Survey Study: Reality Check of Internet and Telemedicine Use in Iraqi Hospitals

Thirteen years after the US invasion of Iraq, the healthcare system remains in shambles, due to inherited and emerging problems. A few solutions have been proposed to overcome these problems, and of all the proposed solutions, telemedicine is the one that can potentially overcome the problems of affordability and access. The Iraqi Telemedicine Centre undertook a study to investigate feasibility of applying telemedicine in Baghdad.  The study explores hospitals’ Internet services in terms of type, use, and access. Methods: A survey-based study was conducted by field visits and direct interviews with administrative representatives of fourteen randomly selected hospitals in Baghdad, eight of them are governmental and six are nongovernmental for-profit hospitals. Results:  71% (10/14) of the hospitals have access to the Internet via fibre optic cable through a commercial small business package plan. Six of the ten with Internet offer Wi-Fi to their physicians and potentially their patients, and five of these hospitals are nongovernmental for-profit hospitals. Five of the 14 hospitals were using some aspect of telemedicine and six of the hospitals were interested in participating in projects utilising telemedicine. These results are probably generalisable to the rest of Iraq, as the healthcare system and Internet services are the same. In conclusion, despite of all the challenges, telemedicine is feasible in Iraq, especially if it was affordable and the technology can operate on low-bandwidth Internet.

Effect of polyphenols on glucoregulatory biomarkers, blood pressure and lipid profile in overweight and obese subjects

This thesis describes a series of in vitro, animal and humans studies conducted with the aim of investigating the effect of polyphenol-rich green coffee bean extract (GCBE) and dark chocolate (DC) on biomarkers of glucose metabolism, lipid profile and blood pressure (BP) in overweight and obese individuals. Green coffee and Theobroma cacao bean extracts were found to be rich in polyphenols and to act as effective free radical scavenging compounds in vitro. A potential role for GCBE in inhibiting pancreatic lipase was identified in vitro. Preliminary human studies revealed a differential effect of GCBE and DC on fasting glucose, total cholesterol, BP and urinary glucocorticoids. Accordingly, consumption of 200mg GCBE containing 90mg chlorogenic acid (CGA) twice daily for 14 days by healthy overweight and obese volunteers reduced systolic BP (P=0.043), urinary free cortisone (P=0.0015) and waist circumference (-0.78cm; P=0.013) but raised salivary cortisone (P=0.042) without significantly affecting capillary fasting glucose, total cholesterol or urinary antioxidant excretion (P>0.05). The ability of CGA to differentially regulate cortisol metabolism was further highlighted in male C57BL6 mice wherein daily administration of a diet containing 0.15% CGA for 17 days marginally increased cortisol in kidney (P=0.108; eta2=0.26) and reduced hepatic cortisol (P=0.219; eta2=0.14). In the preliminary single-blind randomised cross-over DC study, 2-week consumption of 20g DC containing 500mg or 1000mg polyphenols by overweight and obese individuals produced equal reductions in capillary fasting glucose, systolic and diastolic BP. This was further confirmed by the long-term placebo-controlled trial wherein ingestion of 20g DC (500mg polyphenols) for 4 weeks reduced fasting glucose (P=0.028), insulin resistance (P=0.005), systolic (P=0.020), diastolic BP (P=0.008) and improved insulin sensitivity (QUICKI, P=0.04; revised-QUICKI, P=0.026) and urinary antioxidant capacity (total phenolics, P=0.046; ferric-reducing capacity, P=0.048) without significantly affecting lipid profile (P>0.05). A particular contribution of the main study is the finding that overweight and obese individuals respond more effectively to polyphenol-rich DC, compared to lean individuals, but more adversely to polyphenol-deficient placebo. The latter was marked by the rise in fasting insulin, insulin resistance and salivary cortisol. In conclusion, this thesis supports a role for polyphenol-rich GCBE and DC in counteracting overweight and obesity-related complications. The role of GCBE and CGA in modulating glucocorticoid metabolism emerges as a novel and potentially relevant field of research to the prevention of overweight and obesity-related complications.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Oxidative stress, lysosomal damage and dysfunctional autophagy in molluscan hepatopancreas (digestive gland) induced by chemical contaminants

