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Endocannabinoids and their attending cannabinoid type 1 (CB 1 ) receptor have been implicated in animal models of post-traumatic stress disorder (PTSD). However, their specific role has not been studied in people with PTSD. Herein, we present an in vivo imaging study using positron emission tomography (PET) and the CB 1 -selective radioligand [ 11 C]OMAR in individuals with PTSD, and healthy controls with lifetime histories of trauma (trauma-exposed controls (TC)) and those without such histories (healthy controls (HC)). Untreated individuals with PTSD ( N =25) with non-combat trauma histories, and TC ( N =12) and HC ( N =23) participated in a magnetic resonance imaging scan and a resting PET scan with the CB 1 receptor antagonist radiotracer [ 11 C]OMAR, which measures the volume of distribution ( V T ) linearly related to CB 1 receptor availability. Peripheral levels of anandamide, 2-arachidonoylglycerol, oleoylethanolamide, palmitoylethanolamide and cortisol were also assessed. In the PTSD group, relative to the HC and TC groups, we found elevated brain-wide [ 11 C]OMAR V T values (F(2,53)=7.96, P =0.001; 19.5% and 14.5% higher, respectively), which were most pronounced in women (F(1,53)=5.52, P =0.023). Anandamide concentrations were reduced in the PTSD relative to the TC (53.1% lower) and HC (58.2% lower) groups. Cortisol levels were lower in the PTSD and TC groups relative to the HC group. Three biomarkers examined collectively—OMAR V T , anandamide and cortisol—correctly classified nearly 85% of PTSD cases. These results suggest that abnormal CB 1 receptor-mediated anandamide signaling is implicated in the etiology of PTSD, and provide a promising neurobiological model to develop novel, evidence-based pharmacotherapies for this disorder.

Based on epidemiological, clinical and experimental evidence, male circumcision (MC) could have a significant impact on the HIV epidemic in selected areas. We reviewed studies of the acceptability of MC in sub-Saharan Africa to assess factors that will influence uptake of circumcision in traditionally non-circumcising populations. Thirteen studies from nine countries were identified. Across studies, the median proportion of uncircumcised men willing to become circumcised was 65% (range 29-87%). Sixty nine percent (47-79%) of women favored circumcision for their partners, and 71% (50-90%) of men and 81% (70-90%) of women were willing to circumcise their sons. Because the level of acceptability across the nine countries was quite consistent, additional acceptability studies that pose hypothetical questions to participants are unnecessary. We recommend pilot interventions making safe circumcision services available in conjunction with current HIV prevention strategies and evaluating the safety and acceptability of circumcision.

OBJECTIVES: Globally approximately 25% of men are circumcised for religious, cultural, medical, or parental choice reasons. However, controversy surrounds the procedure, and its benefits and risks to health. We review current knowledge of the health benefits and risks associated with male circumcision. METHODS: We have used, where available, previously conducted reviews of the relation between male circumcision and specific outcomes as \"benchmarks\", and updated them by searching the Medline database for more recent information. RESULTS: There is substantial evidence that circumcision protects males from HIV infection, penile carcinoma, urinary tract infections, and ulcerative sexually transmitted diseases. We could find little scientific evidence of adverse effects on sexual, psychological, or emotional health. Surgical risks associated with circumcision, particularly bleeding, penile injury, and local infection, as well as the consequences of the pain experienced with neonatal circumcision, are valid concerns that require appropriate responses. CONCLUSION: Further analyses of the utility and cost effectiveness of male circumcision as a preventive health measure should, in the light of this information, be research and policy priorities. A decision as to whether to recommend male circumcision in a given society should be based upon an assessment of the risk for and occurrence of the diseases which are associated with the presence of the foreskin, versus the risk of the complications of the procedure. In order for individuals and their families to make an informed decision, they should be provided with the best available evidence regarding the known benefits and risks.

Background:In certain parts of Africa, type-specific herpes simplex virus type 2 (HSV-2) ELISAs may have limited specificity. To date, no study has been conducted to validate HerpeSelect and Kalon type-specific HSV-2 ELISAs using both the Western blot and recombinant gG ELISA inhibition testing as reference standards.Methods:A total of 120 men who were HIV seronegative (aged 18–24 years) provided blood samples. HSV-2 IgG serum antibodies were detected using four different methods: HerpeSelect HSV-2 ELISA (n = 120), Kalon HSV-2 ELISA (n = 120), University of Washington Western blot (n = 101) and a recombinant inhibition test (n = 93).Results:HSV-2 seroprevalence differed significantly by HSV-2 detection method, ranging from 24.8% with the Western blot to 69.8% with the HerpeSelect ELISA. Using the Western blot as the reference standard, the HerpesSelect had the highest sensitivity for HSV-2 antibody detection (100%) yet lowest specificity (40%). Similar results were obtained using the inhibition test as the reference standard. The sensitivity and specificity of the Kalon test versus the Western blot were 92% and 79%, respectively, and 80% and 82% versus the inhibition test. Using the inhibition test as the reference standard, the sensitivity of the Western blot appeared low (49%).Conclusions:In men in western Kenya who were HIV seronegative, the HerpeSelect and Kalon type-specific ELISAs had high sensitivities yet limited specificities using the Western blot as reference standard. Overall, the Kalon ELISA performed better than the HerpeSelect ELISA in these young men from Kisumu. Further understanding is needed for the interpretation of HSV-2 inhibition or ELISA test positive/ Western blot seronegative results. Before HSV-2 seropositivity may be reliably reported in selected areas of Africa, performance studies of HSV-2 serological assays in individual geographical areas are recommended.

Halperin and Bailey argue that the epidemiological and biological evidence that links lack of circumcision with HIV transmission has become compelling. It is time to add male circumcision to the current limited AIDS prevention strategies.

