffer & Wittes (2006) and Greenleaf et al (2009). However a number of studies have indicated some women are particularly vulnerable to the development of poor BI in relation to sports participation . Due to the conflicting evidence, we have used an interpretive phenomenological framework to qualitatively explore women's experiences. Specifically we aimed to understand the perceived impact of sports participation and related commentary during childhood on adult body image. Participants were given the opportunity to suggest interventions which would improve their experiences of sports in relation to BI.Women indicated they started to think about their bodies from as young as 6 and 7. They remembered critical incidences that occurred during childhood sports which they perceived to influence their BI either in a positive or negative way. The awareness of their bodies has often come about through commentary from family or coaches, or through sporting uniforms. Suggestions for interventions have included mandatory education on overall health and food from as young as 6 in primary schools.Body Image stream of the 2013 ANZAED Conference.This abstract was presented in the


Measurements of membrane potential traces constitute the main observables to derive a biophysical neuron model; in particular, the dynamics of auxiliary variables and the model parameters are inferred from voltage traces, in a costly process that typically entails a variety of channel blocks and clamping techniques  and some


Often it is mentioned by participants that having peers speak out about their personal journey has instilled a sense of hope and been an inspiring experience. From this evolved the Mentor program. The Body Image and Eating Disorders Treatment and Recovery Service (BETRS) Mentor Program has been developed to complement the professional expertise within the team. Our Mentors share their lived experience of an eating disorder with current patients of BETRS. The invaluable contribution to the service by our mentors has been the following:- Supporting hopefulness and the recovery process by co-facilitating group sessions that focus on how they dealt with issues that are of particular concern to current patients.- Strengthen relapse prevention by giving firsthand accounts of occasions when lapses have not signalled a relapse but have been incorporated into the recovery process.- Mentors have been fostering motivation by encouraging behaviours that supported their own recovery and by assisting with the organisation and general care of the client group.- By sharing their experience of having an eating disorder and providing evidence of hope during the course of recovery mentors have given family and carers and better understanding.Care in Inpatient and Community Settings stream of the 2013 ANZAED Conference.This abstract was presented in the


Enviromental bioburdon is a potential source of healthcare associated infections (HAI) but there has been no evidence based science to authenticate this. Cleaning practices in healthcare environments is often set in place by the environmental service workers  and continued. Standard guidelines of cleaning process are lacking, and as there is no scientific standard to measure the effect of the process and the bioburden, it is often not addressed by medical community. Monitoring of cleanliness is by visual audit  which is a purely aesthetic parameter and subjective. We put in protocols for the cleaning of patient zone and high touch surfaces for the ICU after we had an outbreak of Acinetobacter baumanni infections. We added also an indigenous (detergent) mat at the entrance of the o ICU to decrease the biobuden.To implement a standard domestic hygiene protocol to prevent HAI. To make cleaning an integral part of infection control activity.We took up a pilot project in our 18 bedded medical intensive care unit when there was an outbreak of Acinetobacter baumanni infections. We prepared a protocol for cleaning of the ICU by defining all basic  parameters. Responsibility was delegated to the nursing staff for cleaning the bedside equipment (near patient hand touch surfaces) and the environmental service workers were accountable for the rest of the area. Infection control team gave hands on training to relevant staff. The process was monitored microbiologically (aerobic colony count) and by biochemical (ATP bioluminescence) means.Environmental follow up surveillance showed marked decrease in the colony forming units and biobuden.There has been no outbreaks of Acinetobacter baumanni infections after the implementation and monitoring of this protocol.Awareness and compliance of the protocol is high. A well designed cleaning protocol has been set to maintain clinical environment across hospital today.Environmental contamination is recognized as an important reservoir of the epidemic strains. High standards of domestic cleaning are essential intervention in the control of HAI. Simple hygiene is only solution in this end of antibiotic era to prevent HAI.None declared


Sir,Mansonella perstans and apologize for the inadvertent error. The only reported case of pleural effusion due to M. perstans was of Kahn in 1983.[This is in reference to the letter by an esteemed reader. I appreciate the interest shown by him regarding our case. We regret that the case reported by him was wrongly quoted in our article as caused by We did not consider pleural biopsy as the diagnosis was firmly established by repeated demonstration of microfilariae in pleural fluid, and the patient denied consent for pleural biopsy. The literature shows that pleural biopsy does not always demonstrate microfilariae.3The method used for demonstration of microfilariae in pleural fluid was hematoxylin and eosin stain on smears prepared from the sediment of pleural fluid after centrifuging at 2000 rpm for 15 min. Pleural fluid samples were collected at night time or in early morning.