Autophagy is a highly conserved evolutionary survival or defence process that enables cells and organisms to survive periods of environmental stress by breaking down cellular organelles and macromolecules in autolysosomes to provide a supply of nutrients for cell maintenance. However, autophagy is also a part of normal cellular physiology that facilitates the turnover of cellular constituents under normal conditions: it can be readily augmented by mild environmental stress; but becomes dysfunctional with severe oxidative stress leading to cellular pathology. The molluscan hepatopancreas or digestive gland provides a versatile and environmentally relevant model to investigate lysosomal autophagy and stress-induced dysfunctional autophagy. This latter process has been implicated in many animal and human disease conditions, including degenerative and neurodegenerative diseases, as well as obesity related conditions. Many environmental pollutants have also been found to induce dysfunctional autophagy in molluscan hepatopancreatic digestive cells, and in this study, the marine blue mussel Mytilus galloprovincialis was exposed for 7 days to: 0.1 μM, 1 μM and 10 μM concentrations of fluoranthene and phenanthrene (PAHs); chlorpyrifos and malathion (organophosphorus compounds); atrazine (triazine herbicide); copper (transition metal) and dodecylbenzene sulphonic acid (LAS, surfactant). The marine snail or periwinkle, Littorina littorea, was also exposed to phenanthrene, chlorpyrifos and copper. Indices of oxidative stress, cell injury and dysfunctional autophagy were measured (i.e., lysosomal membrane stability, protein carbonyls, lipofuscin, and lysosomal accumulation of lipid or lipidosis). Evidence of oxidative stress, based on the elevation of lipofuscin and protein carbonyls, was found for all compounds tested; with chlorpyrifos being the most toxic to both species. Dysfunctional autophagy was induced by all of the compounds tested in both species, except for atrazine in mussels. This failure of normal autophagy was consistently associated with oxidative stress. Autophagic dysfunction is an important emerging feature in the aetiology of many disease conditions in animals and humans; and an explanatory conceptual mechanistic model has been developed for dysregulation of autophagy in response to oxidative stress

Metabolically active, non-nitrogen fixing,Trichodesmiumin UK coastal waters during winter

Trichodesmium, a colonial cyanobacterium typically associated with tropical waters, was observed between January and April 2014 in the western English Channel. Sequencing of the heterocyst differentiation (hetR) and 16S rRNA genes placed this community within the Clade IV Trichodesmium, an understudied clade previously found only in low numbers in warmer waters. Nitrogen fixation was not detected although measurable rates of nitrate uptake and carbon fixation were observed. Trichodesmium RuBisCO transcript abundance relative to gene abundance suggests the potential for viable and potentially active Trichodesmium carbon fixation. Observations of Trichodesmium when coupled with a numerical advection model indicate that Trichodesmium communities can remain viable for >3.5 months at temperatures lower than previously expected. The results suggest that Clade IV Trichodesmium occupies a different niche to other Trichodesmium species, and is a cold- or low-light-adapted variant

Associations of the built environment with Type 2 diabetes in Asia: a systematic review

Objectives Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia. Design Systematic review of the literature. Data sources Online databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023. Eligibility criteria Eligible studies included cohort, cross-sectional and case–control studies that explored associations of built environment characteristics with T2D among adults 18 years and older in Asia. Data extraction and synthesis Covidence online was used to remove duplicates and perform title, abstract and full-text screening. Data extraction was carried out by two independent reviewers using the OVID database and data were imported into MS Excel. Out of 5208 identified studies, 28 studies were included in this systematic review. Due to heterogeneity in study design, built environment and outcome definitions, a semiqualitative analysis was conducted, which synthesised results using weighted z-scores. Results Five broad categories of built environment characteristics were associated with T2D in Asia. These included urban green space, walkability, food environment, availability and accessibility of services such as recreational and healthcare facilities and air pollution. We found very strong evidence of a positive association of particulate matter (PM2.5, PM10), nitrogen dioxide and sulfur dioxide (p<0.001) with T2D risk. Conclusion Several built environment attributes were significantly related to T2D in Asia. When compared with Western countries, very few studies have been conducted in Asia. Further research is, therefore, warranted to establish the importance of the built environment on T2D. Such evidence is essential for public health and planning policies to (re)design neighbourhoods and help improve public health across Asian countries. PROSPERO registration number CRD42020214852

Ocean acidification impacts on nitrogen fixation in the coastal western Mediterranean Sea

