Neem oil nanoemulsions: characterisation and antioxidant activity

The aim of the present work is to develop nanoemulsions (NEs), nanosized emulsions, manufactured for improving the delivery of active pharmaceutical ingredients. In particular, nanoemulsions composed of Neem seed oil, contain rich bioactive components, and Tween 20 as nonionic surfactant were prepared. A mean droplet size ranging from 10 to 100nm was obtained by modulating the oil/surfactant ratio. Physicochemical characterisation was carried out evaluating size, f-potential, microviscosity, polarity and turbidity of the external shell and morphology, along with stability in simulated cerebrospinal fluid (CSF), activity of Neem oil alone and in NEs, HEp-2 cell interaction and cytotoxicity studies. This study confirms the formation of NEs by Tween 20 and Neem oil at different weight ratios with small and homogenous dimensions. The antioxidant activity of Neem oil alone and in NEs was comparable, whereas its cytotoxicity was strongly reduced when loaded in NEs after interaction with HEp-2 cells

Multi-Platform Characterization of Cerebrospinal Fluid and Serum Metabolome of Patients Affected by Relapsing-Remitting and Primary Progressive Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic immunemediated disease of the central nervous system with a highly variable clinical presentation and disease progression. In this study, we investigate the metabolomics profile of patients affected by relapsing-remitting MS (RRMS)and primary progressive MS (PPMS), in order to find potential biomarkers to distinguish between the two forms. Methods: Cerebrospinal Fluid CSF and blood samples of 34 patients (RRMS n = 22, PPMS n = 12) were collected. Nuclear magnetic resonance (H-1-NMR) and mass spectrometry (coupled with a gas chromatography and liquid chromatography) were used as analytical techniques. Subsequently, a multivariate statistical analysis was performed; the resulting significant variables underwent U-Mann-Whitney test and correction for multiple comparisons. Receiver Operating Characteristic ROC curves were built and the pathways analysis was conducted. Results: The analysis of the serum and the CSF of the two classes, allowed the identification of several altered metabolites (lipids, biogenic amines, and amino acids). The pathways analysis indicated the following pathways were affected: Glutathione metabolism, nitrogen metabolism, glutamine-glutamate metabolism, arginine-ornithine metabolism, phenylalanine, tyrosine and tryptophan biosynthesis etc. Conclusion: The analysis allowed the identification of a set of metabolites able to classify RRMS and PPMS patients, each of whom express different patterns of metabolites in the two biofluids

Effect of chestnut tannins and short chain fatty acids as anti-microbials and as feeding supplements in broilers rearing and meat quality

Chestnut tannins (CT) and saturated short medium chain fatty acids (SMCFA) are valid alternatives to contrast the growth of pathogens in poultry rearing, representing a valid alternative to antibiotics. However, the effect of their blends has never been tested. Two blends of CT extract and Sn1-monoglycerides of SMCFA (SN1) were tested in vitro against the proliferation of Clostridium perfringens, Salmonella typhymurium, Escherichia coli, Campylobacter jejuni. The tested concentrations were: 3.0 g/kg of CT; 3.0 g/kg of SN1; 2.0 g/kg of CT and 1.0 g/kg of SN1; 1.0 g/kg of CT and 2.0 g/kg of SN1. Furthermore, their effect on broiler performances and meat quality was evaluated in vivo: one-hundred Ross 308 male birds were fed a basal diet with no supplement (control group) or supplemented with CT or SN1 or their blends at the same concentration used in the in vitro trial. The in vitro assay confirmed the effectiveness of the CT and SN1 mixtures in reducing the growth of the tested bacteria while the in vivo trial showed that broiler performances, animal welfare and meat quality were not negatively affected by the blends, which could be a promising alternative in replacing antibiotics in poultry production

PHC Progression Model: A novel mixed-methods tool for measuring primary health care system capacity

High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI´s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country´s PHC system, yet quantitative information about PHC systems´ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and subsequently reviewed by PHCPI to validate results and ensure consistency across countries. In 2018, PHCPI partnered with five countries to pilot the tool and found that it was feasible to implement with fidelity, produced valid results, and was highly acceptable and useful to stakeholders. Pilot results showed that both the participatory assessment process and resulting findings yielded novel and actionable insights into PHC strengths and weaknesses. Based on these positive early results, PHCPI will support expansion of the PHC Progression Model to additional countries to systematically and comprehensively measure PHC system capacity in order to identify and prioritise targeted improvement efforts.Fil: Ratcliffe, Hannah L.. Brigham And Women's Hospital; Estados Unidos. Harvard T.H. Chan School of Public Health; Estados UnidosFil: Schwarz, Dan. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados UnidosFil: Hirschhorn, Lisa R.. Northwestern University; Estados UnidosFil: Cejas, Cintia. Ministerio de Desarrollo Social; Argentina. Ministerio de Salud de la Nación; ArgentinaFil: DIallo, Abdoulaye. Ministry Of Health And Social Action; SenegalFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fifield, Jocelyn. Brigham And Women's Hospital; Estados Unidos. Harvard T.H. Chan School of Public Health; Estados UnidosFil: Gashumba, DIane. Ministry of Health; RuandaFil: Hartshorn, Lucy. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados UnidosFil: Leydon, Nicholas. Bill And Melinda Gates Foundation; Estados UnidosFil: Mohamed, Mohamed. Ministry Of Health And Social Welfare Dar Es Salaam; TanzaniaFil: Nakamura, Yoriko. Results For Development; Estados UnidosFil: Ndiaye, Youssoupha. Ministry Of Health And Social Action; SenegalFil: Novignon, Jacob. Kwame Nkrumah University Of Science And Technology; GhanaFil: Ofosu, Anthony. Ghana Health Service; GhanaFil: Roder Dewan, Sanam. Organización de las Naciones Unidas. Unicef. Fondo de las Naciones Unidas para la Infancia; ArgentinaFil: Rwiyereka, Angelique. Global Health Issues and Solutions; Estados UnidosFil: Secci, Federica. The World Bank Group; Estados UnidosFil: Veillard, Jeremy H.. The World Bank Group; Estados UnidosFil: Bitton, Asaf. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados Unido

Integration of priority population, health and nutrition interventions into health systems: systematic review

Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: a quality improvement study

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy

Institutional field-level change in post-Soviet contexts: logic elaboration in primary care restructuring

This thesis examines the evolution of the healthcare field in two countries, Estonia and Lithuania, using an institutional theory perspective and focusing specifically on institutional logics. The study finds that institutional change does not only occur through a shift in dominant logics, as the current literature suggests, but it can also occur through the elaboration of existing logics. Logic elaboration is a process of reconstruction of role-identities, organisational forms, governance structures, and practices and their gradual incorporation into the existing logic. This research shows that logic elaboration may unfold as a process of grafting or appending, depending on specific societal and field-level factors. Societal level factors relate to the flexibility to accept plurality and the ability to synthesise conflicts in a particular societal context. Field level factors relate to the legitimacy of theorisers within a given field and society, the concentration of theorisers in a field and their ability to channel resources and maintain high commitment, and the socialisation of practitioners to the new role-identity. This research makes several contributions to institutional theory. First, it introduces and develops the concept of logic elaboration. Second, it expands our understanding of logics as toolkits, whose elements can be variably combined in a field. Third, it identifies key contextual factors that shape or impact upon the trajectory of change toward logic elaboration. Key words: logic elaboration, institutional logics, institutional theory, institutional change, institutional field, health systems, health reforms, primary care, family medicine, transition countries, Estonia, Lithuania