Are adults just big kids? Can the newer paediatric weight estimation systems be used in adults?

Background. The weight of a patient is an important variable that impacts on their medical care. Although some drugs are prescribed on a so-called ‘adult dose’ basis, we know that adults come in all shapes and sizes – a ‘one-dose-fits-all’ approach is not necessarily appropriate. As a measured weight may not always be available, an alternative method of accurately estimating weight is required.Objectives. To assess and compare the accuracy of weight estimations in adults by patient self-estimation, the Mercy method, Buckley method, Broca index and PAWPER XL-MAC (paediatric advanced weight prediction in the emergency room eXtra length/eXtra large mid-arm circumference) method.Methods. This was a prospective, cross-sectional study conducted at a tertiary academic hospital in a metropolitan area of Johannesburg, South Africa. Anthropometric variables of height, abdominal circumference, thigh circumference, mid-arm circumference and humeral length were measured. These variables were then applied to the various weight estimation methods and compared with the patient’s actual weight.Results. There were 188 adult patients included in the study. None of the methodologies evaluated in this study achieved the recommended >70% of weight estimations within 10% of the patient’s actual weight (PW10). The Mercy method was the closest to achieving greater than the recommended 95% for weight estimation falling within 20% of the patient’s actual weight (PW20). The PW20 for the Mercy method was 91.5%. The PAWPER XL-MAC and patient self-estimate methods achieved a PW20 of 85.1% and 86.1%, respectively. The Broca and Buckley methods performed poorly overall.Conclusions. None of the evaluated weight estimation methodologies was accurate enough for use in adult weight estimation. The Mercy and PAWPER XL-MAC methodologies both showed significant promise for use in adult weight estimation, but need further refinement. Although patient self-estimates were similarly accurate to those found in previous studies, they were not an accurate option; self-estimations would remain the first choice if the patient was able to provide such an estimation. The Broca index and Buckley method cannot be recommended owing to their poor performance

MEAT QUALITY CHARACTERISTICS OF IMPROVED INDIGENOUS CHICKENS (FUNAAB-ALPHA) FED TURMERIC (Curcuma longa) OR CLOVE (Syzygium aromaticum) AS FEED ADDITIVES

The experiment was conducted to investigate meat quality of improved indigenous chickens (FUNAAB alpha) fed diet containing turmeric (Curcuma longa) and clove (Syzigium aromaticum) powders. One hundred and thirty-five (135) mixed sexed day-old improved indigenous FUNAAB alpha chicks were brooded collectively for two weeks, and assigned into three (3) treatment groups. Each treatment was replicated three times, consisting of fifteen (15) birds. Feed and water were provided ad-libitum through the duration of experiment. The control group was fed the basal diet at starter and  finisher phases (T1), while the other groups were fed clove (Syzygium aromaticum) powder at 3 g/kg (T2) and turmeric (Curcuma longa) (T3) powder at 4 g/kg respectively as additives.   Data obtained were subjected to a One – Way Analysis of Variance in a Completely Randomised Design. Muscle obtained after evisceration was subjected to quality analysis. Proximate composition of meat obtained from chickens fed the basal diet had the highest (p<0.05) moisture content value of 75.45% compared to other treatments. Water absorptive capacity and cook loss of meat obtained from chickens fed 4 g/kg dietary turmeric showed (p<0.05) values of 3% and 16.4% respectively. Meat sensory properties analysed revealed (p<0.05) score in groups fed 3g/kg and 4 g/kg clove and turmeric powders respectively, for tenderness (6.14) and overall acceptability (7.19). Meanwhile (p<0.05) lipoprotein profile was observed in group fed 4 g/kg turmeric powder. Inclusion, turmeric and clove had beneficial effects on FUNAAB Alpha. &nbsp

Cross-sectional study of antioxidant status in normotensive and hypertensive pregnancy

Objectives: The study measured the concentrations of antioxidants in women during pregnancy and the Post Partum Period (PPP) with a view to investigating their role in the aetiology of pregnancy induced hypertension (PIH). Study Design: Informed consent was obtained from 105 women who were divided into three groups: 15 age and parity matched normotensive non-pregnant (control group), 45 normotensive and 45 hypertensive pregnant women. The two groups of pregnant women were divided into three groups of 15 each and studied in the second and third trimesters and PPP respectively. Venous blood was obtained from all the participants for measurements of some antioxidants (uric acid, albumin, catalase and vitamin C). Data were analyzed using descriptive and inferential statistical methods. Results: The results show that the mean concentrations of catalase, albumin, vitamin C and uric acid for the control were 3.1 ± 0.18 µ/l, 46.6 ± 6.6 g/l, 0.38 ± 0.01 mg/dl and 0.16 ± 0.03 mmol/l respectively. The mean concentration of all antioxidants except uric acid were significantly lower during pregnancy when compared with controls (t= 2.06; p<0.01). In the normotensive group of pregnant women, vitamin C was the only antioxidant that showed significant higher concentration when the second trimester concentration and third trimester concentration were compared (t=2.06; p<0.05). Uric acid levels were significantly higher (t=2.06; p<0.05) and nd rd catalase and vitamin C levels were significantly lower in the hypertensive group during the 2 and 3 trimesters (t=2.06; p<0.05). There was a tendency for all antioxidant concentrations to return to normal values during the PPPin the normotensive group; however in the hypertensive group, uric acid levels remained significantly higher (t=2.06; p<0.05). Conclusion: In conclusion this study showed that pregnancy generally reduced the concentration of antioxidants but vitamin C levels were higher in late pregnancy of normotensive women. Therefore higher levels of vitamin C may protect against PIH

