Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce re-ulceration risk among patients with a history of diabetic foot ulcers

Objectives: To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce re-ulceration risk. Methods: Theory-, evidence- and person-based approaches to intervention development were used. In phase 1 of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (N=20). This was used to identify the psychosocial needs and challenges of this population, and barriers and facilitators to the intervention’s target behaviours: regular foot checking, rapid self-referral in the event of changes in foot health, graded and regular physical activity, and emotional management. In phase 2, this evidence was combined with expert consultation to develop the intervention plan. Brief ‘guiding principles’ for shaping intervention development were created. ‘Behavioural analysis’ and ‘logic modelling’ were used to map intervention content onto behaviour change theory to comprehensively describe the intervention and its hypothesised mechanisms. Results: Key challenges to the interventions’ target behaviours included patients’ uncertainty regarding when to self-refer, physical limitations affecting foot checking and physical activity, and, for some, difficulties managing negative emotions. Important considerations for the intervention design included a need to increase patients’ confidence in making a self-referral and in using the maintenance intervention, and a need to acknowledge that some intervention content might be relevant to only some patients (emotional management, physical activity). The behavioural analysis identified the following processes hypothesised to facilitate long-term behaviour maintenance including; increasing patients’ skills, self-efficacy, knowledge, positive outcome expectancies, sense of personal control, social support, and physical opportunity. Conclusions: This research provides a transparent description of the intervention planning for the REDUCE maintenance intervention. It provides insights into potential barriers and facilitators to the target behaviours and potentially useful behaviour change techniques to use in clinical practice

Wild Food:Plants, Fish and Small Animals on the Menu for Early Holocene Populations at al-Khiday, Central Sudan

Al Khiday, located on the bank of the White Nile in Sudan, offers an exceptionally preserved stratigraphic sequence, providing a unique opportunity to use organic residue analysis to investigate diet and subsistence over the full course of the Khartoum Mesolithic together with possible continuity or change into the Early Neolithic, a period of nearly 3000 years (8900-6000 cal BP). Whilst the vast and diverse Mesolithic fish assemblage indicates a strong reliance on products from aquatic habitats, floodplains, vegetated marshes and open water, results from the lipid residue analysis suggest that the fish were not cooked in the pots, likely being consumed in other ways. Rather, pots were more specialised in processing plants, wild grasses, leafy plants and sedges, confirmed by experimental analysis, and for the first time, providing direct chemical evidence for plant exploitation in the Khartoum Mesolithic. Non-ruminant fauna, such as warthog and low lipid-yielding reptiles such as Adanson’s mud turtle and Nile monitor lizard, which were found in significant numbers at al-Khiday, were also cooked in pots. There is little evidence for the processing of wild ruminants in the pots, suggesting either that ruminant species were not routinely hunted, or, that large wild fauna may have been cooked in different ways, possibly grilled over fires. These data suggest sophisticated economic strategies by sedentary people likely exploiting their ecological niche to the fullest. Pottery use changes considerably in the Early Neolithic, with ruminant products being more routinely processed in pots, and while the exploitation of domesticates cannot be confirmed by a small faunal assemblage, some dairying does take place. In summary, our results provide valuable information on Early and Middle Holocene lifeways in central Sudan

The epidemiology of soil-transmitted helminths in Bihar State, India.

BACKGROUND: Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. METHODS: A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. RESULTS: In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. CONCLUSIONS: STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases

Pots, plants and animals:broad-spectrum subsistence strategies in the Early Neolithic of the Moroccan Rif region

The transition from hunter-gathering to food-producing societies in the Mediterranean zone of north Africa was complex and variable, likely influenced by local ecological conditions as well as the socio-economic origins of the population. The adoption of domestic plants and animals was piecemeal, with hunting and gathering continuing as an important part of local subsistence strategies. Here, we investigate the timing and extent of the adoption of agricultural practices, namely herding and cultivation, in three diverse coastal and inland Early Neolithic sites in the Mediterranean Maghreb region, namely Ifri Oudadane, Ifri n’Etsedda and Hassi Ouenzga. Results from absorbed lipid residues extracted from 306 potsherds from these sites are correlated with information from faunal and archaeobotanical assemblages. Our findings suggest that agricultural practices, regarded as being of Neolithic origin, were never fully adopted in the Maghreb but rather that these farmer/foragers adopted a range of strategies including low-level food production (exploiting cereals and animal products, including meat and milk), gathering of wild plants and marine shellfish, and hunting both small and large sized game. These broad-spectrum farmer/foragers were clearly both flexible and resourceful and likely adapted their subsistence practices to maximise resource availability in an increasingly unpredictable environment

