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Introduction Treatment options for chronic obstructive pulmonary disease (COPD) are numerous but adherence remains a key challenge. We performed a discrete choice experiment (DCE) of patients’ preferences in accessing care for the management of COPD. The aim of this study was to understand patients’ preferences for modes of accessing care for the management of COPD. This piece of work was then used to inform resource allocation decisions in five integrated care systems (ICSs) in England.Methods People with diagnosed COPD in five ICSs were invited to complete an online survey from August to September 2022. An experimental design built on the principles of minimal overlap, level balance and orthogonality was used to create 20 sets of 11 scenarios for participants to assess. Participants were presented with three hypothetical options and asked to select their most preferred or state that none was preferred. Data were analysed using a hierarchal Bayes algorithm.Results Of 82 639 patients with COPD in the study area, 520 completed the survey. The mean health-related quality of life score derived using EuroQol 5-Dimensions 5-Level was 0.57 (0.29). The attributes assigned greatest importance were treatment outcomes, treatment delivery and the type of staff who deliver treatment. Mean utility level scores were substantially higher for little relief (22.75 (SD 78.80)) or some relief from symptoms (20.67 (46.77)) than for complete relief (‒43.42 (83.03)). Of the treatment delivery options, in-person individual appointments were preferred (mean utility score 48.34 (SD 48.14)), and care being provided by healthcare professionals was viewed as very important (77.50 (64.39)).Conclusions The DCE approach can help resource allocation decisions by indicating attributes most important to patients and trade-offs they are willing to make in treatment access and delivery.

Abstract Background Left ventricular hypertrophy (LVH) is a marker of increased risk in developing future life-threatening cardiovascular disease (CVD), however, it is unclear how CVD risk factors, such as obesity, blood pressure (BP), and tobacco use, are associated with left ventricular (LV) remodeling and LVH in urban African populations. Therefore, we aimed to identify the prevalence of LVH as well as the health factors associated with LV remodeling and LVH, within black South African adult women and their pre-pubescent children. Methods Black female adults (n = 123; age: 29–68 years) and their children (n = 64; age: 4–10; 55% female) were recruited from the Birth to Twenty Plus Cohort in Soweto, South Africa. Tobacco and alcohol use, physical activity, presence of diabetes mellitus, heart disease, and medication were self-reported. Height, weight, and blood pressure were measured in triplicate to determine the prevalence of obesity and hypertension respectively. Echocardiography was used to assess LV mass at end-diastole, based on linear measurements, and indexed to body surface area to determine LVH. Results Hypertension and obesity prevalences were 35.8% and 59.3% for adults and 45.3% and 6.3% for children. Self-reported tobacco use in adults was 22.8%. LVH prevalence was 35.8% in adults (75% eccentric: 25% concentric), and 6.3% in children. Concentric remodeling was observed in 15.4% of adults, however, concentric remodeling was only found in one child. In adults, obesity [OR: 2.54 (1.07–6.02; p = 0.02)] and hypertension [3.39 (1.08–10.62; p = 0.04)] significantly increased the odds of LVH, specifically eccentric LVH, while concentric LVH was associated with self-reported tobacco use [OR: 4.58 (1.18–17.73; p = 0.03)]. Although no logistic regression was run within children, of the four children LVH, three had elevated blood pressure and the child with normal blood pressure was overweight. Conclusions The association between obesity, hypertension, tobacco use, and LVH in adults, and the 6% prevalence of LVH in children, calls for stronger public health efforts to control risk factors and monitor children who are at risk.

Objectives Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.Design Systematic review and narrative synthesis.Data sources Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022.Eligibility criteria Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread.Data extraction and synthesis Data were extracted and synthesised narratively, according to the methods of Campbell et al.Results Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.Conclusions The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.PROSPERO registration number CRD42022311689.

A changing climate will have demonstrable effects on health and healthcare systems, with specific and disproportionate effects on communities in Africa. Emergency care systems and providers have an opportunity to be at the forefront of efforts to combat the worst health effects from climate change. The 2020 African Conference on Emergency Medicine, under the auspices of the African Federation for Emergency Medicine, convened its first ever workshop on the topic of climate change and human health. Structured as a full day virtual course, the didactic sections were available for both live and asynchronous learning with more than 100 participants enrolled in the course. The workshop introduced the topic of the health effects of climate as they relate to emergency care in Africa and provided a forum to discuss ideas regarding the way forward. Lectures and focused discussions addressed three broad themes related to: health impacts, health care delivery, and advocacy. To our knowledge, this is the first workshop for health professionals to cover topics specific to emergency care, climate change, and health in Africa. The results of this workshop will help to guide future efforts aimed at advancing emergency care approaches in Africa with regard to medical education, research, and policy. African relevance: • Climate-related extreme weather events are adversely affecting health and health care delivery in African countries. • African organisations, cities, and nations have taken positive steps to adapt and build climate resilience. • There are opportunities for emergency care professionals and scholars to continue to expand, and lead, climate and health education, research, and policy initiatives on the continent.

