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The present study examined the prevalence of and risk factors for malnutrition in a population-based cohort of women of childbearing age in rural Bangladesh.
A cross-sectional study that collected pre-pregnancy weight, height, and data on selected risk factors for nutritional status of women.
The study was conducted in Sylhet District of Bangladesh.
Study subjects included 13 230 non-pregnant women of childbearing age. Women were classified into underweight (<18·5 kg/m2), normal (18·5–24·9 kg/m2) and overweight/obese (≥25·0 kg/m2) using BMI; and into moderate to severe stunting (<150 cm), mild stunting (150–<155 cm) and normal (≥155 cm) using height. Two multinomial logistic regression models were fitted for BMI: model 1 examined individual and household factors associated with BMI, and model 2 additionally examined the association of community variables. The same analysis was conducted for height.
Prevalence of underweight, overweight/obesity and moderate to severe stunting was 37·0, 7·2 and 48·6 %, respectively. Women’s education and household wealth were inversely related to both underweight status and stunting. Underweight rate was significantly lower in the post-harvest season. Women with any education and who belonged to households with higher wealth were more likely to be overweight/obese.
The study documented high underweight and stunting, and moderate overweight/obesity rates among rural Bangladeshi women; and recommends design and implementation of a multidimensional intervention programme based on individual-, household- and community-level risk factors that can address underweight, stunting and overweight/obesity to improve the nutritional status of women of childbearing age in Bangladesh.
The anti-leishmania effects of HIV peptidase inhibitors (PIs) have been widely reported; however, the biochemical target and mode of action are still a matter of controversy in Leishmania parasites. Considering the possibility that HIV-PIs induce lipid accumulation in Leishmania amazonensis, we analysed the effects of lopinavir on the lipid metabolism of L. amazonensis promastigotes. To this end, parasites were treated with lopinavir at different concentrations and analysed by fluorescence microscopy and spectrofluorimetry, using a fluorescent lipophilic marker. Then, the cellular ultrastructure of treated and control parasites was analysed by transmission electron microscopy (TEM), and the lipid composition was investigated by thin-layer chromatography (TLC). Finally, the sterol content was assayed by gas chromatography–mass spectrometry (GC/MS). TEM analysis revealed an increased number of lipid inclusions in lopinavir-treated cells, which was accompanied by an increase in the lipophilic content, in a dose-dependent manner. TLC and GC–MS analysis revealed a marked increase of cholesterol-esters and cholesterol. In conclusion, lopinavir-induced lipid accumulation and affected lipid composition in L. amazonensis in a concentration–response manner. These data contribute to a better understanding of the possible mechanisms of action of this HIV-PI in L. amazonensis promastigotes. The concerted action of lopinavir on this and other cellular processes, such as the direct inhibition of an aspartyl peptidase, may be responsible for the arrested development of the parasite.
Hemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).
This was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).
A total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.
In this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.
MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study. Prehosp Disaster Med. 2018;33(3):230–236.
One of the Leishmania species known to be non-infective to humans is Leishmania (Mundinia) enriettii whose vertebrate host is the guinea pig Cavia porcellus. It is a good model for cutaneous leishmaniasis, chemotherapeutic and molecular studies. In the last years, an increased interest has emerged concerning the L. (Mundinia) subgenus after the finding of Leishmania (M.) macropodum in Australia and with the description of other new/putative species such as L. (M.) martiniquensis and ‘L. (M.) siamensis’. This review focused on histopathology, glycoconjugates and innate immunity. The presence of Leishmania RNA virus and shedding of extracellular vesicles by the parasite were also evaluated.
To analyze influential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers
World wide web
We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.
A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they (1) focused on infectious diseases, antimicrobial stewardship, infection control, or medical microbiology; (2) were intended for health professionals; and (3) were written in English and (4) were updated regularly. We mapped blog and blogger characteristics and used an innovative tool to assess the architecture and content of the included blogs. The motivations and perceptions of bloggers and readers were also assessed.
A total of 88 blogs were identified. Moreover, 28 blogs (32%) focused on infectious diseases, 46 (52%) focused on medical microbiology, and 14 (16%) focused on infection control or antimicrobial stewardship. Bloggers were mainly male with medical doctorates and/or PhDs; 32 bloggers (36%) posted at least weekly; and 51 (58%) had a research purpose. The aims were considered clear for 23 blogs (26%), and the field covered was considered broad for 25 blogs (28%). Presentation was considered good for 22 blogs (25%), 51 blogs (58%) were easy to read, and 46 blogs (52%) included expert interpretation. Among the top 10 blogs, 3 focused on infectious diseases, 6 focused on medical microbiology, and 2 focused on infection control (2 were equally ranked). The bloggers we questioned were motivated to share their independent expertise and opinions. Readers appreciated the concise messages on scientific topics and practical updates.
