Hagley Museum and Library

Abstract Tea polyphenols exhibited potent biological activity and were increasingly recognized as potential prebiotics. While their inhibitory effects on certain oral pathogens were well-documented, their impact on oral commensal bacteria remained unclear. This study investigated the effects of tea-derived bioactives on the composition of oral bacterial communities, with quantitative polymerase chain reaction (qPCR) utilized to assess changes in pathogenic and commensal bacteria. Epigallocatechin gallate (EGCG), green tea extract, and theaflavins were found to exert inhibitory effects on key oral pathogens, including Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia. Concurrently, these polyphenols promoted the growth of beneficial oral commensal bacteria, such as Lactobacillus gasseri and Lactobacillus rhamnosus. At sub-inhibitory concentrations, tea polyphenols significantly suppressed the expression of virulence factors in P. gingivalis, suggesting that low concentrations were sufficient to mitigate pathogenicity without disrupting microbial homeostasis. Furthermore, tea polyphenols reduced oral VSCs by downregulating hydrogen sulfide/methyl mercaptan synthase genes. Hence, their dual capacity to inhibit pathogens and support commensal bacteria could make them promising candidates for oral health products.

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Objective Suicide accounts for substantial mortality in low-resourced settings and contributes to nearly 20% of maternal deaths. In Asia, interpersonal conflict is a salient factor that contributes to suicidal thoughts and actions, yet limited research has been done to explore the type and timing of such conflicts and a woman’s accompanying social support. Identifying such risk factors can inform improved efforts to identify who to target for psychosocial interventions. Methods Using the Bachpan Cohort study of mothers in Pakistan (n = 1154), we examined the prevalence and interpersonal influences on SI within the past two weeks of pregnancy and then at 3, 6, and 24 months after birth. Using hierarchical mixed effects models, we explored the separate and combined associations of interpersonal factors [e.g., social support, interpersonal conflict, isolation, and past year intimate partner violence (IPV)] on SI at each timepoint. Results SI prevalence was highest in pregnancy (12.2%) and dropped to 5% throughout two years postpartum. The interpersonal conflict was independently associated with increased odds of SI in pregnancy and 24 months postpartum. IPV was associated with increased SI in pregnancy and 24 months postpartum. Isolation was not associated with SI at any timepoint. Perceived social support remained a robust independent factor associated with reduced SI at all timepoints. Conclusion In addition to screening and deploying interventions for perinatal women with depression, targeting interventions for those who also experience interpersonal conflict, including intimate partner violence, may significantly reduce suicidal thoughts and related sequelae. Social support is a viable and potentially powerful target to reduce the burden of suicide among women. HIGHLIGHTS Suicidal ideation prevalence was higher in pregnancy compared to postpartum. Perceived social support was independently associated with reduced suicidal ideation. Interventions addressing suicide must attend to women’s family and social context.

Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure. Next, they realigned to support continuity of care. Then, clinics improved access by adding urgent care, patient portals, or extending hours. Most then improved planning and management of patient visits. Only a handful worked explicitly on improving access with same day slots, scheduling processes, and test result communication. The clinics' changes align with specific NCQA PCMH standards but also include adding physicians and services, culture changes, and improved communication with patients. NCQA PCMH level 3 recognition is only the beginning of a continuous improvement process to become patient centered. Full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy before changes to delivery of and access to care.

Turner syndrome, a congenital condition that affects ∼1/2,500 births, results from absence or structural alteration of the second sex chromosome. There has been substantial effort by numerous clinical and genetic research groups to delineate the clinical, pathophysiological, cytogenetic, and molecular features of this multisystem condition. Questions about the molecular-genetic and biological basis of many of the clinical features remain unanswered, and health care providers and families seek improved care for affected individuals. The inaugural "Turner Resource Network (TRN) Symposium" brought together individuals with Turner syndrome and their families, advocacy group leaders, clinicians, basic scientists, physician-scientists, trainees and other stakeholders with interest in the well-being of individuals and families living with the condition. The goal of this symposium was to establish a structure for a TRN that will be a patient-powered organization involving those living with Turner syndrome, their families, clinicians, and scientists. The TRN will identify basic and clinical questions that might be answered with registries, clinical trials, or through bench research to promote and advocate for best practices and improved care for individuals with Turner syndrome. The symposium concluded with the consensus that two rationales justify the creation of a TRN: inadequate attention has been paid to the health and psychosocial issues facing girls and women who live with Turner syndrome; investigations into the susceptibility to common disorders such as cardiovascular or autoimmune diseases caused by sex chromosome deficiencies will increase understanding of disease susceptibilities in the general population.