Objectives Cardiovascular disease is increasing in many low and middle-income countries, including those in Africa. To inform strategies for the prevention of cardiovascular disease in South Africa, we sought to determine the broad heritability of phenotypic markers of cardiovascular risk across three generations.Design A cross-sectional study conducted in a longitudinal family cohort.Setting Research unit within a tertiary hospital in a historically disadvantaged, large urban township of South Africa.Participants 195 individuals from 65 biological families with all three generations including third-generation children aged 4–10 years were recruited from the longest running intergenerational cohort study in Africa, the Birth to Twenty Plus cohort. All adults (grandparents and parents) were female while children were male or female.Primary and secondary outcome measures The primary outcome was heritability of blood pressure (BP; brachial and central pressures). Secondary outcomes were heritability of arterial stiffness (pulse wave velocity), carotid intima media thickness (cIMT) and left ventricular mass indexed to body surface area (LVMI).Results While no significant intergenerational relationships of BP or arterial stiffness were found, there were significant relationships in LVMI across all three generations (p

Knowledge of cotton fiber length uniformity is important for the cotton industry. The accurate and reliable measurement of fiber length uniformity would allow cotton breeders to release new cotton varieties with improved fiber length variation. This knowledge would also help spinning mills to optimize their machine setup, which would improve yarn processing performance. Currently, the high volume instrument (HVI) is most commonly used to characterize the cotton fiber length variation. The HVI length measurement is based on the fibrogram principle. The HVI length measurement characterizes 2 points, 1.8% as the upper half mean length (UHML) and 7.8% span length as the mean length (ML) from the fibrogram, and reports UHML and uniformity index (UI). The ratio of ML to the UHML is used to calculate the UI and is expressed as a percentage. UI measurement does not represent the shorter fibers as the above two span lengths only represent the longest fibers within a sample. We propose to calculate the uniformity of the cotton fiber length using the complete fibrogram as an alternative. First, the area of the measured fibrogram curve is calculated. Second, the area of a theoretical mono-length fibrogram with a length equal to the maximum length of the fibers for the same sample is calculated. Finally, we calculate a new length uniformity as the ratio of the measured fibrogram area to the mono-length fibrogram area expressed as a percentage. Based on the results obtained using a set of 991 commercial samples, the new length uniformity shows promise. We also applied this new length uniformity to a set of 60 commercial-like samples and developed partial least square regression (PLSR) prediction models to predict yarn quality. The results obtained demonstrate that the new length uniformity predicts yarn quality better than the current UI.

Abstract Background People living with the Human Immunodeficiency Virus (PLHIV) have an increased susceptibility to develop non-communicable diseases such as cardiovascular disease (CVD). Infection with HIV contributes to the development of CVD independent of traditional risk factors, with endothelial dysfunction being the central physiological mechanism. While HIV-related mortality is declining due to antiretroviral treatment (ART), the number of deaths due to CVD is rising in South Africa - the country with the highest number of PLHIV and the world’s largest ART programme. The EndoAfrica study was developed to determine whether HIV infection and ART are associated with cardiovascular risk markers and changes in vascular structure and function over 18 months in adults from different provinces of South Africa. This paper describes the rationale, methodology and baseline cohort profile of the EndoAfrica study conducted in the North West Province, South Africa. Methods In this case-control study, conducted between August 2017 and June 2018, 382 volunteers of African descent (276 women; 106 men), comprising of 278 HIV infected and 104 HIV free individuals were included. We measured health behaviours, a detailed cardiovascular profile, and performed biomarker analyses. We compared baseline characteristics, blood pressure, vascular function and biochemical markers between those infected and HIV free. Results At baseline, the HIV infected participants were older (43 vs 39 years), less were employed (21% vs 40%), less had a tertiary education (7% vs 16%) and their body mass index was lower (26 vs 29 kg/m2) than that of the HIV free participants. While the cardiovascular profile, flow-mediated dilation and pulse wave velocity did not differ, glycated haemoglobin was lower (p = 0.017) and total cholesterol, high density lipoprotein cholesterol, triglycerides, gamma-glutamyltransferase and tobacco use were higher (all p

