The Relationship between Nutritional Status and Anthropometric Measurements of Preschool Children in a Sierra Leonean Clay Factory Displaced Camp

Weight is a sensitive index for the evaluation of nutritional status of preschool children, particularly where their precise ages are known. Regrettably in Sierra Leone there are no known local standards of weight of preschool children and their ages are most times difficult to obtain. Thus weight alone cannot be the most suitable index in the evaluation of the nutritional status of preschool children in Sierra Leone. Thus the current study was undertaken to determine the relative merits of anthropometric measurements commonly used in nutrition survey for the evaluation of the nutritional status of preschool children in the clay factory displaced camp. Three hundred and six (306) children of both sexes aged 1-5 years were classified into three groups: Normal, protein-energy malnutrition (PEM) and vitamin deficiency (VD). The relative importance of the various anthropometric measurements was assessed in these three categories of children through comparison of their mean values and correlation coefficients. A close relationship was observed between the severity of PEM on the one hand and weight, weight-height ratio and mid-upper arm circumference (MUAC) on the other. The indices weight and weight-height ratio were found to be very sensitive in the assessment of nutritional status of the children. Moreover, these indices showed a close association with other measurements. It was concluded that the weight-height ratio which is independent of age, is the most suitable index for the detection of early cases of PEM in our environment. Keywords: Nutritional status, Protein-Energy malnutrition, Vitamin deficiency, Preschool children, Weight-Height Ratio and Mid-upper arm circumference

Who acquires infection from whom and how? Disentangling multi-host and multi-mode transmission dynamics in the 'elimination' era

Multi-host infectious agents challenge our abilities to understand, predict and manage disease dynamics. Within this, many infectious agents are also able to use, simultaneously or sequentially, multiple modes of transmission. Furthermore, the relative importance of different host species and modes can itself be dynamic, with potential for switches and shifts in host range and/ or transmission mode in response to changing selective pressures, such as those imposed by disease control interventions. The epidemiology of such multi-host, multi-mode infectious agents thereby can involve a multi-faceted community of definitive and intermediate/secondary hosts or vectors, often together with infectious stages in the environment, all of which may represent potential targets, as well as specific challenges, particularly where disease elimination is proposed. Here, we explore, focusing on examples fromboth human and animal pathogen systems, why and how we should aim to disentangle and quantify the relative importance of multi-host multi-mode infectious agent transmission dynamics under contrasting conditions, and ultimately, how this can be used to help achieve efficient and effective disease control. This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'

Moral disengagement and the harms of cocaine use

There has been recent UK media attention on the global impact of the cocaine trade and the morality of personal use of cocaine powder. In this study we investigated whether people who use cocaine engage in moral disengagement (MD) strategies to reduce anticipated guilt associated with use. Participants read text describing the impact of the global cocaine market on others and completed a range of measures including assessments of substance use, MD, anticipated guilt, internalised moral identity, and empathy. We hypothesised that cocaine-related MD would positively predict cocaine use, and this would be partly mediated by anticipated guilt. Complete data were obtained from 254 participants through an anonymous cross-sectional survey (59.8% Female; mean age 30.8 ± 12.6 years). Our hypotheses were supported; i) MD predicted cocaine use positively and anticipated guilt negatively; ii) anticipated guilt negatively predicted cocaine use; anticipated guilt partially mediated the relationship between MD and cocaine use. People who use powder cocaine may use MD to reduce the anticipated guilt associated with knowledge of the harms associated with the drugs trade. Campaigns that focus on the morality of cocaine use or ethical choices may therefore have limited impact unless MD is challenged as part of these campaigns

Effects of messaging on public support for drug consumption rooms in Scotland, UK

Background There is evidence to suggest that medically supervised drug consumption rooms (DCRs) may form part of responses to reduce drug-related harm. Although DCRs have been established globally, they are perceived by some to be a controversial approach in the UK, and Government has repeatedly rejected proposals to establish one in Glasgow, Scotland. As public support is an important component of policy development and enactment, we sought to investigate the effects of different types of message framing on public support for DCR. Methods We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample. Participants were randomised to one of six message conditions comprising combinations of four components. All conditions included i) a basic description of a DCR, and conditions included combinations of ii) factual information; iii) preemptive refutation of common public concerns about DCR; and/or iv) a sympathetic narrative describing a mother whose son died from a heroin overdose. After reading each message, participants completed a bespoke measure assessing support for DCR. Data were analysed using ANCOVA. Results Complete data were obtained from 1591 participants (50.3% Female; mean age 44.9 ± 16.1 years). Compared to reading a basic description of DCR alone, there was greater support for DCR in participants receiving the refutation (p < .001); sympathetic + factual (p < .05); and sympathetic + factual + refutation (p < .001) message conditions. Presenting factual or sympathetic messages alone were not associated with increased support. Conclusion Our findings suggest that public support for DCRs is not improved through communication of factual statements outlining potential benefits of the intervention alone. Advocates seeking to foster public support, and thus influence policy making, should also consider communication campaigns that address common concerns that the public might have about DCRs, and present the intervention in relation to potential benefits that they hold for people indirectly affected by drug-related harm

