Patient symptoms and experience following COVID-19: results from a UK-wide survey

Objectives: To investigate the experience of people who continue to be unwell after acute COVID-19, often referred to as ‘long COVID’, both in terms of their symptoms and their interactions with healthcare. Design: We conducted a mixed-methods analysis of responses to a survey accessed through a UK online post-COVID support and information hub between April and December 2020 about people’s experiences after having acute COVID-19. Participants: 3290 respondents, 78% female 92.1% white ethnicity and median age range 45-54 years; 12.7% had been hospitalised. 494(16.5%) completed the survey between 4 and 8 weeks of the onset of their symptoms, 641(21.4%) between 8 and 12 weeks and 1865(62.1%) >12 weeks after. Results: The ongoing symptoms most frequently reported were; breathing problems (92.1%), fatigue (83.3%), muscle weakness or joint stiffness (50.6%), sleep disturbances (46.2%), problems with mental abilities (45.9%) changes in mood, including anxiety and depression (43.1%) and cough (42.3%). Symptoms did not appear to be related to the severity of the acute illness or to the presence of pre-existing medical conditions. Analysis of free text responses revealed three main themes (1) Experience of living with COVID-19 – physical and psychological symptoms that fluctuate unpredictably; (2) Interactions with healthcare that were unsatisfactory; (3) Implications for the future – their own condition, society and the healthcare system, and the need for research Conclusion: Consideration of patient perspective and experiences will assist in the planning of services to address problems persisting in people who remain symptomatic after the acute phase of COVID-19

Improvement of diaphragmatic performance through orthotopic application of decellularized extracellular matrix patch.

AbstractMuscle tissue engineering can provide support to large congenital skeletal muscle defects using scaffolds able to allow cell migration, proliferation and differentiation. Acellular extracellular matrix (ECM) scaffold can generate a positive inflammatory response through the activation of anti-inflammatory T-cell populations and M2 polarized macrophages that together lead to a local pro-regenerative environment. This immunoregulatory effect is maintained when acellular matrices are transplanted in a xenogeneic setting, but it remains unclear whether it can be therapeutic in a model of muscle diseases. We demonstrated here for the first time that orthotopic transplantation of a decellularized diaphragmatic muscle from wild animals promoted tissue functional recovery in an established atrophic mouse model. In particular, ECM supported a local immunoresponse activating a pro-regenerative environment and stimulating host muscle progenitor cell activation and migration. These results indicate that acellular scaffolds may represent a suitable regenerative medicine option for improving performance of diseased muscles

Physical factors contributing to rural water supply functionality performance in Malawi

This report communicates the findings generated from one of the project surveys – deconstruction and forensic analysis of 50 individual water points in Malawi. The report presents the new data generated to Malawi’s groundwater resource potential; the nature and condition of hand-pump borehole installations; and the significance of both of these factors to service performance. Based on the evidence collected, the main physical factor affecting functionality performance within Malawi is shown to be the poor condition of handpump components. Functionality of handpumps is considerably higher than in the other study countries, Ethiopia and Uganda, and the resource potential, depth to groundwater and recharge are generally favourable. Improved systems for rapid maintenance and repair would help increase functionality further. This finding should not, however, be considered to be the only driving force of functionality outcomes in these regions of Malawi, and the results of this survey need to be examined alongside the wider project findings. Wider institutional arrangements, resources and dynamics, are likely to play a significant role in the implementation of appropriate borehole construction, siting and design; procurement processes; and the management capacity available for water points at national to local levels

How clusters create shared value in rural areas: An examination of six case studies