This study describes high-level blogs in the fields of infectious diseases, infection control, and medical microbiology. Our findings suggest ways in which bloggers should build/orientate blogs for readers, and we have highlighted current gaps in blog topics such as antimicrobial stewardship.
This article presents previously unknown archaeological evidence of a mid-second-millennium bc kingdom located in central western Anatolia. Discovered during the work of the Central Lydia Archaeological Survey in the Marmara Lake basin of the Gediz Valley in western Turkey, the material evidence appears to correlate well with text-based reconstructions of Late Bronze Age historical geography drawn from Hittite archives. One site in particular—Kaymakçı—stands out as a regional capital and the results of the systematic archaeological survey allow for an understanding of local settlement patterns, moving beyond traditional correlations between historical geography and capital sites alone. Comparison with contemporary sites in central western Anatolia, furthermore, identifies material commonalities in site forms that may indicate a regional architectural tradition if not just influence from Hittite hegemony.
A TEM study of pure tantalum and tantalum-tungsten alloys explosively shocked at a peak pressure of 30 GPa (strain rate: ∼1 x 104 sec-1) is presented. While no ω (hexagonal) phase was found in shock-recovered pure Ta and Ta-5W that contain mainly a low-energy cellular dislocation structure, shock-induced ω phase was found to form in Ta-10W that contains evenly distributed dislocations with a stored dislocation density higher than 1 x 1012 cm-2. The TEM results clearly reveal that shock-induced α (bcc) → ω (hexagonal) shear transformation occurs when dynamic recovery reactions which lead the formation low-energy cellular dislocation structure become largely suppressed in Ta-10W shocked under dynamic (i.e., high strain-rate and high-pressure) conditions. A novel dislocation-based mechanism is proposed to rationalize the transition of dislocation glide to twinning and/or shear transformation in shock-deformed tantalum. Twinning and/or shear transformation take place as an alternative deformation mechanism to accommodate high-strain-rate straining when the shear stress required for dislocation multiplication exceeds the threshold shear stresses for twinning and/or shear transformation.
To describe the development of the Patient Barcode Registration System (PBRS) over time and confirm the usability and feasibility of the system’s latest version during a large trauma drill.
The development of a PBRS started around 1993 aiming to provide an effective tool for patient registration, tracking, and tracing during major incidents. The PBRS uses wristbands with barcodes to follow and register patients in the care process. During a large trauma drill, 120 patients and 40 relatives were registered and traced in the system. Errors in registration, tracking, and tracing of persons were registered.
Of the 120 patients, no patient data were lost and patients could be traced in real time throughout the treatment process by the command team. Strategic decisions could be made based on the information provided by the system. Patient relatives were easily matched and government agencies received regular updates on the number and characteristics of the patients.
The PBRS is a usable, feasible, and sustainable patient tracking and tracing tool to be used during the hospital response to major incidents. Lessons learned during the last 20 years include the need for continuous updates to withstand the challenge of time. (Disaster Med Public Health Preparedness. 2017;11:244–250)
Social scientists and historians have identified the exclusion of agricultural workers and domestic servants from social insurance programs during the New Deal as a cause of the racially divided US welfare state. The most prominent explanation for these exclusions is that they originated in a Southern-dominated congress and were deliberately designed to exclude a majority of African-American workers from the emerging welfare state. This article examines recent historical scholarship, archival evidence, and information on unemployment compensation programs internationally to situate this policy choice in a wider context. The exclusion of these categories of workers is consistent with the experience of other unemployment insurance programs. Given the close linkages between the technical experts who drafted the US legislation and their counterparts abroad, the exclusion of agricultural workers and domestic servants from unemployment insurance is best understood as an example of policy diffusion.
Background: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. Aims: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Method: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Results: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. Conclusions: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.