TGF-β receptor expression and binding in rat mesangial cells: Modulation by glucose and cyclic mechanical strain

TGF-β receptor expression and binding in rat mesangial cells: Modulation by glucose and cyclic mechanical strain.BackgroundTransforming growth factor-β (TGF-β) is a causal factor in experimental glomerulosclerosis, and it mediates the increased extracellular matrix (ECM) accumulation that occurs in cultured mesangial cells (MCs) exposed to high glucose concentrations and cyclic mechanical strain. This change is associated with increased levels of TGF-β, but may also involve alterations in receptor expression and binding.MethodsRat MCs cultured in media containing either 8 or 35 mM glucose were seeded into culture plates with elastin-coated flexible bottoms. Thereafter, they were subjected to cyclic stretch or static conditions and then examined for125I-TGF-β1 binding and expression of TGF-β receptors at the gene and protein levels.ResultsKinetic studies showed that MCs bound TGF-β1 in a time- and concentration-dependent manner, expressing 6800 high-affinity receptors per cell, with an apparent dissociation constant (Kd) of 15.4 pM, while cross-linking analysis identified three TGF-β receptors (βR) corresponding to βRI, βRII, and βRIII of 54, 73, and 200 kDa, respectively. Immunocytochemical studies of βRI and βRII protein revealed MC expression in a homogeneous, punctate distribution, whereas Northern analysis demonstrated the presence of the corresponding mRNAs. Exposure to cyclic stretching significantly increased (10%) the overall number of TGF-β receptors, whereas ligands associated with βRs I, II, and III also increased (25 to 50%). The finding of increased (30 to 40%) βRI and βRII transcript levels and immunoreactive protein (163 and 59%, respectively) in the absence of significant changes in the apparent Kd indicated that stretch-induced binding was the result of increased receptor synthesis and expression and not due to a change in binding affinity. In a similar, but more dramatic fashion, exposure to high glucose also elevated (50%) the receptor number, as well as the amount of ligands associated with βRs I, II, and III (100 to 250%). This same treatment also increased the levels of βRI and βRII mRNA (30 to 40%) and the immunoreactive protein (82 and 82%, respectively), without significantly altering the binding affinity of the receptor. A concerted or synergistic effect of both stimuli was not evidenced.ConclusionThese results suggest that the modulation of TGF-β receptors may be an additional control point in mediating the glucose- and mechanical force-induced increase in ECM deposition by MCs

Germany and the United States: Reliable Allies. But Disagreement on Russia, Global Leadership and Trade

This Pew Research Center report, in association with Bertelsmann Foundation, examines American and German attitudes toward each other and their respective geopolitical roles. This report is based on telephone surveys in the United States and Germany. In the U.S., interviews were conducted February 26 to March 1, 2015 among a national sample of 1,003 persons, 18 years of age or older. In Germany, interviews were conducted February 24-25, 2015 among a national sample of 963 persons, 18 years of age or older. For more details, see survey methods and topline results

Biotransformation of Silver Released from Nanoparticle Coated Titanium Implants Revealed in Regenerating Bone

Antimicrobial silver nanoparticle coatings have attracted interest for reducing prosthetic joint infection. However, few studies report in vivo investigations of the biotransformation of silver nanoparticles within the regenerating tissue and its impact on bone formation. We present a longitudinal investigation of the osseointegration of silver nanoparticle-coated additive manufactured titanium implants in rat tibial defects. Correlative imaging at different time points using nanoscale secondary ion mass spectrometry, transmission electron microscopy (TEM), histomorphometry, and 3D X-ray microcomputed tomography provided quantitative insight from the nano- to macroscales. The quality and quantity of newly formed bone is comparable between the uncoated and silver coated implants. The newly formed bone demonstrates a trabecular morphology with bone being located at the implant surface, and at a distance, at two weeks. Nanoscale elemental mapping of the bone−implant interface showed that silver was present primarily in the osseous tissue and colocalized with sulfur. TEM revealed silver sulfide nanoparticles in the newly regenerated bone, presenting strong evidence that the previously in vitro observed biotransformation of silver to silver sulfide occurs in vivo

