Neurological and neuropsychological sequelae of Zika virus infection in children in León, Nicaragua

Objectives. To describe the presence and persistence of neurological and neuropsychological sequelae among children with acquired Zika virus infection and assess whether those sequelae were more common in children infected with Zika virus compared to uninfected children. Methods. We conducted a prospective cohort study of children with and without Zika virus infection in León, Nicaragua, using a standard clinical assessment tool and questionnaire to collect data on symptoms at three visits, about 6 months apart, and a battery of standardized instruments to evaluate neurocognitive function, behavior, depression, and anxiety at the last two visits. Results. Sixty-two children were enrolled, with no significant differences in demographics by infection group. Children infected with Zika virus had a range of neurological symptoms, some of which persisted for 6 to 12 months; however, no consistent pattern of symptoms was observed. At baseline a small percentage of children infected with Zika virus had an abnormal finger-to-nose test (13%), cold touch response (13%), and vibration response (15%) versus 0% in the uninfected group. Neurocognitive deficits and behavioral problems were common in both groups, with no significant differences between the groups. Children infected with Zika virus had lower cognitive efficiency scores at the 6-month visit. Anxiety and depression were infrequent in both groups. Conclusions. Larger studies are needed to definitively investigate the relationship between Zika virus infection and neurological symptoms and neurocognitive problems, with adjustment for factors affecting cognition and behavior, including mood and sleep disorders, home learning environment, history of neuroinvasive infections, and detailed family history of neuropsychological problems

A Non Membrane-Targeted Human Soluble CD59 Attenuates Choroidal Neovascularization in a Model of Age Related Macular Degeneration

Age related macular degeneration (AMD) is the most common cause of blindness amongst the elderly. Approximately 10% of AMD patients suffer from an advanced form of AMD characterized by choroidal neovascularization (CNV). Recent evidence implicates a significant role for complement in the pathogenesis of AMD. Activation of complement terminates in the incorporation of the membrane attack complex (MAC) in biological membranes and subsequent cell lysis. Elevated levels of MAC have been documented on choroidal blood vessels and retinal pigment epithelium (RPE) of AMD patients. CD59 is a naturally occurring membrane bound inhibitor of MAC formation. Previously we have shown that membrane bound human CD59 delivered to the RPE cells of mice via an adenovirus vector can protect those cells from human complement mediated lysis ex vivo. However, application of those observations to choroidal blood vessels are limited because protection from MAC- mediated lysis was restricted only to the cells originally transduced by the vector. Here we demonstrate that subretinal delivery of an adenovirus vector expressing a transgene for a soluble non-membrane binding form of human CD59 can attenuate the formation of laser-induced choroidal neovascularization and murine MAC formation in mice even when the region of vector delivery is distal to the site of laser induced CNV. Furthermore, this same recombinant transgene delivered to the intravitreal space of mice by an adeno-associated virus vector (AAV) can also attenuate laser-induced CNV. To our knowledge, this is the first demonstration of a non-membrane targeting CD59 having biological potency in any animal model of disease in vivo. We propose that the above approaches warrant further exploration as potential approaches for alleviating complement mediated damage to ocular tissues in AMD

Building information modelling demystified: Does it make business sense to adopt BIM

Building Information Modeling (BIM) offers a revolutionising way to design, document and procure buildings. BIM promises to become a new international benchmark for building design and documentation across industry on the basis of improved efficiencies and collaboration capabilities. However, BIM requires rethinking current practices and process thus it calls for a paradigm shift in the way we procure, design and operate buildings. There seems no question that BIM methodologies are to become the norm in the long term but more factual evidence is required today to provide guidance to industry. This paper investigates current business drivers for BIM adoption by architecture and building engineering consultants. BIM needs to compete against well-ingrained methods to deliver projects in a fragmented and rather traditional industry. This paper investigates 47 value propositions for the adoption of BIM under a multiple case study investigation carried out in Australia and Hong Kong (Aranda-Mena et. al 2008). The selected case study projects included a range of public (1) and private (4) sector building developments of small and large scale. Findings were coded, interpreted and synthesised in order to identify the challenges and business drivers, and the paper focuses mainly on challenges and benefits for architectural and engineering consultants, contractors and steel fabricators. As a condition for the selection criteria all case studies had to be collaborating by sharing BIM data between two or more consultants / stakeholders. As practices cannot afford to ignore BIM this paper aims to identify those immediate business drivers as to provoke debate amongst the professional and academic community

Office spatial design attributes, sitting, and face-to-face interactions: Systematic review and research agenda

Office spatial design can affect the way workers move and interact in the workplace, which can have implications for health and productivity. This systematic review examined office spatial design attributes associated with sitting and face-to-face interactions (FTFIs) at work. The initial search using six databases (Art and Architecture Source; Business Source Complete; Ergonomics Abstracts; PubMed; Scopus; Web of Science) produced 2016 articles. After screening, 20 articles that met the inclusion criteria were reviewed. Of these, nine studies examined sitting, 10 studies examined FTFIs, and one study examined both. The following five design attributes were identified in these studies: office type; shared space; spatial layout; proximity of co-workers; and visibility of co-workers. Overall, the review found some evidence of office spatial attributes associated with workplace sitting or FTFIs. The studies reviewed suggested that workers in open-plan offices appear to have shorter overall sitting time and shorter bouts of sitting, compared to those in closed offices. Better visibility of workers was associated with shorter bouts of sitting. It was also found that proximity to co-workers was related to more frequent and longer FTFIs. These findings suggest that open-plan offices without visual barriers support shorter total sitting time and more frequent breaks of sitting. FTFIs are more likely to happen among workers whose workstations are close to each other. The review identified several gaps in the literature and proposed a research agenda to help advance the understanding of how to modify office spaces to encourage workers’ movement and interactions

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson’s Ten Group Classification System

Abstract Background Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson’s Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR

Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network

Background The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. Objectives To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. Methods This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. Results In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29–21.05]), being single (PRadj 1.45, 95% CI [1.32–1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14–2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70–5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16–1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01–1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43–7.23]), diabetes (PRadj 1.49, 95% CI [1.11–1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14–2.37]). Conclusion Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health