Sputum microbiome and chronic obstructive pulmonary disease in a rural Ugandan cohort of well-controlled HIV infection

Sub-Saharan Africa has increased morbidity and mortality related to chronic obstructive pulmonary disease (COPD). COPD among people living with HIV (PLWH) has not been well studied in this region, where HIV/AIDS is endemic. Increasing evidence suggests that respiratory microbial composition plays a role in COPD severity. Therefore, we aimed to investigate microbiome patterns and associations among PLWH with COPD in Sub-Saharan Africa. We conducted a cross-sectional study of 200 adults stratified by HIV and COPD in rural Uganda. Induced sputum samples were collected as an easy-to-obtain proxy for the lower respiratory tract microbiota. We performed 16S rRNA gene sequencing and used PICRUSt2 (version 2.2.3) to infer the functional profiles of the microbial community. We used a statistical tool to detect changes in specific taxa that searches and adjusts for confounding factors such as antiretroviral therapy (ART), age, sex, and other participant characteristics. We could cluster the microbial community into three community types whose distribution was shown to be significantly impacted by HIV. Some genera, e.g., Veillonella, Actinomyces, Atopobium, and Filifactor, were significantly enriched in HIV-infected individuals, while the COPD status was significantly associated with Gammaproteobacteria and Selenomonas abundance. Furthermore, reduced bacterial richness and significant enrichment in Campylobacter were associated with HIV-COPD comorbidity. Functional prediction using PICRUSt2 revealed a significant depletion in glutamate degradation capacity pathways in HIV-positive patients. A comparison of our findings with an HIV cohort from the United Kingdom revealed significant differences in the sputum microbiome composition, irrespective of viral suppression. IMPORTANCE: Even with ART available, HIV-infected individuals are at high risk of suffering comorbidities, as shown by the high prevalence of noninfectious lung diseases in the HIV population. Recent studies have suggested a role for the respiratory microbiota in driving chronic lung inflammation. The respiratory microbiota was significantly altered among PLWH, with disease persisting up to 3 years post-ART initiation and HIV suppression. The community structure and diversity of the sputum microbiota in COPD are associated with disease severity and clinical outcomes, both in stable COPD and during exacerbations. Therefore, a better understanding of the sputum microbiome among PLWH could improve COPD prognostic and risk stratification strategies. In this study, we observed that in a virologically suppressed HIV cohort in rural Uganda, we could show differences in sputum microbiota stratified by HIV and COPD, reduced bacterial richness, and significant enrichment in Campylobacter associated with HIV-COPD comorbidity

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

MODERATING INFLUENCE OF PERSONAL FACTORS ON STRESS AMONG ACADEMIC STAFF OF MAKERERE UNIVERSITY, UGANDA

The study investigated whether personal factors had a moderating influence on stress among academic staff of Makerere University. The phenomenon of stress is a major factor that negatively affects work performance in universities and negatively affects the workers' health state. Therefore, to mitigate the effects of stress, it is necessary to minimize factors, particularly personal factors that cause stress among employees. Pragmatism paradigm was used to conduct this research and cross-sectional survey too with an approach of convergent parallel survey was used to arrive at the findings of this study. The researcher used 253 respondents for data collection. The researcher further used disproportionate stratified sampling to select colleges and staff, and purposive sampling for administrators. The collection of Quantitative data employed stress questionnaire and inferential statistics and descriptive analysis were used for data analysis. On the other hand, structured interview was used to collect qualitative data and thematic analysis was used to analyse the qualitative data. Findings from this study showed that individual factors (self-esteem, locus of control as a personality factor, and optimism) partook a moderating impact on academic staff stress. The combination of predictors and moderators contributed 41.9% of the variance in academic stress (Adjusted R2 = .419). It was further revealed that there is high stress at 74.38% that the Makerere University academic staff reported. Consequently, intra-organizational factors and extra-organizational factors partake a bearing on academic staff stress, and individual factors interact with intra-organizational and extra-organizational factors to effect stress among academic staff at Makerere University. It was thus recommended that organizations and institutions should initiate and embolden a communication that is open and honest so as to advance a working environment where there is less likelihood of stress among the employees. There should be an assurance from the academic staff Managers and supervisors in universities about intra-organizational factors such as workload and responsibility for people having no bearing on stress amongst academic staff of Makerere University. Article visualizations

The Effect of ICT Outsourcing on the Performance of Tanzania Police Force

This research study sought to examine the effect of outsourcing ICT projects on the performance of Tanzania Police Force. The study adopted a cross sectional descriptive research design using a mixed approach. Purposive sampling technique was used to obtain a sample size of 62 respondents. Questionnaires and document review were the tools used to collect data. Quantitative data analysis using mean, correlation and regression analysis was used. Qualitative data analysis was done using content analysis and data were presented in statements. The findings showed that there was a significant relationship between ICT projects outsourcing and cost reduction, quality of services and employee motivation. Secondary data indicated that outsourcing is more expensive than in-house sourcing. Also the study found that TPF outsourced for the wrong reasons including corruption and self interest,favouritism/nepotism, politics and fear for accountability. The conclusion reached was that ICT projects outsourced did not achieve the intended objectives of cost reduction, increased credibility and reputation of the Tanzania Police Force. The study recommended more involvement of ICT professional Police officers in decision making involving outsourcing of ICT projects. The study recommended future studies to be conducted in other sectors to see if similar results will be obtained or conduct the same study using a different methodology

Financial Stability and Bank Loan Portfolio Choice

Households are generally perceived to play a passive role in credit markets. Although the literature on household credit remains scarce and underdeveloped, evidence shows that households, especially in developed and emerging economies, have become active borrowers in credit markets. The 2007-2008 financial crisis was a wakeup call for both credit market institutions and policy makers as it prompted important questions concerning the sustainability of household debts and its possible impact on the stability of the financial sector. Motivated by the aftermaths of the financial crisis, this paper seeks to better understand the relationship between household credit expansion and financial outcomes. I use an approach that focuses on the direct and explicit interactions between household credit growth and financial outcomes. To analyze these relationships, I applied the ordinary least-square and probit regression models. The results obtained suggest that household credit expansion can lead to improvements in the financial sector through the organization of credit markets; implicit diversification of credit risks; and the overall increased trust in financial markets

A Culturally Relevant "NoBody's Perfect" Parenting Program for African Immigrant Women in Canada

This study examines the curriculum and impact of The Nobody’s Perfect parenting program delivered by the Public Health Agency of Canada. Specifically, the study challenges notions of this program as an adaptable and effective model for training first time, young and immigrant mothers in parenting skills that empower both families and children. The present study highlights the program’s deeply Eurocentric and Western values and imaginations through the case of 17 African immigrant mothers whose voices and knowledge are erased and devalued by such modern Canadian parenting training schemes presuming these racialized women’s cultures backward and their childrearing experiences unusable in the Canadian context. Drawing from 17 personal interviews with immigrant women from 12 countries in Africa, the study illuminates the complex nature of the childrearing experiences of these women, shining light especially on their transnational and hybridized parenting practises informed by African and indigenous cultural values and beliefs yet already internalized parental models disseminated by European colonialism and political domination over Africa. The analysis leads to recommendations for ways to ground parental support in Canada in immigrant cultures thus positioning immigrant children and families for prosperity and wellbeing in Canada.  Ph.D

Observation on how intramolecular hydrogen bonding of alcohol with fluorine affects its intermolecular hydrogen bonding with acceptors

248th National Meeting of the American-Chemical-Society (ACS), San Francisco, CA, AUG 10-14, 2014International audienc