This study aimed to transform weakly acidic poorly water-soluble drugs (PWSD) into ionic liquids (ILs) to promote solubility in, and the utility of, lipid-based formulations. Ionic liquids (ILs) were formed directly from tolfenamic acid (Tolf), meclofenamic acid, diclofenac, and ibuprofen by pairing with lipophilic counterions. The drug-ILs were obtained as liquids or low melting solids and were significantly more soluble (either completely miscible or highly soluble) in lipid based, self-emulsifying drug delivery systems (SEDDS) when compared to the equivalent free acid. In vivo assessment of a SEDDS lipid solution formulation of Tolf didecyldimethylammonium salt and the same formulation of Tolf free acid at low dose (18 mg/kg, where the free acid was soluble in the SEDDS), resulted in similar absorption profiles and overall exposure. At high dose (100 mg/kg), solution SEDDS formulations of the Tolf ILs (didecyldimethylammonium, butyldodecyldimethylammonium or didecylmethylammonium salts) were possible, but the lower lipid solubility of Tolf free acid dictated that administration of the free acid was only possible as a suspension in the SEDDS formulation or as an aqueous suspension. Under these conditions, total drug plasma exposure was similar for the IL formulations and the free acid, but the plasma profiles were markedly different, resulting in flatter, more prolonged exposure profiles and reduced Cmax for the IL formulations. Isolation of a weakly acidic drug as an IL may therefore provide advantage as it allows formulation as a solution SEDDS rather than a lipid suspension, and in some cases may provide a means of slowing or sustaining absorption. The current studies compliment previous studies with weakly basic PWSD and demonstrate that transformation into highly lipophilic ILs is also possible for weakly acidic compounds.

Recent studies suggest a diet low in dietary magnesium intake or lower blood magnesium levels is linked with increased prostate cancer risk. This study investigates the race-specific link between blood magnesium and calcium levels, or dietary magnesium intake, and the diagnosis of low-grade and high-grade prostate cancer. The study included 637 prostate cancer cases and 715 biopsy-negative controls (50% black) recruited from Nashville, TN or Durham, NC. Blood was collected at the time of recruitment, and dietary intake was assessed by food frequency questionnaire. Percent genetic African ancestry was determined as a compliment to self-reported race. Blood magnesium levels and dietary magnesium intake were significantly lower in black compared to white men. However, magnesium levels or intake were not associated with risk of total prostate cancer or aggressive prostate cancer. Indeed, a higher calcium-to-magnesium diet intake was significantly protective for high-grade prostate cancer in black (OR = 0.66 (0.45, 0.96), p = 0.03) but not white (OR = 1.00 (0.79, 1.26), p = 0.99) men. In summary, there was a statistically significant difference in magnesium intake between black and white men, but the biological impact was unclear, and we did not confirm a lower prostate cancer risk associated with magnesium levels.

BACKGROUND

Increasing lay responder cardiopulmonary resuscitation and automated external defibrillator use during sudden cardiac arrest depends on an individual's choice. Investigators designed and piloted an instrument to measure the affective domain of helping behaviors by applying the theory of planned behavior (TPB) to better understand lay responders' intent to use lifesaving skills.

METHODS

Questionnaire items were compiled into 10 behavioral domains informed by the TPB constructs followed by refinement via piloting and expert review. Two samples from an American Red Cross-trained lay-responder population ( N = 4,979) provided data for an exploratory (EFA, n = 235) and confirmatory (CFA, n = 198) factor analyses. EFA derived interitem relationships into factors and affective subscales. CFA yielded statistical validation of factors and subscales.

RESULTS

The EFA identified four factors, aligned with the TPB constructs of attitudes, norms, confidence, and intention to act to explain 57% of interitem variance. The internal consistency of factor-derived subscales ranged between 0.71 and 0.91. Reduction of instrument items went from 47 to 32 (32%). The CFA yielded good model fit with the switching of the legal ramification item from the social norm to intention construct.

CONCLUSIONS

The Intent to Aid (I2A) survey derived from this investigation aligned with the constructs of the TPB yielding four subscales. The I2A allows health education researchers to differentiate modalities and content impact on learner intention to act in a first aid (FA) emergency. I2A compliments cognitive and psychomotor measurements of learning outcomes. The experimental instrument aims to allow curricula developers and program evaluators a means of assessing the affective domain of human learning regarding intention-to-act in an FA emergency. In combination of with assessment of functional knowledge and essential skills, this instrument may provide curricula developers and health educators an avenue to better describe intention to act in an FA emergency.