African great apes are susceptible to infections with several species of Plasmodium, including the predecessor of Plasmodium falciparum. Little is known about the ecology of these pathogens in gorillas. A total of 131 gorilla fecal samples were collected from Dzanga-Sangha Protected Areas to study the diversity and prevalence of Plasmodium species. The effects of sex and age as factors influencing levels of infection with Plasmodium in habituated gorilla groups were assessed. Ninety-five human blood samples from the same locality were also analysed to test for cross-transmission between humans and gorillas. According to a cytB PCR assay 32% of gorilla's fecal samples and 43·1% human individuals were infected with Plasmodium spp. All Laverania species, Plasmodium vivax, and for the first time Plasmodium ovale were identified from gorilla samples. Plasmodium praefalciparum was present only from habituated individuals and P. falciparum was detected from human samples. Although few P. vivax and P. ovale sequences were obtained from gorillas, the evidence for cross-species transmission between humans and gorillas requires more in depth analysis. No association was found between malaria infection and sex, however, younger individuals aged ≤6 years were more susceptible. Switching between two different Plasmodium spp. was observed in three individuals. Prolonged monitoring of Plasmodium infection during various seasons and recording behavioural data is necessary to draw a precise picture about the infection dynamics.
Making decisions between alternative investments, projects, or policies that affect the provision of ecosystem services often involves weighing up and comparing multiple costs and benefits that are measured in different metrics and are incurred at different points in time. For example, the establishment of a new protected area might involve costs in terms of the purchase of land, compensation of local communities, and ongoing maintenance and enforcement costs; and benefits in terms of biodiversity conservation, recreational use, and improved watershed services. These costs and benefits are likely to be measured in different units, incurred by different groups and have different time profiles. Organizing, comparing, and aggregating information on such a complexity of impacts, and subsequently choosing between alternative options with different impact profiles require a structured approach. Methods for evaluation or appraisal of complex decision contexts provide systems for structuring the information and factors that are relevant to a decision.
Benjamin Franklin’s description of his own approach to making complex decisions sets out the intuition behind evaluation methods (Franklin, 1772):
When difficult cases occur, they are difficult chiefly because while we have them under consideration, all the reasons pro and con are not present to the mind at the same time . . . To get over this, my way is to divide half a sheet of paper by a line into two columns; writing over the one “Pro”, and the other “Con”. . .
A theoretical model and an experimental model of surge motions of an ice floe due to regular waves are presented. The theoretical model is a modified version of Morrison’s equation, valid for small floating bodies. The experimental model is implemented in a wave basin at a scale 1:100, using a thin plastic disc to model the floe. The processed experimental data display a regime change in surge amplitude when the incident wavelength is approximately twice the floe diameter. It is shown that the theoretical model is accurate in the high-wavelength regime, but highly inaccurate in the low-wavelength regime.
Here we present a single mask sacrificial molding process that allows ultrathin 2-dimensional membranes to be fabricated using biocompatible polymeric materials. For initial investigations, polycaprolactone (PCL) was chosen as a model material. The process is capable of creating 250-500 nm thin, through-hole PCL membranes with various geometries, pore-sizes and spatial features approaching 2.5 micrometers using contact photolithography. The technique uses a mold created from two layers of lift-off resist (LOR). The upper layer is patterned, while the lower layer acts as a sacrificial release layer for the polymer membrane. For mold fabrication, photoresist on top of the layers of lift-off resist is patterned using conventional photolithography. During development the mask pattern is transferred onto the first LOR layer and the photoresist is removed using acetone, leaving behind a thin mold. The mold is filled with a solution of the desired polymer. Subsequently, both the patterned and lower LOR layers are dissolved by immersion in an alkaline solution. The membrane can be mounted onto support structures pre-release to facilitate handling.
There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.
In this chapter we look at the costs and benefits of three possible interventions that would enhance the planet's biodiversity and improve its ecosystems over the next forty years. The results are based on a study carried out across four research institutes and coordinated by the Scottish Agricultural College (Hussain et al., 2011) that combined a global biophysical model (IMAGE-GLOBIO), which analyzed the biophysical impacts of different development scenarios compared to the counterfactual, with a set of valuation studies that placed monetary values on the outcomes resulting from the different policy options in terms of biodiversity and ecosystem services (ESSs).
While reference is frequently made in the popular press to biodiversity losses, in practice it is difficult to quantify and value them. There are several studies that attempt to do this in specific cases but no one has successfully estimated the value of the loss of biodiversity at a global level. This is because the links between biodiversity and biolo-gical systems and the economic and social values that they support are extremely complex. Even the measurement of biodiversity is problematic, with a multi-dimensional metric regarded as appropriate (Purvis and Hector, 2000; Mace et al., 2003), but with further work considered necessary to define the appropriate combination.