How can we reach out to institutions, artists and audiences with sometimes radically different agendas to encourage them to see, participate in and support the development of new practices and programs in the performing arts? In this paper, based on a plenary panel at PSi#18 Performance Culture Industry at the University of Leeds, Clarissa Ruiz (Columbia), AnuradhaKapur (India) and Sheena Wrigley (England) together with interloctorBree Hadley (Australia) speak about their work in as policy-makers, managers and producers in the performing arts in Europe, Asia and America over the past several decades. Acknowledged trailblazers in their fields, Ruiz, Kapur and Wrigley all have a commitment to creating a vital, viable and sustainable performing arts ecologies. Each has extensive experience in performance, politics, and the challenging process of managing histories, visions, stakeholders, and sometimes scarce resources to generate lasting benefits for the various communities have worked for, with and within. Their work, cultivating new initiatives, programs or policy has made them expert at brokering relationships in and in between private, public and political spheres to elevate the status of and support for performing arts as a socially and economically beneficial activity everyone can participate in. Each gives examples from their own practice to provide insight into how to negotiate the interests of artistic, government, corporate, community and education partners, and the interests of audiences, to create aesthetic, cultural and / or economic value. Together, their views offer a compelling set of perspectives on the changing meanings of the ‘value of the arts’ and the effects this has had for the artists that make and arts organisations that produce and present work in a range of different regional, national and cross-national contexts.

Background: Reduced time to administration of intravenous thrombolysis for acute ischemic stroke (AIS) is associated with improved functional outcomes. Less than one-third of AIS patients receive IV rt-PA with a door-to-needle (DTN) ≤ 60 minutes with only modest improvements reported over time. We investigated factors that may adversely prolong DTN time including reduced resident physician experience, low stroke severity on presentation, patient presentation time (day, evening, night) and day of week. Methods: A consecutive series of 258 patients with AIS received IV rt-PA at an academic comprehensive stroke center with a developed process for IV rt-PA administration and a neurology training program. Patient presentation times in the emergency department were divided into shifts defined as 07:00-14:59 (day), 15:00-22:59 (evening) and 23:00-06:59 (night). Neurology resident experience level was grouped as July-December (less experienced) vs. January-June (more experienced). Day of the week was grouped into weekday (Monday-Friday) and weekend (Saturday-Sunday). Variables associated with DTN time were assessed by t-test, ANOVA and by logistic regression. Results: The group had a mean age of 70.7±14.3 years, NIHSS score 13.3±6.8, DTN time 70.0±28.1 minutes, onset to ED arrival time 77.5±38.0 minutes. Patients presenting during evening and night hours had prolonged DTN times, day=65.5, evening=71.8 and night=78.3 minutes (p=0.05) by ANOVA. Patients arriving on weekends also had prolonged DTN times weekdays= 66.6 vs. weekends=77.2 minutes (p=.01). Increased time from onset to ED arrival was also associated with reduced DTN time (p<0.001). Age, gender, race, stroke severity on presentation, and resident experience level were not related to DTN time. Both presentation time by shift and day of week were predictive of prolonged DTN time by multivariable analysis (p<0.01). Conclusions: Presentation time during the evening and night hours and weekends is associated with prolonged DTN times. Reduced staffing and support on nights and weekends may adversely affect DTN time.

In this article I examine how artists with disabilities use public-space performance to encourage passersby to reflect on the construction of public discourses about disability – and, therefore, th...

We should not ask ourselves ‘What is a lie?’ but rather ‘What does a lying do, and, first of all, what does it want?’. (Derrida 2002: 34) The Panel ‘Duplicity/Complicity: Performing and Misperformi...