Genome-Wide Association Study of Non-Alcoholic Fatty Liver Disease using Electronic Health Records

Genome‐wide association studies (GWAS) have identified several risk loci for nonalcoholic fatty liver disease (NAFLD). Previous studies have largely relied on small sample sizes and have assessed quantitative traits. We performed a case‐control GWAS in the UK Biobank using recorded diagnosis of NAFLD based on diagnostic codes recommended in recent consensus guidelines. We performed a GWAS of 4,761 cases of NAFLD and 373,227 healthy controls without evidence of NAFLD. Sensitivity analyses were performed excluding other co‐existing hepatic pathology, adjusting for body mass index (BMI) and adjusting for alcohol intake. A total of 9,723,654 variants were assessed by logistic regression adjusted for age, sex, genetic principal components, and genotyping batch. We performed a GWAS meta‐analysis using available summary association statistics. Six risk loci were identified (P < 5*10(−8)) (apolipoprotein E [APOE], patatin‐like phospholipase domain containing 3 [PNPLA3, transmembrane 6 superfamily member 2 [TM6SF2], glucokinase regulator [GCKR], mitochondrial amidoxime reducing component 1 [MARC1], and tribbles pseudokinase 1 [TRIB1]). All loci retained significance in sensitivity analyses without co‐existent hepatic pathology and after adjustment for BMI. PNPLA3 and TM6SF2 remained significant after adjustment for alcohol (alcohol intake was known in only 158,388 individuals), with others demonstrating consistent direction and magnitude of effect. All six loci were significant on meta‐analysis. Rs429358 (P = 2.17*10(−11)) is a missense variant within the APOE gene determining ϵ4 versus ϵ2/ϵ3 alleles. The ϵ4 allele of APOE offered protection against NAFLD (odds ratio for heterozygotes 0.84 [95% confidence interval 0.78‐0.90] and homozygotes 0.64 [0.50‐0.79]). Conclusion: This GWAS replicates six known NAFLD‐susceptibility loci and confirms that the ϵ4 allele of APOE is associated with protection against NAFLD. The results are consistent with published GWAS using histological and radiological measures of NAFLD, confirming that NAFLD identified through diagnostic codes from consensus guidelines is a valid alternative to more invasive and costly approaches

The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries:a systematic review and meta-analysis

Abstract Malnutrition is an independent predictor for postoperative complications in low- and middle-income countries (LMICs). We systematically reviewed evidence on the impact of preoperative oral nutrition supplementation (ONS) on patients undergoing gastrointestinal cancer surgery in LMICs. We searched EMBASE, Cochrane Library, Web of Science, Scopus, WHO Global Index Medicus, SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) databases from inception to March 21, 2022 for randomised controlled trials evaluating preoperative ONS in gastrointestinal cancer within LMICs. We evaluated the impact of ONS on all postoperative outcomes using random-effects meta-analysis. Seven studies reported on 891 patients (446 ONS group, 445 control group) undergoing surgery for gastrointestinal cancer. Preoperative ONS reduced all cause postoperative surgical complications (risk ratio (RR) 0.53, 95% CI 0.46–0.60, P < 0.001, I 2 = 0%, n = 891), infection (0.52, 0.40–0.67, P = 0.008, I 2 = 0%, n = 570) and all-cause mortality (0.35, 0.26–0.47, P = 0.014, I 2 = 0%, n = 588). Despite heterogeneous populations and baseline rates, absolute risk ratio (ARR) was reduced for all cause (pooled effect −0.14, −0.22 to −0.06, P = 0.006; number needed to treat (NNT) 7) and infectious complications (−0.13, −0.22 to −0.06, P < 0.001; NNT 8). Preoperative nutrition in patients undergoing gastrointestinal cancer surgery in LMICs demonstrated consistently strong and robust treatment effects across measured outcomes. However additional higher quality research, with particular focus within African populations, are urgently required

Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

Abstract Background By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. Methods A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. Results Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%). Conclusions In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care