The main aim of this paper is to demonstrate that clusters can support the sustainable development of rural areas through the creation of shared value. This is done via the close examination of six different cases of rural clusters in Greece, Italy, Germany, Poland, Denmark, and Sweden. Qualitative as well as quantitative data were taken from the clusters, which demonstrated that their main business approaches naturally coincided with the creation of economic, social, and environmental benefits for the local communities in which they operated. The case clusters were created in a top-down manner, aimed at boosting regional R&D activities and making the local economy more competitive and more sustainable. However, private initiative took over and al-lowed these clusters to flourish because meeting the regions’ economic, social, and environmental needs successfully coincided with the target of the clusters’ own development and profitability. The results show that clusters, with their potential for shared value creation, can constitute a powerful engine for the revitalisation and development of rural areas, addressing the significant challenges which they are currently facing

Drinking water quality from rural handpump-boreholes in Africa

Groundwater provides a vital source of drinking water for rural communities in many parts of Africa, particularly in the dry season when there are few safe alternative sources. This paper summarises results from a study (n = 428) assessing dry season water quality, both microbiological and inorganic chemistry, in handpump equipped boreholes (HPBs) across the Ethiopia Highlands (n = 142), Malawi (n = 162) and Uganda (n = 124) using a stratified, randomised sampling design. This study seeks to examine general water quality by randomly sampling rural groundwater supplies across larger areas with different geology and climate. The majority, 72%, of HPBs surveyed provide good quality dry season drinking water as defined by WHO drinking water quality criteria. Within this overall picture, the most notable constraints were from thermotolerant coliforms (TTCs), which exceeded the WHO drinking water guideline of zero colony forming units (cfu/100 ml) in 21% of sites (range 0–626 cfu/100 ml). TTC contamination was found to have a significant and positive correlation with annual average rainfall (ρ = 0.2, p = 0.00003). Across all three countries, WHO health based chemical drinking water quality values were exceeded at 9% of sites and were found for manganese (4%), fluoride (2.6%) and nitrate (2.5%); arsenic concentrations were below the guideline value of 10 μg l−1 (range 400 μg l−1) found in drinking water sources in Uganda challenges the decision by WHO not to formalise a health-based guideline for Mn. While the overall level of microbiological contamination from HPBs is low, results from this study strongly suggest that at a national and regional level, microbiological contamination rather than chemical contamination will provide a greater barrier to achieving targets set for improved drinking water quality under the UN-SDG 6. Efforts should be made to ensure that boreholes are properly sited and constructed effectively to reduce pathogen contamination

The Human Pancreas as a Source of Protolerogenic Extracellular Matrix Scaffold for a New-generation Bioartificial Endocrine Pancreas

OBJECTIVES: Our study aims at producing acellular extracellular matrix scaffolds from the human pancreas (hpaECMs) as a first critical step toward the production of a new-generation, fully human-derived bioartificial endocrine pancreas. In this bioartificial endocrine pancreas, the hardware will be represented by hpaECMs, whereas the software will consist in the cellular compartment generated from patient's own cells. BACKGROUND: Extracellular matrix (ECM)-based scaffolds obtained through the decellularization of native organs have become the favored platform in the field of complex organ bioengineering. However, the paradigm is now switching from the porcine to the human model. METHODS: To achieve our goal, human pancreata were decellularized with Triton-based solution and thoroughly characterized. Primary endpoints were complete cell and DNA clearance, preservation of ECM components, growth factors and stiffness, ability to induce angiogenesis, conservation of the framework of the innate vasculature, and immunogenicity. Secondary endpoint was hpaECMs’ ability to sustain growth and function of human islet and human primary pancreatic endothelial cells. RESULTS: Results show that hpaECMs can be successfully and consistently produced from human pancreata and maintain their innate molecular and spatial framework and stiffness, and vital growth factors. Importantly, hpaECMs inhibit human naïve CD4+ T-cell expansion in response to polyclonal stimuli by inducing their apoptosis and promoting their conversion into regulatory T cells. hpaECMs are cytocompatible and supportive of representative pancreatic cell types. DISCUSSION: We, therefore, conclude that hpaECMs has the potential to become an ideal platform for investigations aiming at the manufacturing of a regenerative medicine-inspired bioartificial endocrine pancreas