Facial asymmetry is a common condition and only becomes a problem if there is a significant difference between both sides. In the Asian community, the difference between the height and width of the palpebral fissures and the skin creases is usually the most apparent on photographs. There has not been any reports on the prevalence of such differences between the various racial groups in Malaysia. This study looks at the incidence of asymmetry of the palpebral fissue and upper eyelid crease in young Malaysians of Malay and Chinese origins of which form the biggest racial groups in Malaysia. Data obtained from such studies would be useful for reconstructive and aesthetic surgery as well as for counselling patients with dysmorphophobia.Malaysian students between the ages of 18 and 26 were randomly selected at University Malaysia Sarawak. These students comprised of 197 Malays and 198 Chinese. The following parameters of both eyes were obtained with a millimeter ruler: palpebral fissure width (PFW), palpebral fissure height (PFH), intercanthal distance (ICD) and upper eyelid skin crease height (UESC). The presence and absence of skin creases were also recorded. Data collected was analyzed with Microsoft Excel and SPSS.There is statistical significant difference between the different sexes and races for PFW and PFH but none between the two sides. There is statistical significant difference between the two eyes for UESC. Chinese males have the highest percentage of PFW and PFH asymmetry. Malay males have the highest percentage of UESC asymmetry.Eyelid asymmetry is common amongst Malaysians. Asymmetry of PFW, PFH and UESC is commoner in males than females. Of the three parameters, asymmetry of UESC is the commonest. PFW and PFH asymmetry is more common in Chinese than Malays but UESC asymmetry is more common in Malays. UESC is almost universally present in Malays whereas in the Chinese there is a significant percentage of subjects with asymmetry of presence of UESC  which gives rise to a more obvious eyelid asymmetry. This data is useful for oculoplastic surgeons who are keen on counselling patients who wish to undergo aesthetic procedures pre and post-operatively.


The introduction of mandatory Continuing Professional Development (CPD) as a condition of podiatry registration has caused quite a deal of manic amongst the Podiatry population. What practitioners may underestimate is the amount of CPD that is undertaken as part of their everyday work practices. The podiatrists at Eastern Health are fortunate to have a supportive work environment that aims to foster learning opportunities and career advancement. This poster shows an audit of the amount and types of learning opportunities logged by the 12 member podiatry department for the first six months of the mandatory CPD period. The audit uncovered that many of the staff members had satisfied the Podiatry Board of Australia’s mandatory requirements within a two-month period. It is hoped that this poster will inspire others to think about their ongoing CPD opportunities within their own workplace.


I World Health Organization Global Malaria Action Plan sets out an ambitious plan for improved control, leading to regional elimination and includes as the ultimate goal the eradication of malaria. The ambitious goal of malaria eradication can however not be achieved with the tools and approaches currently available. Research and development of new tools must accompany and complement the Global Action Plan. We critically review and discuss the progress so far made to pursue the R&D agenda and about the key R&D issues where renewed attention and investments are required [Malaria elimination and eradication is back on the global health agenda. The Roll Back Malaria required . The folP. vivax: in vitro culture and study of the biology of hypnozoites.– The strengthened focus on – Drugs to be used for mass drug administration to clear infections and provide prophylaxis to prevent new infections Vaccines that aim at interrupting transmission.A. gambiae.– New vector control approaches for (i) outdoor biting / resting mosquitoes and (ii) achieving permanent reductions of vectorial capacity in areas where transmission is predominantly due to – New approaches for fast and accurate assessment of transmission at community level and strengthened diagnostic, monitoring, and surveillance tools/approaches that are linked and embedded in the health and social health systems.– New approaches in mathematical modelling to inform Target Product Profiles of tools, and predict expected outcomes of intervention strategies for elimination.– Tools to scientifically assess and determine health system readiness for moving from control to elimination.The review will conclude by pinpointing the challenges that are still ahead of us in the development of the science for elimination and application of its results to effectively complement the Global Action Plan.


Annals exists in part to keep surgeons up to date with advances in surgical research. We also have a responsibility to inform our readers of research opportunities that they may wish to join. Professor John Scholefield heads the National Institute for Health Research (NIHR) National Surgery Specialty Group and he has asked us to publish regular updates of surgical research activity taking place across the UK. We are pleased to do so and provide some additional information below.The  The Comprehensive Clinical Research Network (CCRN) is one of eight NIHR networks in England that provide researchers with the practical support they need to make clinical trials happen in the NHS so that more patients can take part in clinical research in England. The devolved nations have similar arrangements in place to support clinical research.The Surgery Specialty Group is 1 of 24 specialty groups that provide national networks of topic-specific expertise. These groups are key to the success of the CCRN. They work at both national and local levels to ensure the successful delivery of research in their specialties. This means ensuring that studies are delivered to target and on time.>We offer opportunities for surgeons and other healthcare professionals to become involved in research as well as for existing researchers to access a network of skilled research support staff and wider patient populations.>Comprehensive Local Research Networks can provide: assistance with the research and development approvals process; research nurses to consent patients into studies and perform study-related procedures; support for services such as pharmacy, imaging and pathology; and access to training opportunities.>http://www.crncc.nihr.ac.uk/about_us/ccrn/specialty/) or you can email the CCRN specialty groups team .Detailed information about specialty groups including contact details for regional representatives can be found on the Clinical Research Network website  of the Chief Investigator.>Get in touch with the named contact>Click on the link for each trial (if viewing online)>http://public.ukcrn.org.uk/search/)Visit the website of the Clinical Research Network Study Portfolio (For further details: