Cardiac biomarkers by point-of-care testing - back to the future?

The measurement of the cardiac troponins (cTn), cardiac troponin T (cTnT) and cardiac troponin I (cTnI) are integral to the management of patients with suspected acute coronary syndromes (ACS). Patients without clear electrocardiographic evidence of myocardial infarction require measurement of cTnT or cTnI. It therefore follows that a rapid turnaround time (TAT) combined with the immediacy of results return which is achieved by point-of-care testing (POCT) offers a substantial clinical benefit. Rapid results return plus immediate decision-making should translate into improved patient flow and improved therapeutic decision-making. The development of high sensitivity troponin assays offer significant clinical advantages. Diagnostic algorithms have been devised utilising very low cut-offs at first presentation and rapid sequential measurements based on admission and 3 h sampling, most recently with admission and 1 h sampling. Such troponin algorithms would be even more ideally suited to point-of-care testing as the TAT achieved by the diagnostic laboratory of typically 60 min corresponds to the sampling interval required by the clinician using the algorithm. However, the limits of detection and analytical imprecision required to utilise these algorithms is not yet met by any easy-to-use POCT systems

Center Directors Committee - Ecoregional Study: Workshop on Ecoregional Research

Summary prepared by Michael Collinson of discussions at a workshop on ecoregional research organized by the Center Directors Committee and held at ISNAR headquarters in the Hague, August 20-23, 1996. The author added some comments based in part on visits to IRRI, ICRISAT, and some national institutions.Issues addressed at the workshop included the new skills IARCs would require to carry out the ecoregional approach, methods of selection of representative research farms and stations, and the integration of priority setting at local, national and regional levels. A large share of the issues to be addressed would be institutional in nature. Participants stressed the importance of disseminating the rationale and importance of the approach to ensure the participation of NARS and NGOs in ecoregional initiatives.Agenda document, TAC 71

Migration and the epidemiological transition: insights from the Agincourt sub-district of northeast South Africa

KIMBACKGROUND: Migration and urbanization are central to sustainable development and health, but data on temporal trends in defined populations are scarce. Healthy men and women migrate because opportunities for employment and betterment are not equally distributed geographically. The disruption can result in unhealthy exposures and environments and income returns for the origin household. OBJECTIVES: The objectives of the paper are to describe the patterns, levels, and trends of temporary migration in rural northeast South Africa; the mortality trends by cause category over the period 2000-2011; and the associations between temporary migration and mortality by broad cause of death categories. METHOD: Longitudinal, Agincourt Health and Demographic Surveillance System data are used in a continuous, survival time, competing-risk model. FINDINGS: In rural, northeast South Africa, temporary migration, which involves migrants relocating mainly for work purposes and remaining linked to the rural household, is more important than age and sex in explaining variations in mortality, whatever the cause. In this setting, the changing relationship between temporary migration and communicable disease mortality is primarily affected by reduced exposure of the migrant to unhealthy conditions. The study suggests that the changing relationship between temporary migration and non-communicable disease mortality is mainly affected by increased livelihood benefits of longer duration migration. CONCLUSION: Since temporary migration is not associated with communicable diseases only, public health policies should account for population mobility whatever the targeted health risk. There is a need to strengthen the rural health care system, because migrants tend to return to the rural households when they need health care

Integrating multiple representations: fighting asthma

This paper seeks to engage debates about integrating pluralisms regarding multiple forms/representations and how they might function smoothly if they are closely aligned. This paper offers, narrative poetry with an artistic impression aimed at seeing how these might interact with each other. Like poetry, visual images are unique and can evoke particular kinds of emotional and visceral responses. By offering narrative poetry together with an artistic representation it is not meant to de-value the importance of either, but it is aimed at seeing how these arts-based methods and creative analytical practices might unite as a narrative to offer knew ways of ‘knowing’ and ‘seeing

Prolonging disuse in aged mice amplifies cortical but not trabecular bones’ response to mechanical loading

Objective: Short-term neurectomy-induced disuse (SN) has been shown to restore load responses in aged mice. We examined whether this restoration was further enhanced in both cortical and trabecular bone by simply extending the SN. Methods: Following load: strain calibration, tibiae in female C57BL/J6 mice at 8, 14 and 20 weeks and 18 months (n=8/group) were loaded and bone changes measured. Effects of long-term SN examined in twenty-six 18 months-old mice, neurectomised for 5 or 100 days with/without subsequent loading. Cortical and trabecular responses were measured histomorphometrically or by micro-computed tomography. Results: Loading increased new cortical bone formation, elevating cross-sectional area in 8, 14 and 20 week-old (p <0.05), but not 18 month-old aged mice. Histomorphometry showed that short-term SN reinstated load-responses in aged mice, with significant 33% and 117% increases in bone accrual at 47% and 37%, but not 27% of tibia length. Cortical responses to loading was heightened and widespread, now evident at all locations, following prolonged SN (108, 167 and 98% at 47, 37 and 27% of tibial length, respectively). In contrast, loading failed to modify trabecular bone mass or architecture. Conclusions: Mechanoadaptation become deficient with ageing and prolonging disuse amplifies this response in cortical but not trabecular bone