We make the case for the possible integration of affect experience induced via embodiment techniques with CBT for the treatment of emotional disorders in clinical settings. Theoretically we propose a possible integration of cognitive behavioural theory, neuroscience, embodied cognition and important processes of client change outcomes such as the therapeutic alliance to enhance client outcomes. We draw from evidence of bidirectional effects between embodiment modes of bottom-up (sensory-motor simulations giving rise to important basis of knowledge) and top-down (abstract mental representations of knowledge) processes such as CBT in psychotherapy. The paper first describes the dominance and success of CBT for the treatment of a wide range of clinical disorders. Some limitations of CBT, particularly for depression are also outlined. There is a growing body of evidence for the added value of experiential affect-focused interventions combined with CBT. Evidence for the embodied model of cognition and emotion is reviewed. Advantages of embodiment is highlighted as a complimentary process model to deepen the intensity and valence of affective experience. It is suggested that an integrated embodiment approach with CBT enhances outcomes across a wide range of emotional disorders. A description of our embodiment method integrated with CBT for inducing affective experience, emotional regulation, acceptance of unwanted emotions and emotional mastery is given. Finally, the paper highlights the importance of the therapeutic alliance as a critical component of the change process. The paper ends with a case study highlighting some clinical strategies that may aid the therapist to integrate embodiment techniques in CBT that can further explore in future research on affective experience in CBT for a wider range of clinical disorders.

The public health nurses' scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child's parent(s)/guardian(s) and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

The individual cellular level and quantitative Polyphosphate (PolyP)-metal compositions in EBPR (enhanced biological phosphorus removal) systems have hardly been investigated and its potential link to EBPR performance therefore remain largely unknown. In this study, we applied scanning electron microscopy combined with energy dispersive X-ray spectroscopy (SEM/EDX) method that enabled detection and semiquantification of metal elemental compositions in intact intracellular PolyP granules in individual PAO (polyphosphate accumulating organism) cells. We, for the first time, revealed diverse and dynamic distributions of different metals ions in the PolyP-metal granules in different EBPR systems operated with the same influent metal composition but varying SRT of 5-30 days. We further demonstrated that the PolyP-metal composition diversity correlated with 16S rRNA gene based PAO phylogenetic diversity, suggesting the possible phylogeny-dependent PolyP-metal composition variation. The impact of PolyP metal composition in EBPR system, especially the Mg content in PolyP granules, was evidenced by the significant and strong positive correlation between PolyP-Mg content and the long-term stability of the four EBPR systems with varying SRTs. The PolyP-Mg content can therefore possibly serve as an indicator for EBPR performance monitoring. The results demonstrated that phenotyping techniques, such as PolyP-metal-based profiling, in compliment, or combined with genotyping techniques such as phylogenetic and functional gene sequencing, can provide more insights into the mechanisms and performance prediction of this important microbial ecosystem.

All healthcare providers working in an acute setting need to be empowered to provide an optimal patient experience with quality outcomes. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a national standardized survey instrument designed to assess the patient's perspective of hospital care for public reporting purposes. These results are posted on the Center for Medicare and Medicaid Services (CMS) website for consumers to access comparison data related to a hospital's performance, create new incentives for hospitals to improve quality outcomes and enhance accountability through transparency (1). HCAHPS has 10 measures that evaluate the patient's recent hospital experience. Six of these are summary measures. One key measure, "communication with nurses," can directly affect both the patient satisfaction and patient safety scores (2). Patients tend to rate this domain based on the caregivers, and this rating can have a financial impact upon the institution. The skills and art associated with service are neither innate nor automatic. Communication skills are acquired and refined only through practice. The Magnet recognition program was developed to recognize health care organizations that provide nursing excellence and a vehicle for disseminating successful nursing practices and strategies (3). To assist the nurse in the patient's perception to care, a Patient Navigator program was developed to provide patients with the best possible hospital experience. The Patient Navigator program compliments the direct patient care that is provided on the patient care unit. HCAHPS is a national standardized survey instrument designed to assess the patients' perspective of hospital care for public reporting purposes. There are a total of 27 survey items that are divided into six composite measures, two individual items and two global ratings. The six summary measures and two global ratings are listed below.

Gushudan (GSD), a traditional Chinese medicine with a history of more than 15 years, has been shown to have anti-osteoporosis effects, but the specific therapeutic mechanism behind it is still unclear. To further elucidate the pathogenesis of osteoporosis and the preventive mechanism of GSD on glucocorticoid-induced osteoporosis (GIOP) rats, a rapid and comprehensive ¹H NMR metabolomics method was established to detect urinary metabolic profiles in the control group, model group and GSD treatment group in this study. The orthogonal partial least squares discriminant analysis (OPLS-DA) was performed to investigate changes in the metabolites, and related metabolic pathways were discovered using MetaboAnalyst platform. As a result, a total of 27 differential metabolites were identified. Of these, 17 metabolites such as formate, allantoin and l-threonate were newly discovered as GIOP potential biomarkers. Energy metabolism, intestinal flora metabolism, amino acid metabolism and oxidative stress response were significantly changed in the urinary profiles of GIOP rats, and GSD could play an anti-osteoporosis role by regulating these metabolic pathways. This study compliments the earlier LC-MS based urine metabolomics research, and helps further understand the pathogenesis of osteoporosis and the potential preventive effects of GSD on GIOP rats.

Keywords: (1)H NMR; GSD; Metabolomics; Osteoporosis.

This review focuses on the radiology of mesenteric ischaemia. Covering the acute and chronic presentations, both of which result from impaired vascularisation of the gastrointestinal tract, we evaluate the role of radiographs, ultrasound, CT, MRI, and catheter angiography in the diagnosis of these conditions. Looking to the future, we also assess some of the emerging imaging techniques. Across medicine and surgery there has been a significant shift towards minimally invasive interventions. Although percutaneous revascularisation of chronic mesenteric ischaemia has been performed for some time, there has been a developing trend for the use of such techniques in acute mesenteric ischaemia. We evaluate the available evidence for the use of these percutaneous interventions and assess how they compare with or in some instances compliment traditional surgical alternatives.

Ventilation management is an ever growing and changing the environment in which medical professionals, through positive patient outcomes can determine the best approach to patient care. This article will be focused specifically on pressure support ventilation and its role in assisting the spontaneous breathing patient population. Evidence-based practice will also be referenced regarding the pressure support mode and its role in liberating patients from mechanical ventilation. Pressure support breathing is a mode of ventilation that is made up of patient-triggered, pressure-limited, flow-cycled breaths. Each patient breath is supplemented with a set amount of positive pressure. Low levels of pressure support less than 5 cm H2O are often utilized to decrease resistance by overcoming ventilator accessory dead space such as the circuitry and its components. Higher levels of pressure support are introduced to alleviate work of breathing by introducing positive pressure to compliment the patient’s spontaneous effort. If pressure support levels of 10 to 12 mL/kg are utilized, all of the work of breathing is being assumed by the ventilator. It is valuable to note that the patient has consistent control over breath frequency, breath duration and flow while in a pressure support ventilation environment. The volume of each breath is a direct result of set pressures, patient effort, and potentially other mechanical settings that may oppose ventilation.

OBJECTIVE

The purpose of this study was to describe the process and evaluate the effect of positive group psychotherapy and motivational interviewing as an intervention for smoking cessation.

METHODS

A qualitative descriptive study was conducted at a university in South Korea. Positive group psychotherapy and motivational interviewing were attended by 36 smokers for 1 hour once a week, for 6 hours. A recorded exit interview was conducted after the intervention. The resulting transcripts were analyzed with content analysis and thematic analysis.

RESULTS

Among the 36 study participants, the importance of stopping smoking was rated higher in the successful cessation (defined as those who ceased smoking for at least 3 months; hereafter, success group) group (8.6 ± 0.4, n = 10) than in the failed cessation (defined as those who did not cease smoking for at least 3 months; hereafter, failure group) group (7.75 ± 0.3, n = 26; p < .01). The confidence to stop smoking was rated higher by the successes (8.4 ± 0.3) than by the failures (5.5 ± 0.4; p < .01). More successes wanted to stop smoking for the sake of their loved ones (60%) and health (50%), whereas more failures wanted to stop smoking for saving money (45.5%). Failures had more cross-addiction than successes (three to four addictions: 31.5% vs. 20%). When participants were asked to find 10 personality merits, 78% of the successes and 47% of the failures found their 10 merits. The therapeutic process was described as "sharing the smoking cessation process with others," "detailed guidance for stress management and smoking cessation," and "compliments about efforts for smoking cessation."