The effects of ocean acidification on nitrogen (N2) fixation rates and on the community composition of N2-fixing microbes (diazotrophs) were examined in coastal waters of the North-Western Mediterranean Sea. Nine experimental mesocosm enclosures of ∼50 m3 each were deployed for 20 days during June-July 2012 in the Bay of Calvi, Corsica, France. Three control mesocosms were maintained under ambient conditions of carbonate chemistry. The remainder were manipulated with CO2 saturated seawater to attain target amendments of pCO2 of 550, 650, 750, 850, 1000 and 1250 μatm. Rates of N2 fixation were elevated up to 10 times relative to control rates (2.00 ± 1.21 nmol L-1d-1) when pCO2 concentrations were >1000 μatm and pHT (total scale) < 7.74. Diazotrophic phylotypes commonly found in oligotrophic marine waters, including the Mediterranean, were not present at the onset of the experiment and therefore, the diazotroph community composition was characterised by amplifying partial nifH genes from the mesocosms. The diazotroph community was comprised primarily of cluster III nifH sequences (which include possible anaerobes), and proteobacterial (α and γ) sequences, in addition to small numbers of filamentous (or pseudo-filamentous) cyanobacterial phylotypes. The implication from this study is that there is some potential for elevated N2 fixation rates in the coastal western Mediterranean before the end of this century as a result of increasing ocean acidification. Observations made of variability in the diazotroph community composition could not be correlated with changes in carbon chemistry, which highlights the complexity of the relationship between ocean acidification and these keystone organisms

Nitrite regeneration in the oligotrophic Atlantic Ocean

The recycling of scarce nutrient resources in the sunlit open ocean is crucial to ecosystem function. Nitrification directs ammonium (NH+4) derived from organic matter decomposition towards the regeneration of nitrate (NO− 3), an important resource for photosynthetic primary producers. However, the technical challenge of making nitrification rate measurements in oligotrophic conditions combined with the remote nature of these environments means that data availability, and the understanding that provides, is limited. This study reports nitrite (NO−2) regeneration rate (RNO2– the first product of nitrification derived from NH+ 4 oxidation)over a 13 000 km transect within the photic zone of the Atlantic Ocean. These measurements, at relatively high resolution (order 300 km), permit the examination of interactions between RNO2 and environmental conditions that may warrant explicit development in model descriptions. At all locations we report measurable RNO2 with significant variability between and within Atlantic provinces. Statistical analysis indicated significant correlative structure between RNO2 and ecosystem variables, explaining ∼ 65 % of the data variability. Differences between sampling depths were of the same magnitude as or greater than horizontally resolved differences, identifying distinct biogeochemical niches between depth horizons. The best overall match between RNO2 and environmental variables combined chlorophyll-a concentration, light-phase duration, and silicate concentration (representing a short-term tracer of water column physical instability). On this basis we hypothesize that RNO2 is related to the short-term autotrophic production and heterotrophic decomposition of dissolved organic nitrogen (DON), which regenerates NH+4 and supports NH+4 oxidation. However, this did not explain the observation that RNO2 in the deep euphotic zone was significantly greater in the Southern Hemisphere compared to the Northern Hemisphere. We present the complimentary hypothesis that observations reflect the difference in DON concentration supplied by lateral transport into the gyre interior from the Atlantic’s eastern boundary upwelling ecosystems

A Novel Ca2+ Signaling Pathway Coordinates Environmental Phosphorus Sensing and Nitrogen Metabolism in Marine Diatoms

Diatoms are a diverse and globally important phytoplankton group, responsible for an estimated 20% of carbon fixation on Earth. They frequently form spatially extensive phytoplankton blooms, responding rapidly to increased availability of nutrients, including phosphorus (P) and nitrogen (N). Although it is well established that diatoms are common first responders to nutrient influxes in aquatic ecosystems, little is known of the sensory mechanisms that they employ for nutrient perception. Here, we show that P-limited diatoms use a Ca2+-dependentsignaling pathway, notpreviouslydescribed ineukaryotes,tosenseandrespondto thecritical macronutrient P. We demonstrate that P-Ca2+ signaling is conserved between a representative pennate (Phaeodactylum tricornutum) and centric (Thalassiosira pseudonana) diatom. Moreover, this pathway is ecologically relevant, being sensitive to sub-micromolar concentrations of inorganic phosphate and a range of environmentally abundant P forms. Notably, we show that diatom recovery from P limitation requires rapid and substantial increases in N assimilation and demonstrate that this process is dependent on P-Ca2+ signaling. P-Ca2+ signaling thus governs the capacity of diatoms to rapidly sense and respond to P resupply, mediating fundamental cross-talk between the vital nutrients P and N and maximizing diatom resource competition in regions of pulsed nutrient supply

A communal catalogue reveals Earth’s multiscale microbial diversity

Our growing awareness of the microbial world’s importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth’s microbial diversity