Abstract Background In the UK, several initiatives have resulted in the creation of local data warehouses of electronic patient records. Originally developed for commissioning and direct patient care, they are potentially useful for research, but little is known about them outside their home area. We describe one such local warehouse, the Whole Systems Integrated Care (WSIC) database in NW London, and its potential for research as the “Discover” platform. We compare Discover with the Clinical Practice Research Datalink (CPRD), a popular UK research database also based on linked primary care records. Methods We describe the key features of the Discover database, including scope, architecture and governance; descriptive analyses compare the population demographics and chronic disease prevalences with those in CPRD. Results As of June 2019, Discover held records for a total of 2.3 million currently registered patients, or 95% of the NW London population; CPRD held records for over 11 million. The Discover population matches the overall age-sex distribution of the UK and CPRD but is more ethnically diverse. Most Discover chronic disease prevalences were comparable to the national rates. Unlike CPRD, Discover has identifiable care organisations and postcodes, allowing mapping and linkage to healthcare provider variables such as staffing, and includes contacts with social, community and mental health care. Discover also includes a consent-to-contact register of over 3000 volunteers to date for prospective studies. Conclusions Like CPRD, Discover has been a number of years in the making, is a valuable research tool, and can serve as a model for other areas developing similar data warehouses.

Background: Cross-talk between the macro-and microvasculature is considered an important contributor to target organ damage. Previous findings were predominantly in adult populations and investigation into this mechanism in children may provide insight into the development of early adverse vascular changes. Whether any ethnic differences in cross-talk is evident, also remains to be determined.Objective: To determine whether retinal microvascular diameters are associated with large artery stiffness in young children and whether ethnic differences are evident.Materials and Methods: In this cross-sectional study, 730 black (n = 437) and white (n = 293) school children aged 5-9 years were included. Pulse wave velocity (PWV) was measured and the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) diameters were calculated from fundus images. The arterio-venous ratio (AVR) was subsequently calculated.Results: Pulse wave velocity was lower (p ≤ 0.001) in the black group when compared to the white group. The black group had a narrower CRAE, wider CRVE and lower AVR (all p < 0.001). Pulse wave velocity associated negatively with CRAE (r = –0.141, p = 0.003) and AVR (r = –0.185, p ≤ 0.001) in the black group only. A positive association between PWV and CRVE was seen in the black (r = 0.174, p ≤ 0.001) and white (r = 0.119, p = 0.043) group.Conclusion: Large artery stiffness is associated with retinal arterial narrowing and venular widening in children, suggesting cross-talk between the macro-and microvasculature. Ethnic differences in these associations are also evident. Our findings warrant further investigation into environmental and sociocultural risk factors contributing to premature cardiovascular disease development.

We currently find ourselves living in precarious times, with old and new social inequities on the rise due to the challenges associated with an unprecedented rise of global migration and neoliberalism, amplified in our post COVID-19 world. Research has demonstrated that there is a high correlation between inequality at the societal level and the overall health and wellbeing of individuals within those societies. We believe that school health and physical education (HPE) has a significant role to play in addressing and acting on social inequities that impact on the wellbeing of both students and society as a whole. Based on the findings of an international research project called EDUHEALTH which explored pedagogies for social justice in school health and physical education (HPE) across Sweden, Norway and New Zealand, this paper aims to highlight the addressing of (in)equality and student wellbeing through HPE practice. In particular, the paper presents nine different but complementary pedagogies for social justice that we believe can improve individual, collective, and societal wellbeing. We conclude by proposing that, if adopted across a whole school curriculum, these nine pedagogies for social justice could form the basis of a holistic school-wide community approach aimed at improving both student and societal wellbeing.

Objective: Pulse pressure amplification (PPA) is described as the amplification of pulse pressure from central arteries to the periphery [1] and individuals with a decreased PPA have an increased risk of cardiovascular disease [2]. Adverse changes in PPA are evident in diabetic populations [3]; however, it is unclear whether PPA differs along varying degrees of glycaemia in young healthy populations. We therefore investigated whether PPA is attenuated with higher levels of glycemic markers and whether PPA is associated with glycemic markers independent of other known risk factors. Methods: We included 1195 men and women from the African-PREDICT study, aged 20–30 years, with no prior diagnosis of chronic disease. We determined supine central PP (cPP) using the SphygmoCor XCEL device and PPA was defined as the ratio of the amplitude of the PP between the distal and proximal locations (bPP/cPP). Fasting glucose and glycated haemoglobin were determined and the study population was stratified by tertiles of each glycemic marker. Results: The mean PPA was lower in the highest tertile of fasting glucose when compared to the lowest tertile (1.11 vs. 1.23; p ≤ 0.001). PPA declined with increasing levels of fasting glucose (p–trend ≤ 0.001) after adjustment for age, sex, ethnicity, height, heart rate and mean arterial pressure. In multivariable adjusted regression, we found an independent inverse association between PPA and fasting glucose (β = −0.15, p ≤ 0.001). Conclusion: PPA decreases with an increase in fasting glucose in adults younger than 30 years, exemplifying early vascular changes which may increase future cardiovascular risk. FigurePulse pressure amplification plotted against tertiles of fasting glucose. Values are adjusted for age, sex, heart rate, height and mean arterial pressure. *indicates p-value < 0.05 between the lowest and highest glucose group. Adjusted R2 Pulse pressure amplification 0.15 β (SE) p Age (years) –0.17 (0.03)

Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children.Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ~1,000 primary school children (black and white boys and girls between ages 5–9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging.Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs.Trial registration: The study was retrospectively registered on ClinicalTrials.gov on 15 August 2019 (NCT04056377).

Cotton fiber length is an essential parameter for the cotton industry and cotton research. However, differences between industry- and laboratory-scale ginning may lead to inconsistencies between research and industry results for measured length. Seedcotton from farms is processed in large industry-scale gins, while researchers typically use small laboratory-scale gins. The proposed method successfully reduces the differences in fiber length parameters between these two types of ginning. Only one new step is needed before assessing fiber quality in lint from a laboratory-scale gin to simulate the processing effect of an industry-scale gin. • Cotton seeds and lint are separated from seedcotton with a laboratory-scale gin. • Lint is post-processed with a laboratory-scale lint cleaner, the micro dust and trash analyzer 3. • The length fiber quality profile resembles the results of industry-scale ginned samples.

Abstract Background The Health of the Nation Outcomes Scale (HoNOS) is recommended for use by the English National Service Framework for Mental Health and by the working group on outcome indicators for severe mental illnesses to the Department of Health. It was developed to measure the health and social functioning of people with severe mental illness. Since the development of the HoNOS many have debated its latent structure. This paper examines the latent structure of the HoNOS using current factor analysis techniques. Method HoNOS data for 12,910 patients with ICD10 diagnoses F20 to F29 at a UK National Health Service Mental Health Trust were analysed using exploratory, confirmatory and bifactor analysis for categorical data. The fit of models was assessed using relative and absolute fit indices. Results Exploratory followed by confirmatory factor analysis identified a four factor solution which fit the data better than existing models. The corresponding bifactor factor solution identified three robust factors and one weak factor after accounting for a general factor. The factor loadings on the general factor were not appreciably different when compared to a unidimensional factor solution indicating the existence of a common trait. Conclusion Existing models proposed in the literature did not fit well in our data. Factor analysis identified a new four factor solution. These factors showed clinical relevance according to published literature. The bifactor model demonstrated that there is not much loss of information when the HoNOS is used as a unidimensional construct. Further studies should explore this structure in larger samples and in alternative sample populations. A bifactor approach may have implications for how the HoNOS is used in practice, since there is ongoing debate on whether HoNOS item scores should be aggregated for interpretation.

Introduction: Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. Methods: A retrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 patient care records were included (n = 530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5 mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4 mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). Discussion: Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.

During the past decade, the ability of surface-enhanced Raman spectroscopy (SERS) to measure extremely low concentrations, such as mg/L and below, and the availability of hand-held Raman spectrometers, has led to a significant growth in the number and variety of applications of SERS to real-world problems. Most of these applications involve the measurement of drugs, such as quantifying medication in patients, identifying illicit drugs in impaired drivers, and more recently, identifying drugs used as weapons. Similar to Raman spectroscopy, most of the point-of-care and field applications involve the identification of the drug to determine the course of action. However, unlike Raman spectroscopy, spectral libraries are not readily available to perform the necessary identification. In a large part, this is due to the uniqueness of the commercially available SERS substrates, each of which can produce different spectra for the same drug. In an effort to overcome this limitation, we have measured numerous drugs using the most common, and readily available SERS material and hand-held Raman analyzers, specifically gold colloids and analyzers using 785 nm laser excitation. Here we present the spectra of some 39 drugs of current interest, such as buprenorphine, delta-9 tetrahydrocannabinol, and fentanyl, which we hope will aid in the development of current and future SERS drug analysis applications.