CONCLUSIONS

The importance of and confidence in smoking cessation were predictors for successful cessation for 3-6 months. Motivational interviewing increased motivations, whereas positive group psychotherapy increased positive thoughts and confidence.

Five studies show that being the target of a positive stereotype is a negative interpersonal experience for those from individualistic cultures because positive stereotypes interfere with their desire to be seen as individuals separate from their groups. U.S.-born Asian Americans and women who heard a positive stereotype about their group in an intergroup interaction (e.g., "Asians are good at math," "women are nurturing") derogated their partner and experienced greater negative emotions than those who heard no stereotype. Negative reactions were mediated by a sense of being depersonalized, or "lumped together" with others in one's group, by the positive stereotype (Studies 1-3). Cross-cultural differences (Study 4) and an experimental manipulation of cultural self-construal (Study 5) demonstrated that those with an independent self-construal reacted more negatively to positive stereotypes than those with an interdependent self-construal. By bringing together research on stereotypes from the target's perspective with research on culture, this work demonstrates how cultural self-construals inform the way people interpret and respond to being the target of positive stereotypes.

METHODS

Case-control analysis of transcranial motor evoked potential (MEP) responses and clinical outcome.

OBJECTIVE

To determine the sensitivity and specificity of MEPs to predict isolated nerve root injury causing dorsiflexion weakness in selected patients having complex lumbar spine surgery.

BACKGROUND

The surgical correction of distal lumbar spine deformity involves significant risk for damage to neural structures that control muscles of ankle and toe dorsiflexion. Procedures often include vertebral translation, interbody fusion, and posterior-based osteotomies. The benefit of using MEP monitoring to predict dorsiflexion weakness has not been well-established. The purpose of this paper is to describe the relationship between neural complications from lumbar surgery and intraoperative MEP changes.

METHODS

Included were 542 neurologically intact patients who underwent posterior spinal fusion for the correction of distal lumbar deformity. Two myotomes, including tibialis anterior (TA) and extensor hallucis longus (EHL), were monitored. MEP and free-running electromyography data were assessed in each patient. Cases of new dorsiflexion weakness noted postoperatively were identified. Data in case and control patients were compared. There was no direct funding for this work. The Department of Anesthesiology and Perioperative Care provides salary support for authors one and six. Authors two and three report employment in the field of intraoperative neurophysiological monitoring as a study-specific conflict of interest.

RESULTS

Twenty-five patients (cases) developed dorsiflexion weakness. MEP amplitude decreased in the injured myotomes by an average of 65 ± 21% (TA) and 60±26% (EHL), which was significantly greater than the contralateral uninjured side or for control subjects. (p < .01) Receiver operator characteristic (ROC) curves showed high sensitivity, specificity, and predictive value for changes in MEP amplitude using either the TA or EHL. Analysis of MEP changes to either TA or EHL yielded a superior ROC curve. Net reclassification improvement analysis showed assessing MEP changes to both TA and EHL improved the predictability of injury.

CONCLUSIONS

The use of MEP amplitude change is highly sensitive and specific to predict a new postoperative dorsiflexion injury. Monitoring two myotomes (both TA and EHL) is superior to relying on MEP changes from a single myotome. Electromyography activity was less accurate but compliments MEP use. Additional studies are needed to define optimal intraoperative MEP warning thresholds.

Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15-49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07-0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05-0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it's mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.