Contribution of physical factors to handpump borehole functionality in Africa

Handpumps are the main water supply for rural communities across sub-Saharan Africa. However, studies show that >25 % of handpumps are non-functional at any time. We present results from a systematic field study of handpump borehole functionality. The study was designed to investigate the contribution of physical factors to functionality outcomes, including; hydrogeology, borehole configuration, and handpump components. To achieve this, we deconstructed and examined 145 handpump boreholes in Ethiopia, Uganda and Malawi. Pumping tests showed that 19 % of boreholes were located in aquifers with transmissivity below the minimum required to sustain a handpump. Water levels, measured during the dry season, had a complex relationship with borehole configuration and transmissivity. The handpump cylinder was <10 m below the water table at 38 % of sites, which increases the risk of the handpump running dry during intensive use and/or in areas of low transmissivity. The water column was <20 m at 23 % of sites and screens were <10 m long at 29 % of sites and often sub-optimally positioned in the borehole. Borehole depth had no clear relationship with functionality. Using multinomial regression and four functionality categories (functional; unreliable; low yield; unreliable and low yield) as dependant variables, we found that transmissivity is a significant risk factor for the classification of handpump boreholes as low yield. The configuration of the borehole (e.g. cylinder position, screen/casing configuration and water column) is a statistically significant risk factor for the classification of handpump boreholes as unreliable. Handpump components were in poor overall condition but rising main pipes were a particular problem with 53 % of galvanised pipes corroded and 82 % of uPVC pipes damaged, with implications for handpump performance. Our study highlights the importance of; understanding aquifer properties, investing in borehole siting, construction (including supervision) and commissioning, and improving the quality of components and maintenance of handpumps

Analysis of Different Views and Conceptualizations of the Literacy Practices of Pupils, Families, and Teachers in Costa Rican Primary Education

This article is based on a socio-cultural discourse model of literacy, whereby literacy events are regarded as being situated within social practices, creating various formal, informal, and non-formal literacy events that are part of 10multiliteracies. The aim of the research was to analyze primary pupils ’ literacy practices (8–12 years) from the perspectives of 1,354 primary pupils, 1,020 family members, and 96 teachers in Costa Rica, using an ex-post facto design and a survey method. The findings indicate that the three groups of participants (pupils, family members, and teachers) have different views on 15and conceptualizations of literacy practices in school and in the community. The results show that young learners develop their literacy practices according to their different communicative needs inside and outside school. A multimodal literacy is promoted outside school to meet students’ daily communicative needs. However, the school promotes a monomodal lit20eracy, which allows pupils to respond essentially to school needs

Generation of a Functioning and Self-Renewing Diaphragmatic Muscle Construct

Surgical repair of large muscular defects requires the use of autologous graft transfer or prosthetic material. Naturally derived matrices are biocompatible materials obtained by tissue decellularization and are commonly used in clinical practice. Despite promising applications described in the literature, the use of acellular matrices to repair large defects has been only partially successful, highlighting the need for more efficient constructs. Scaffold recellularization by means of tissue engineering may improve not only the structure of the matrix, but also its ability to functionally interact with the host. The development of such a complex construct is challenging, due to the complexity of the native organ architecture and the difficulties in recreating the cellular niche with both proliferative and differentiating potential during growth or after damage. In this study, we tested a mouse decellularized diaphragmatic extracellular matrix (ECM) previously described by our group, for the generation of a cellular skeletal muscle construct with functional features. The decellularized matrix was stored using different conditions to mimic the off‐the‐shelf clinical need. Pediatric human muscle precursors were seeded into the decellularized scaffold, demonstrating proliferation and differentiation capability, giving rise to a functioning three‐dimensional skeletal muscle structure. Furthermore, we exposed the engineered construct to cardiotoxin injury and demonstrated its ability to activate a regenerative response in vitro promoting cell self‐renewal and a positive ECM remodeling. Functional reconstruction of an engineered skeletal muscle with maintenance of a stem cell pool makes this a promising tool toward future clinical applications in diaphragmatic regeneratio