Objectives: Retinal vessels are part of the intracranial vasculature and analysis thereof complements behavioural and brain measures. Mental stress was related to downregulation of norepinephrine in Africans. Hence we continue by assessing prospective associations between sympathetic nervous system activity and retinal vessel calibres. Methods: Black and Caucasian participants (n = 275; 45 ± 9 years) were stratified into tertiles according norepinephrine:creatinine (NE:Cr) ratio at baseline. Three year prospective % changes (Δ) for depression (PHQ-9), urinary NE:Cr, serum cortisol and High-Density-Lipoprotein (HDL, neuronal-membrane-integrity and ischemic stroke risk marker) were obtained. At 3yr-follow-up, retinal microvascular calibres were quantified from digital images in the mydriatic eye and salivary cortisol (sC) and α-amylase (sAA), adrenergic activity marker were obtained. Results: Only the low NE:Cr-tertile group (44% Black; 64% Men), showed chronic depression and hypertension prevalence. Over 3yrs, their NE:Cr increased whereas cortisol and HDL decreased. At 3yr-follow-up, wider venules (stroke risk marker) were apparent in the low- compared to the high-tertile group (Figure 1). In the low-tertile group, chronic depression was associated with stroke risk markers, wider venules [OR 1.7; P = 0.03] and lower HDL [OR 4.8; P = 0.04]. In this group, arteriole narrowing was associated with ΔNE:Cr, Δcortisol and sAA; whilst a wider venule was associated with ΔNE:Cr and sC. Conclusions: In reaction to depression and low NE:Cr levels, homeostatic reflexes facilitated upregulation of norepinephrine and concurrent downregulation of cortisol. Stress-induced sympathetic nervous system activity however disturbed myogenic tone, neuronal-membrane-integrity and retinal venular widening; increasing the susceptibility for ischemic stroke.

Background: Masked hypertension (MH) is prevalent in young adults and is associated with similar vascular complications as sustained hypertension, but whether this is already evident in young adults is unclear. We therefore compared retinal vessel calibres and function in response to flicker light induced provocation (FLIP) in young healthy adults stratified by MH status and explored associations between these parameters. Methods: We used data from the first 566 participants (aged 20–30 years) taking part in the African-PREDICT study. Participants were clinically normotensive (70% valid readings) were measured and MH status determined. The central retinal artery (CRAE) and vein equivalent (CRVE) were calculated from fundus images and retinal vessel dilation responses to FLIP determined. Results: MH showed a prevalence of 16%. MHs’ had a lower CRAE (155 ± 10 MU vs. 160 ± 12 MU, p = 0.002), but similar CRVE and vessel dilation in response to FLIP when compared to normotensives. The latter findings remained consistent upon adjustment for sex, ethnicity, age and body mass index. Multivariate regression analysis demonstrated an independent association between CRAE and the presence of MH (R2 = 0.07, β = −0.10 (−0.20; −0.01)). No further associations existed between retinal vessel parameters and MH status. Conclusion: Already at a young age, healthy adults with MH show slight adverse changes in the retinal microvasculature. Considering the prevalence of MH in young adults, and the predictive value of reduced CRAE, our data emphasize the early identification of altered 24 hr blood pressure patterns.

Background and Objectives: It is known that physical activity is inversely associated with arterial stiffness in healthy adults 1. Data regarding the effect of physical activity on PPA is limited. Such data is of importance especially in South Africa, where alarming rates of physical inactivity have been reported 2,3. The aim of this study was to determine the relationship between pulse pressure amplification (PPA) and physical activity in a young, healthy black and white South African cohort. Methods: The sub-study was embedded in the African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) and included 591 white and 604 black participants aged 20–30 years. Systolic, diastolic and central blood pressures were determined with the SphygmoCor apparatus. Biochemical variables were analysed with known methods. Results: The SBP (124 vs. 121 mmHg, p < 0.001), DBP (76 vs. 71 mmHg, p < 0.001) and central SBP (110 vs. 105 mmHg, p < 0.001) were significant higher in the black compared to white participants. No differences were encountered in c-fPWV and PPA. The physical activity levels did not differ but the total energy expenditure was significant lower in the blacks compared to whites (2205.5 vs. 2373.6 kCal, p < 0.001). After multiple regression analysis only in black participants the PPA showed an independent and significant negative association with age (ß = −0.282, p < 0.001) and a positive association with height (ß = 0.247, p < 0.001). In whites the PPA only associated positively with sex (ß = 0.180, p = 0.032). Conclusion: No association was encountered between arterial stiffness (PPA) and physical activity markers.

Raman spectroscopy has proven valuable for determining the composition of manufactured drug products, as well as identifying counterfeit drugs. Here we present a simple method to determine the active pharmaceutical ingredient (API) mass percent in a sample that does not require knowledge of the identities or relative mass percents of the inactive pharmaceutical ingredients (excipients). And further, we demonstrated the ability of the method to pass or fail a manufactured drug product batch based on a calculated acceptance value in accordance with the US Pharmacopeia method for content uniformity. The method was developed by fitting the Raman spectra of 30 Claritin® tablets with weighted percentages of the Raman spectrum of its API, loratadine, and a composite spectrum of the known excipients. The mean loratadine mass of 9.79 ± 40 mg per 100 mg tablet compared favorably to the 10.21 ± 0.63 mg per 100 mg tablet determined using high-performance liquid chromatography, both of which met the acceptance value to pass the 10 mg API product as labelled. The method was then applied to a generic version of the Claritin product that employed different excipients of unknown mass percents. A Raman spectrum representative of all excipients was created by subtracting the API Raman spectrum from the product spectrum. The Raman spectra of the 30 generic tablets were then fit with weighted percents of the pure loratadine spectrum and the created excipient spectrum, and used to determine a mean API mass for the tablets of 10.12 ± 40 mg, again meeting the acceptance value for the 10 mg API product. The data suggest that this simple method could be used to pass or fail manufactured drug product batches in accordance with the US Pharmacopeia method for content uniformity, without knowledge of the excipients.

Purpose : To report peri-operative fractionated high-dose-rate (HDR) brachytherapy with a 3D customized Freiburg flap applicator to treat locally recurrent Wilms’ tumor, followed by immediate hyperthermic intraperitoneal chemotherapy for a 16-year-old with a second recurrence of nephroblastoma (Wilms’ tumor). Material and methods: The tumor was excised and surgical bed was treated with fractionated HDR brachytherapy using a Freiburg flap applicator. Hyperthermic intraperitoneal chemotherapy was performed immediately after the removal of brachytherapy applicator. Results: The Freiburg flap was successfully reconstructed to enable delivery of conformable peri-operative HDR brachytherapy. The clinical target volume (CTV) D90 was 26 Gy in 5 fractions. Conclusions : Peri-operative fractionated HDR brachytherapy with a customized Freiburg flap applicator was delivered successfully across a large multi-disciplinary team.

Abstract Background Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs. Methods A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected. Results Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (−0.80, 95 % confidence interval −1.2 to −0.3;p

Background: Bangladesh is facing the unavoidable challenge of adaptation to climate change. However, very little is known in relation to climate change and health. This article provides information on potential climate change impact on health, magnitude of climate-sensitive diseases, and baseline scenarios of health systems to climate variability and change. Design: A cross-sectional study using multistage cluster sampling framework was conducted in 2012 among 6,720 households of 224 rural villages in seven vulnerable districts of Bangladesh. Information was obtained from head of the households using a pretested, interviewer-administered, structured questionnaire. A total of 6,720 individuals participated in the study with written, informed consent. Results: The majority of the respondents were from the low-income vulnerable group (60% farmers or day labourers) with an average of 30 years’ stay in their locality. Most of them (96%) had faced extreme weather events, 45% of people had become homeless and displaced for a mean duration of 38 days in the past 10 years. Almost all of the respondents (97.8%) believe that health care expenditure increased after the extreme weather events. Mean annual total health care expenditure was 6,555 Bangladeshi Taka (BDT) (1 USD=77 BDT in 2015) and exclusively out of pocket of the respondents. Incidence of dengue was 1.29 (95% CI 0.65–2.56) and malaria 13.86 (95% CI 6.00–32.01) per 1,000 adult population for 12 months preceding the data collection. Incidence of diarrhoea and pneumonia among under-five children of the households for the preceding month was 10.3% (95% CI 9.16–11.66) and 7.3% (95% CI 6.35–8.46), respectively. Conclusions: The findings of this survey indicate that climate change has a potential adverse impact on human health in Bangladesh. The magnitude of malaria, dengue, childhood diarrhoea, and pneumonia was high among the vulnerable communities. Community-based adaptation strategy for health could be beneficial to minimise climate change attributed health burden of Bangladesh.