Musculoskeletal injuries are prevalent in professional soccer and can result in lost training time or match play. It is intuitive that the "return to play" (RTP) pathway will depend, in large part, on the expertise of sports medicine practitioners (e.g., surgeons, physicians, physiotherapists) responsible for player's recovery. Consensus statements on returning athletes to sport following injury acknowledge the contributions of sport psychology and sports nutrition. However, specific consideration on how to integrate these two recognized - but often overlooked components of injury rehabilitation - into existing sport medicine approaches has yet to be examined. Using a framework of milestones directed by the medical physician and physical trainer, evidence is summarised and suggestions provided on the integration of sports psychology and sports nutrition into an interdisciplinary RTP approach. We examine recovery from a phase approach (acute injury and functional recovery) to highlight interdisciplinary opportunities in the management of musculoskeletal soccer injuries. An interdisciplinary approach is understood to achieve outcomes that could not be achieved within the framework of a single discipline. The incorporation of sports psychology and nutrition theoretically compliment milestones used in current medically-based RTP models. Our hope is that this article serves as a catalyst for interdisciplinary practice and research - not only in sports nutrition and sports psychology - but across all sport and exercise disciplines.

Keywords: Injury; exercise; medicine; muscle; nutrition; psychology.

Genetic variations in complement factor H (CFH) confer greater risk for age-related macular degeneration (AMD). In this issue of Immunity, Calippe et al. (2017) uncover a non-canonical role for CFH in the inhibition of mononuclear phagocyte elimination from sub-retinal lesions, providing insight into the pathophysiology of AMD associated with CFH variants.

Diabetes is a chronic metabolic disorder that results in distorted insulin signaling and microvascular complications. Current antidiabetic drugs possess harmful long term side effects, necessitating the need for alternate or compliment therapy with lesser issues. Medicinal plants such as ginger have been reported to possess several beneficial activities including antidiabetic activity. The antidiabetic efficacy of microwave-assisted polyphenolic extracts of Indian ginger cultivars from Odisha (MPO) and Tamil Nadu (MPT) is reported here. MPT and MPO showed insulin stimulated glucose uptake of 1.74 ± 0.25 and 1.47 ± 0.15 fold at 6.25 µg/ml of concentrations in C2C12 cells respectively when compared to control. MPT possessed α-amylase, α-glucosidase inhibitory and anti-glycation properties. It also showed DPPH radical scavenging activity (7.69 ± 0.001%), inhibited LPS-induced nitric oxide production (1.06 ± 0.004 fold) than the latter and increased the GLUT4 protein expression by 1.4 fold. Major active compounds such as shogaol and gingerol derivatives, curcumene, zingiberone were identified through GC-ESI/MS analysis and D-pinitol (cyclitol) was identified through HPLC analysis in this variety. This is the first paper to report the presence of an antidiabetic compound, D-pinitol, in the ginger variety. Polyphenol rich, biologically potent ginger extracts can be a good food and nutraceutical supplement to address diabetes and related complications. PRACTICAL APPLICATIONS: Ginger is a native spice of South Asian Countries including India. Ginger extracts possess several medicinal properties such as anti-inflammatory, antidiabetic and antioxidant activities. It is used to treat nausea, vomiting and commonly used as a food flavouring agent and dietary food supplement. Our study shows the antidiabetic, anti-glycation and antioxidant efficacy of polyphenol rich Indian ginger cultivars grown in different geographical regions. Variations in the biological activities between the MPT and MPO ginger variety was observed. Different environmental conditions and their corresponding metabolite accumulation can be correlated with the better activity shown by MPT variety. It showed an increased GLUT4 expression even at a lower dose of 6.25 µg/ml. Ginger cultivar, especially MPT variety can be used as an adjuvant therapy for treating diabetes. Therefore, our study indicates that polyphenols rich ginger cultivar has major application in functional food product development.

Keywords: GC-MS; GLUT 4; HPLC; active compounds; antioxidant; diabetes; ginger.

Tract-based spatial statistics (TBSS) of diffusion tensor imaging (DTI) studies have consistently shown diminished white matter (WM) integrity for individuals with cocaine use disorder (CUD). The present study used seed-based d mapping (SDM) to determine the extent to which a systematic difference in the WM integrity of cocaine users may exist (as compared with that of healthy controls). Articles from 2006 (when TBSS was first developed) to present were reviewed, with eight selected for inclusion. Meta-analysis found lower fractional anisotropy (FA) in the genu of the corpus callosum for cocaine users, with a small-to-moderate peak effect size (Hedge's g = -0.331). Sensitivity analyses mostly supported the robustness of the obtained difference. Differences detected at exploratory thresholds for significance suggested insult to WM integrity extending beyond the corpus callosum. The present results compliment a previous region-of-interest (ROI)-based meta-analysis of DTI studies in individuals with CUD. These findings have significant implications for the potential role of neuroprotective agents in the treatment of CUD and merit additional iteration as more studies accrue in the literature.