Less than human: dehumanisation of people who use heroin

Purpose Stigma reduction is an important public health challenge because of the large morbidity and mortality associated with some forms of substance use. Extreme stigma can lead to dehumanisation of target groups, who are ascribed with lesser humanity. We examined whether there was blatant and subtle dehumanisation of people who use heroin, and if these were associated with levels of support for non-discriminatory drug policy. Methods A cross-sectional online study using a UK convenience sample (n = 307; 75.2% female, mean age 28.6 ± 12.2 years). Participants completed assessments of blatant (Ascent of Humans scale) and subtle (an emotion attribution task), dehumanisation, and a bespoke measure assessing support for non-discriminatory drug policies. Other measures controlled for stigma towards people who use drugs, and moral disgust. Findings There was greater blatant dehumanisation of people who used heroin compared to the general population and other potentially stigmatised reference groups, including people who use cannabis. We also found evidence of subtle dehumanisation, and people who used heroin were rated as being less likely to feel uniquely human emotions, less likely to feel positive emotions, and more likely to feel negative emotions. Blatant dehumanisation was associated with significantly lower probability of support for non-discriminatory drug policy. Originality This is the first study to investigate blatant and subtle dehumanisation of people who use heroin, and how this relates to public support for drug policy. Conclusions Dehumanisation may present significant challenges for stigma reduction initiatives and in fostering public support for drug policy and treatment. Denial of the humanity of this group could be used to justify discriminatory policies or relative deprioritisation of support services in funding decisions. Activities that seek to ‘rehumanise’ people who use drugs, including social inclusion, and encouraging compassionate media representations that portray the lived experiences of substance use may be useful areas of future work

Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion

There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4–12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection

Selective Enhancement of Insulin Sensitivity in the Endothelium In Vivo Reveals a Novel Proatherosclerotic Signaling Loop

Rationale: In the endothelium, insulin stimulates endothelial NO synthase (eNOS) to generate the antiatherosclerotic signaling radical NO. Insulin-resistant type 2 diabetes mellitus is associated with reduced NO availability and accelerated atherosclerosis. The effect of enhancing endothelial insulin sensitivity on NO availability is unclear. Objective: To answer this question, we generated a mouse with endothelial cell (EC)–specific overexpression of the human insulin receptor (hIRECO) using the Tie2 promoter–enhancer. Methods and Results: hIRECO demonstrated significant endothelial dysfunction measured by blunted endothelium-dependent vasorelaxation to acetylcholine, which was normalized by a specific Nox2 NADPH oxidase inhibitor. Insulin-stimulated phosphorylation of protein kinase B was increased in hIRECO EC as was Nox2 NADPH oxidase–dependent generation of superoxide, whereas insulin-stimulated and shear stress–stimulated eNOS activations were blunted. Phosphorylation at the inhibitory residue Y657 of eNOS and expression of proline-rich tyrosine kinase 2 that phosphorylates this residue were significantly higher in hIRECO EC. Inhibition of proline-rich tyrosine kinase 2 improved insulin-induced and shear stress–induced eNOS activation in hIRECO EC. Conclusions: Enhancing insulin sensitivity specifically in EC leads to a paradoxical decline in endothelial function, mediated by increased tyrosine phosphorylation of eNOS and excess Nox2-derived superoxide. Increased EC insulin sensitivity leads to a proatherosclerotic imbalance between NO and superoxide. Inhibition of proline-rich tyrosine kinase 2 restores insulin-induced and shear stress–induced NO production. This study demonstrates for the first time that increased endothelial insulin sensitivity leads to a proatherosclerotic imbalance between NO and superoxide

Field assessment of dog as sentinel animal for plague in endemic foci of Madagascar

Funding Information: Sincere thanks to Mrs. L Angeltine Ralafiarisoa for technical assistance and the staff of the Plague Unit for their assistance during sample collections. This work was funded by an internal research grant (Ref: PA 14.25) from the Institut Pasteur de Madagascar. This research was also funded in part by the Wellcome Trust [095171/Z/10/Z]. For the purpose of Open Access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.Peer reviewedPublisher PD

Accommodation and vergence response gains to different near cues characterize specific esotropias

Aim. To describe preliminary findings of how the profile of the use of blur, disparity and proximal cues varies between non-strabismic groups and those with different types of esotropia. Design. Case control study Methodology. A remote haploscopic photorefractor measured simultaneous convergence and accommodation to a range of targets containing all combinations of binocular disparity, blur and proximal (looming) cues. 13 constant esotropes, 16 fully accommodative esotropes, and 8 convergence excess esotropes were compared with age and refractive error matched controls, and 27 young adult emmetropic controls. All wore full refractive correction if not emmetropic. Response AC/A and CA/C ratios were also assessed. Results. Cue use differed between the groups. Even esotropes with constant suppression and no binocular vision (BV) responded to disparity in cues. The constant esotropes with weak BV showed trends for more stable responses and better vergence and accommodation than those without any BV. The accommodative esotropes made less use of disparity cues to drive accommodation (p=0.04) and more use of blur to drive vergence (p=0.008) than controls. All esotropic groups failed to show the strong bias for better responses to disparity cues found in the controls, with convergence excess esotropes favoring blur cues. AC/A and CA/C ratios existed in an inverse relationship in the different groups. Accommodative lag of >1.0D at 33cm was common (46%) in the pooled esotropia groups compared with 11% in typical children (p=0.05). Conclusion. Esotropic children use near cues differently from matched non-esotropic children in ways characteristic to their deviations. Relatively higher weighting for blur cues was found in accommodative esotropia compared to matched controls

A novel asynchronous access method with binary interfaces

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