Objective—To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma. Methods—A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125 000 new patients/year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional. Results—Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis. Conclusion—This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice.

One hypothesis for the decline of the North American greater ( Aythya marila ) and lesser ( A. affinis ) scaup population is that contaminant burdens acquired on wintering or staging areas impair reproduction or cause lethal or sublethal health effects. Recent studies have found increased selenium (Se) concentrations in scaup but have focused on the fall and spring staging periods. From January to March 2006 and December to March 2006 and 2007, we analyzed liver tissues collected from greater scaup wintering in western Lake Ontario for 16 trace elements. We also measured Se concentrations in greater scaup blood and Dreissenid mussel tissue. Se was the only trace element that occurred at increased concentrations (>10 μg/g liver dry weight) in a substantial proportion (99%) of greater scaup livers. We also found that hepatic Se concentrations increased throughout winter and were increased in nearly all birds from January to March, suggesting that accumulation of this trace element occurred soon after their arrival in fall. Se concentrations were similar in male and female birds, but juvenile birds had higher concentrations than did adults. Blood Se concentrations were correlated to liver Se concentrations in 2006 only, suggesting that blood Se concentration is an unreliable predictor of liver concentration. Se in Dreissenid mussels generally decreased with mussel size and did not change throughout winter. Overall, our results suggest that greater scaup wintering on western Lake Ontario acquire sufficiently high Se concentrations to potentially impact their health. Thus, several indicators of health and survival should be examined in relation to Se concentrations in wintering scaup.

Community-led total sanitation (CLTS) is an intervention that strives to end the practice of open defaecation. This study measured the effectiveness of CLTS in Nyando District by examining the association between community open defaecation-free (ODF) status and childhood diarrhoeal illness. A cross-sectional study design was used among households with children ⩽5 years old to ascertain information on acute diarrhoea in the past year (outcome), sanitation and health behaviours. Water testing was conducted to determine Escherichia coli and turbidity levels for 55 water sources. Data were obtained from 210 parents or caregivers from an ODF community and 216 parents or caregivers in a non-ODF community. The non-ODF participants reported a non-significant 16% increased risk of diarrhoea compared with the participants from the ODF community. Children's HIV positivity (adjusted prevalence ratio (aPR) = 2.29; 95% CI 2.07–2.53), unsafe child stool disposal (aPR = 1.92; 95% CI 1.74–2.12) and low household income (aPR = 1.93; 95% CI 1.46–2.56) were associated with diarrhoea, in the non-ODF community. The ODF location had a higher percentage of E. coli in the drinking water compared with the non-ODF location (76.7% vs. 60%). Diarrhoeal disease rates in children ⩽5 years old did not differ by whether a latrine intervention was implemented. Water sampling findings suggest water safety may have decreased the effectiveness of the CLTS’ improvement of childhood diarrhoea. Improved water treatment practices, safe stool disposal and education may improve the CLTS intervention in ODF communities and therefore reduced the risk of childhood diarrhoea.

Whether modern tectonic processes differ substantially from those in Archaean times (>2,500 Myr ago) remains controversial. One view 1 is that Archaean tectonic processes were some combination of modern ones, occurring faster or more shallowly because of the larger heat output of the early Earth, but others 2 have proposed that significantly different processes operated. Here I argue that gravitational spreading of Archaean continents would have caused them continuously and pervasively to ‘overflow’ onto adjacent ocean basins, and that this process would have naturally ceased at the end of the Archaean era. Because modern continental crust is believed to be ductile rather than brittle below a depth corresponding to a temperature of about 350–400 °C ( ref. 3 ), it seems likely that such a ductile zone was universally present within the hotter Archaean continental crust. If the mean geothermal gradient of the continents had exceeded ∼25–30 °C km −1 , then the resulting ductile zone would have caused continental overflow to occur, and such a process can account for many of the distinctive peculiarities observed in the Archaean geological record. The cessation of continental overflow corresponds naturally to the stabilizing ‘cratonization’ which marked the end of the Archaean era, with its timing dependent on the evolution of both the geothermal gradient in the continents and the depth of the ocean basins.

Objectives:To identify factors associated with herpes simplex virus type 2 (HSV-2) infection among men aged 18–24 in Kisumu, Kenya.Methods:Baseline data from a randomised trial of male circumcision were analysed. Participants were interviewed for sociodemographic and behavioural risks. The outcome was HSV-2 by antibody status. Risk factors were considered singly and in combination through logistic regression models.Results:Among 2771 uncircumcised men, 766 (27.6%; 95% confidence interval (CI) 26.0% to 29.3%) tested antibody positive for HSV-2. The median age at first sex was 16 years, and the median number of lifetime sexual partners was four. HSV-2 seroprevalence increased from 19% among 18-year-olds to 43% among 24-year-olds (p<0.001). In multivariable analysis, statistically significant risks for infection were increasing age (adjusted odds ratio (AOR) = 1.22–2.58), being married or having a live-in female partner (AOR = 1.80; 95% CI 1.28 to 2.53), preferring “dry” sex (AOR = 1.39; 95% CI 1.14 to 1.69), reported penile cuts or abrasions during sex (AOR = 1.58; 95% CI 1.32 to 1.91), increasing lifetime sex partners (multiple response categories; AORs ranging from 1.65 to 1.97), and non-student occupation (multiple response categories; AORs ranging from 1.44 to 1.93). Risk decreased with reported condom used at last sex (AOR = 0.82; 95% CI 0.68 to 0.99).Conclusion:Primary prevention efforts should be initiated at an early age. The same behavioural interventions used currently for HIV prevention—abstinence, reducing the number of sex partners and increasing condom use—should be effective for HSV-2 prevention.