Abstract Background Bangladesh is one of the countries most vulnerable to climate change (CC). A basic understanding of public perception on vulnerability, attitude and the risk in relation to CC and health will provide strategic directions for government policy, adaptation strategies and development of community-based guidelines. The objective of this study was to collect community-based data on peoples’ knowledge and perception about CC and its impact on health. Methods In 2012, a cross-sectional survey was undertaken among 6720 households of 224 enumeration areas of rural villages geographically distributed in seven vulnerable districts of Bangladesh, with total population of 19,228,598. Thirty households were selected randomly from each enumeration area using the household listing provided by the Bangladesh Bureau of Statistics (BBS). Information was collected from all the 6720 research participants using a structured questionnaire. An observation checklist was used by the interviewers to collect household- and community-related information. In addition, we selected the head of each household as the eligible participant for an interview. Evidence of association between sociodemographic variables and knowledge of CC was explored by cross-tabulation and measured using chi-square tests. Logistic regression models were used to further explore the predictors of knowledge. Results The study revealed that the residents of the rural communities selected for this study largely come from a low socioeconomic background: only 9.6 % had postsecondary education or higher, the majority worked as day labourer or farmer (60 %), and only 10 % earned a monthly income above BDT 12000 (equivalent to US $150 approx.). The majority of the participants (54.2 %) had some knowledge about CC but 45.8 % did not (p

Background: Following activation by vitamin K (VK), matrix Gla protein (MGP) inhibits arterial calcification, but its role in preserving renal function remains unknown. Methods: In 1166 white Flemish (mean age, 38.2 years) and 714 South Africans (49.2% black; 40.6 years), we correlated estimated glomerular filtration (eGFR [CKD-EPI formula]) and stage of chronic kidney disease (CKD [KDOQI stages 2–3]) with inactive desphospho-uncarboxylated MGP (dp-ucMGP), using multivariable linear and logistic regression. Results: Among Flemish and white and black Africans, between-group differences in eGFR (90, 100 and 122 mL/min/1.73 m2), dp-ucMGP (3.7, 6.5 and 3.2 μg/L), and CKD prevalence (53.5, 28.7 and 10.5%) were significant, but associations of eGFR with dp-ucMGP did not differ among ethnicities (P ≥ 0.075). For a doubling of dp-ucMGP, eGFR decreased by 1.5 (P = 0.023), 1.0 (P = 0.56), 2.8 (P = 0.0012) and 2.1 (P

Background/Objectives: Tetrahydrobiopterin (BH4) is a cofactor for nitric oxide synthase (NOS). Oxidative stress, reported in black populations (1), may lead to the oxidation of BH4, the uncoupling of eNOS, decreased NO and increased superoxide levels (2,3). We compared BH4 and markers of oxidative stress and their association, between black and white cohorts. Methods: In the African-PREDICT study, we included black (n = 300) and white (N = 297) participants (aged 20–30 years). We measured blood pressure, and determined serum levels of BH4 and markers of oxidative stress. Results: Blacks had higher blood pressure (p < 0.001). In blacks the following serum levels were lower: BH4 (p < 0.0001), total antioxidant status (TAS) (p < 0.0001), glutathione peroxidase (GPx), while reactive oxygen species (ROS) (p < 0.03) was higher. In blacks BH4 related positively with GPx in single, partial (adjusted for socio-economic status, sex, age, BMI, GGT and cotinine) and multiple regression (R2 = 0.16, β = 0.17, p = 0.02) and glutathione reductase (GR) (R2 = 0.16, β = 0.15, p = 0.05). We found a negative correlation between BH4 and GPx (R2 = 0.07, β = −0.26, p = 0.0006) in whites. Conclusions: Higher oxidative stress levels in young blacks (increased ROS, lower TAS and GPx) could explain the low concentrations of BH4, the possible uncoupling of eNOS, resulting in higher blood pressure. The uncoupling of eNOS may explain the production of ROS and peroxinitrite and may be linked to the positive correlation of BH4 with GPx and GR found in blacks, that may lead to early vascular changes.

Abstract Objective: Introducing new technologies into society raises considerable public concern. We determine the public concern about nanoparticles, and compare this concern to other environmental health issues such as wind farms and coal seam gas production. Methods: A repeat cross sectional survey examining views on environmental health issues, risk, chemicals and trust was undertaken in more than 1,300 Australian residents in 2000 and 2013. Logistic regression and principal component analysis was used to investigate predictors of nanoparticle concern and identify a component structure for environmental health issues that could explain a trend of future nanoparticle concern. Results: Australians have a relatively low level of concern about the risks of nanoparticles to health when compared to their concerns about other environmental health issues. Items associated with concern included gender, a general wish to avoid chemicals and possibly trust in politicians. Concern over nanoparticles clustered with similar views on technological risks. Conclusions: Current public concern over the risks of nanoparticles is low. However, a reframing of the issue towards ‘chemicals’ is likely to have a negative effect on risk perceptions. This paper raises questions about appropriate channels for the effective communication of risk.