Hepatitis C Virus infection in apparentenly healthy individuals with family history of diabetes in Vom, Plateau State Nigeria

Hepatitis C virus (HCV) infection is an important public health problem worldwide. Its association with, and predisposing nature for diabetes mellitus (DM) has been long established. This research was carried out to determine the prevalence of Hepatitis C virus (HCV) amongst people with possible genetic predisposition to diabetes mellitus living in and around Vom, Plateau State, Nigeria. 188 subjects were screened after they filled a structured questionnaire to determine some of their demographic data, social habits and possible risk factors. 5 ml of blood was collected from each subject and sera separated out. Biotech's third generation ELISA Kit for HCV antibodies was used for the screening. Liver enzyme analysis was carried out on positive samples to determine their disease status. A prevalence of 14.36% was recorded with the highest seropositive group being those in the age bracket of 18 – 37 years. 13(13.40%) of males and 14(15.38%) of females were sero-positive. Liver enzyme analysis of sero-positive subjects showed increased levels which may imply early onset of liver damage. These result showed that these individuals could later suffer diabetes which may be triggered by their HCV infection if not treated. This is not over-looking the economic significance of their ill health, assuming they progress to cirrhotic HCV or develop hepatocelluar carcinoma due to HCV chronicity

Appraisal of Ferry Terminals Design Compliance to Guidelines for Universal Accessibility in Lagos State Nigeria

Accessibility of public buildings has been an issue of global interest and importance in the society in recent times. It has been promoted by the need to ensure universal equality and end discrimination of persons either based on size, ability and mobility disorder. Given the important role of water transportation in aiding mobility, movement of goods and services in coastal cities such as Lagos, this study reviewed the compliance of design, construction and operation of Ferry Terminals towards accessibility of users. The research adopts the case study approach and interviews in appraising the three existing Ferry Terminals in Lagos State, Nigeria for accessibility compliance. The case study involved observation and evaluation of the facilities, and the interviews focused on 18 of the ‘facilities operators and passengers’ about their experiences of associated facilities. Findings from the study revealed poor compliance to accessibility in both the external and internal environments. As such, there is a high degree of limitation in use of the facilities for all facets of water travel; from building approach; waiting, boarding and disembarking areas. Existing facilities have inadequate accessibility and are below standards to ensure use by all and without discrimination or segregation of users. It is therefore imperative for Ferry terminal buildings and amenities to be accessible in effectively enabling all users achieve true mobility in barrier-free environments that foster user-comfort through the adoption and application of universal design principle

The global burden of adolescent and young adult cancer in 2019:a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Abstract: Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Global energy governance : a review and research agenda

Over the past few years, global energy governance (GEG) has emerged as a major new field of enquiry in international studies. Scholars engaged in this field seek to understand how the energy sector is governed at the global level, by whom and with what consequences. By focusing on governance, they broaden and enrich the geopolitical and hard-nosed security perspectives that have long been, and still are, the dominant perspectives through which energy is analysed. Though still a nascent field, the literature on GEG is thriving and continues to attract the attention of a growing number of researchers. This article reviews the GEG literature as it has developed over the past 10 years. Our aim is to highlight both the progress and limitations of the field, and to identify some opportunities for future research. The article proceeds as follows. First, it traces the origins of the GEG literature (section “Origins and roots of GEG research”). The subsequent sections deal with the two topics that have received the most attention in the GEG literature: Why does energy need global governance (section “The goals and rationale of global energy governance”)? And, who governs energy (section “Mapping the global energy architecture”)? We then address a third question that has received far less attention: How well or poor is energy governed (section “Evaluating global energy governance”)? In our conclusions (section “Conclusions and outlook”), we reflect on the current state of GEG, review recent trends and innovations, and identify some questions that warrant future consideration by scholars. This article is published as part of a thematic collection on global governance

Local-Scale Patterns of Genetic Variability, Outcrossing, and Spatial Structure in Natural Stands of Arabidopsis thaliana

As Arabidopsis thaliana is increasingly employed in evolutionary and ecological studies, it is essential to understand patterns of natural genetic variation and the forces that shape them. Previous work focusing mostly on global and regional scales has demonstrated the importance of historical events such as long-distance migration and colonization. Far less is known about the role of contemporary factors or environmental heterogeneity in generating diversity patterns at local scales. We sampled 1,005 individuals from 77 closely spaced stands in diverse settings around Tübingen, Germany. A set of 436 SNP markers was used to characterize genome-wide patterns of relatedness and recombination. Neighboring genotypes often shared mosaic blocks of alternating marker identity and divergence. We detected recent outcrossing as well as stretches of residual heterozygosity in largely homozygous recombinants. As has been observed for several other selfing species, there was considerable heterogeneity among sites in diversity and outcrossing, with rural stands exhibiting greater diversity and heterozygosity than urban stands. Fine-scale spatial structure was evident as well. Within stands, spatial structure correlated negatively with observed heterozygosity, suggesting that the high homozygosity of natural A. thaliana may be partially attributable to nearest-neighbor mating of related individuals. The large number of markers and extensive local sampling employed here afforded unusual power to characterize local genetic patterns. Contemporary processes such as ongoing outcrossing play an important role in determining distribution of genetic diversity at this scale. Local “outcrossing hotspots” appear to reshuffle genetic information at surprising rates, while other stands contribute comparatively little. Our findings have important implications for sampling and interpreting diversity among A. thaliana accessions