BACKGROUND

Subarachnoid hemorrhage (SAH) is fatal and detrimental to quality of life. Clinically, options for monitoring are often limited, potentially missing subtle neurological changes especially in low-grade patients. This article reviewed miRNA dysregulation in SAH and analyzed their functional and clinical relevance.

METHODS

With adherence to PRISMA guideline, PubMed, EMBASE, GEO and ArrayExpress were searched comprehensively for relevant clinical and animal models. Datasets were analyzed and enriched by experimentally validated targets and multiple databases using R v3.4.2, Ingenuity Pathway Analysis, and miRPath v3.0.

RESULTS

Among 1926 search results, 18 studies were screened for full-text assessment. The 8 included studies revealed a marked miRNA dysregulation after SAH. 2 datasets were retrieved. In both serum and CSF, different miRNA profiles were associated with Early Brain Injury, Delayed Cerebral Infarction, vasospasm and prognosis. In CSF, a dramatic restructure of inter-miRNA correlation matrix was observed. Enrichment analysis revealed strong association (1) BBB instability, with adherens, extra-cellular matrix, actin cytoskeleton, integrin, TGF-β, Wnt/β-catenin etc; (2) autophagy, with MTORC1, HIF-1, ULK2, and FoxO etc; (3) apoptosis, with PI3K-Akt, p53, and AMPK. We analyzed common miRNAs across SAH and cerebral ischemia. They were related to neuronal differentiation, oxidation stress, apoptosis, angiogenesis, Alzheimer's disease, NMDA-induced calcium influx, excitotoxicity and NO production.

CONCLUSIONS

Clinical progression of SAH is associated with different miRNA fingerprints. They carry neuro-pathological relevance and can be a potential biomarker which compliments SAH management.

A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological viewpoint but not more inclined to anger than the average Dutch male. They report less anxiety in situations in which criticism can be given but more anxiety in situations in which someone can be given a compliment. When comparing domestically violent patients with generally violent patients, domestically violent patients score lower on anger as disposition and on aggressive behavior than the generally violent patients do. However, both groups do not differ from each other in their score on the dimension of psychopathy.

Since its first report in the USA on 13 January 2020, the novel coronavirus (nCOVID-19) pandemic like in other previous epicentres in India, Brazil, China, Italy, Spain, UK, and France has until now hampered economic activities and financial markets. To offer one of the first empirical insights into the economic/financial effect of the COVID-19 pandemic, especially in the USA, this study utilized the daily frequency data for the period 25 February 2020-30 March 2020. By employing the empirical Markov switching regression approach and the compliments of cointegration techniques, the study establishes a two-state (stable and distressing) financial stress situation resulting from the effects of COVID-19 daily deaths, COVID-19 daily recovery, and the USA' economic policy uncertainty. From the result, it is assertive that daily recovery from COVID-19 eases financial stress, while the reported daily deaths from COVID-19 further hamper financial stress in the country. Moreover, the uncertainty of the USA' economic policy has also cost the Americans more financial stress and other socio-economic challenges. While the cure for COVID-19 remains elusive, as a policy instrument, the USA and similar countries with high severity of COVID-19 causalities may intensify and sustain the concerted efforts targeted at attaining a landmark recovery rate.

Keywords: COVID-19 pandemic; Daily deaths; Daily recoveries; Economic uncertainty; Financial stress; USA.

Diseases of the genitourinary system are the leading cause of hospital deaths in El Salvador, and chronic kidney disease of unknown origin has been gaining attention as a public health problem among farmers in particular. Epidemiological studies point, in part, to environmental risk factors, which have shifted over time with the deployment of modern agricultural science and ongoing climate change. We examined how diseases of the genitourinary system were situated at several margins of an epidemic in one rural Salvadoran municipality where these environmental and epidemiological changes are occurring, albeit relatively slow. By using this approach to study diseases of the genitourinary system, we illustrate one way in which shifting human/environment entanglements can be experimentally "known" in the context of human diseases associated with them. Our approach offers a unique perspective in thinking with ethnographic data to compliment ongoing epidemiological investigations of kidney disease in El Salvador.

Keywords: El Salvador; agrichemicals; entanglements; genitourinary system; modern agricultural science.