Pharmaceutical drugs are available to astronauts to help them overcome the deleterious effects of weightlessness, sickness and injuries. Unfortunately, recent studies have shown that some of the drugs currently used may degrade more rapidly in space, losing their potency before their expiration dates. To complicate matters, the degradation products of some drugs can be toxic. Here, we present a preliminary investigation of the ability of Raman spectroscopy to quantify mixtures of four drugs; acetaminophen, azithromycin, epinephrine, and lidocaine, with their primary degradation products. The Raman spectra for the mixtures were replicated by adding the pure spectra of the drug and its degradant to determine the relative percent contributions using classical least squares. This multivariate approach allowed determining concentrations in ~10 min with a limit of detection of ~4% of the degradant. These results suggest that a Raman analyzer could be used to assess drug potency, nondestructively, at the time of use to ensure crewmember safety.

The USA is in the midst of an opioid crisis that included over 60,000 overdose fatalities in 2017, mostly unintentional. This is due to excessive use of prescription opioids and the use of very strong synthetic opioids, such as fentanyl, mixed with illicit street drugs. The ability to rapidly determine if people or packages entering the country have or contain drugs could reduce their availability, and thereby decrease the use of illicit drugs. In an effort to address this problem, we have been investigating the ability of surface-enhanced Raman spectroscopy to detect trace amounts of opioids on clothing and packages. Here, we report the measurement of codeine and fentanyl at 100 ng/mL for 5 min on a pad impregnated with gold colloids, as well as a preliminary measurement of 500 pg of fentanyl on a glass surface using one of these pads. The calculated limit of detection for this measurement was 40 pg. This data strongly suggests that these pads, used with portable Raman analyzers, would be invaluable to airport security, drug raids, crime scenes, and forensic analysis.

Background: Retinal microvascular function can be assessed using flicker light induced provocation (FLIP). Reduced vessel dilation responses to FLIP are noted in various disease conditions. Comparative studies between ethnic groups are scarce, while the importance of different phases of the vessel responses during and following FLIP are not well studied. We compared retinal vessel dilation, constriction and vessel diameter parameters following FLIP in a cohort of black (n=152) and white (n=178) teachers. Methods: Retinal vessel responses to FLIP were assessed using the Dynamic Vessel Analyzer (IMEDOS Systems, Jena, Germany). Ambulatory blood pressure (BP), anthropometry and blood sampling were performed. Results: Black participants displayed a better maximum percentage dilation (artery: 4.1±3.5% vs. 3.5±2.0%, p

Bangladesh is one of the most vulnerable countries to climate change. People are getting educated at different levels on how to deal with potential impacts. One such educational mode was the preparation of a school manual, for high school students on climate change and health protection endorsed by the National Curriculum and Textbook Board, which is based on a 2008 World Health Organization manual. The objective of this study was to test the effectiveness of the manual in increasing the knowledge level of the school children about climate change and health adaptation.This cluster randomized intervention trial involved 60 schools throughout Bangladesh, with 3293 secondary school students participating. School upazilas (sub-districts) were randomised into intervention and control groups, and two schools from each upazila were randomly selected. All year seven students from both groups of schools sat for a pre-test of 30 short questions of binary response. A total of 1515 students from 30 intervention schools received the intervention through classroom training based on the school manual and 1778 students of the 30 control schools did not get the manual but a leaflet on climate change and health issues. Six months later, a post-intervention test of the same questionnaire used in the pre-test was performed at both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model.None of the various school level and student level variables were significantly different between the control and intervention group. However, the intervention group had a 17.42% (95% CI: 14.45 to 20.38, P =

Background. Multiple sclerosis (MS) is now more common among black and minority ethnic groups in the UK but little is known about the costs of care amongst different ethnic groups. Objective. This study examined and compared service use and costs for people severely affected with MS from Black Caribbean (BC) and White British (WB) backgrounds in the UK and identified predictors of cost for both groups. Method. Population-based cross-sectional study of 43 BC and 43 WB patients with MS (EDSS ≥ 6) and their informal caregivers recruited from an MS service in southeast London. Interviews collected data on health and social service use and informal care support. Costs were calculated using UK unit cost data. Using regression analyses we compared costs between the ethnic groups and identified possible predictors of cost. Results. The mean (SD) costs for the WB and BC groups were £25,778 (£39,387) and £23,186 (£30,433), respectively. Results identified no significant difference in total cost between the two ethnic groups. The EDSS score alone was a significant predictor of cost. Conclusion. Similar costs between ethnic groups indicate that with regard to this MS service and geographical area, access to care was not affected by ethnicity.