Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana.

BACKGROUND: Very little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic. METHODS: Between May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents' health records. We used logistic regression analyses to explore the risk factors for multimorbidity. RESULTS: We interviewed 1,527 patients and retrieved matching medical records for 1,399 (91.6%). The median age of participants was 52.1 years (37-64 years). While the prevalence of multimorbidity was 38.8%, around half (48.6%) of the patients with multimorbidity were aged between 18-59 years old. The most common combination of conditions was hypertension and diabetes mellitus (36.6%), hypertension and musculoskeletal conditions (19.9%), and hypertension and other cardiovascular conditions (11.4%). Compared with patients aged 18-39 years, those aged 40-49 years (OR 4.68, 95% CI: 2.98-7.34), 50-59 years (OR 12.48, 95% CI: 8.23-18.92) and 60 years or older (OR 15.80, 95% CI: 10.66-23.42) were increasingly likely to present with multimorbidity. While men were less likely to present with multimorbidity, (OR 0.71, 95% CI: 0.45-0.94, p = 0.015), having a family history of any chronic disease was predictive of multimorbidity (OR 1.43, 95% CI: 1.03-1.68, p = 0.027). CONCLUSIONS: Multimorbidity is a significant problem in this population. By identifying the risk factors for multimorbidity, the results of the present study provide further evidence for informing future policies aimed at improving clinical case management, health education and medical training in Ghana

H2O2-mediated modulation of cytosolic signaling and organelle function in rat hippocampus

Reactive oxygen species (ROS) released from (dys-)functioning mitochondria contribute to normal and pathophysiological cellular signaling by modulating cytosolic redox state and redox-sensitive proteins. To identify putative redox targets involved in such signaling, we exposed hippocampal neurons to hydrogen peroxide (H2O2). Redox-sensitive dyes indicated that externally applied H2O2 may oxidize intracellular targets in cell cultures and acute tissue slices. In cultured neurons, H2O2 (EC50 118 µM) induced an intracellular Ca2+ rise which could still be evoked upon Ca2+ withdrawal and mitochondrial uncoupling. It was, however, antagonized by thapsigargin, dantrolene, 2-aminoethoxydiphenyl borate, and high levels of ryanodine, which identifies the endoplasmic reticulum (ER) as the intracellular Ca2+ store involved. Intracellular accumulation of endogenously generated H2O2—provoked by inhibiting glutathione peroxidase—also released Ca2+ from the ER, as did extracellular generation of superoxide. Phospholipase C (PLC)-mediated metabotropic signaling was depressed in the presence of H2O2, but cytosolic cyclic adenosine-5′-monophosphate (cAMP) levels were not affected. H2O2 (0.2–5 mM) moderately depolarized mitochondria, halted their intracellular trafficking in a Ca2+- and cAMP-independent manner, and directly oxidized cellular nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FADH2). In part, the mitochondrial depolarization reflects uptake of Ca2+ previously released from the ER. We conclude that H2O2 releases Ca2+ from the ER via both ryanodine and inositol trisphosphate receptors. Mitochondrial function is not markedly impaired even by millimolar concentrations of H2O2. Such modulation of Ca2+ signaling and organelle interaction by ROS affects the efficacy of PLC-mediated metabotropic signaling and may contribute to the adjustment of neuronal function to redox conditions and metabolic supply

Continuous vital sign monitoring in patients after elective abdominal surgery:a retrospective study on clinical outcomes and costs

Aim: To assess changes in outcomes and costs upon implementation of continuous vital sign monitoring in postsurgical patients. Materials &amp; methods: Retrospective analysis of clinical outcomes and in-hospital costs compared with a control period. Results: During the intervention period patients were less frequently admitted to the intensive care unit (ICU) (p = 0.004), had shorter length of stay (p &lt; 0.001) and lower costs (p &lt; 0.001). The intervention was associated with a lower odds of ICU admission (odds ratio: 0.422; p = 0.007) and ICU related costs (odds ratio: -662.4; p = 0.083). Conclusion: Continuous vital sign monitoring may have contributed to fewer ICU admissions and lower ICU costs in postsurgical patients.</p

Endogenous Sex Steroid Hormones, Lipid Subfractions, and Ectopic Adiposity in Asian Indians

BackgroundEstradiol, testosterone (T), and sex hormone binding globulin (SHBG) levels are associated with lipid subfractions in men and women. Our objective was to determine if associations are independent from adipose tissue area among Asian Indians.MethodsWe used data from 42 women and 57 Asian Indian men who did not use exogenous steroids or lipid-lowering medications. Lipoprotein subfractions including low-density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL), and intermediate density lipoprotein (IDL) were assessed by ion mobility spectrometry. Intra-abdominal adiposity was assessed by computed tomography. Multivariable regression models estimated the association between sex hormones with lipoprotein subfractions before and after adjustment for adiposity.ResultsAmong women, lower logSHBG levels were associated with smaller logLDL particle size and higher logtriglycerides, logVLDL, and logIDL, although these associations were attenuated with adjustment for visceral adiposity in particular. Among women, lower logSHBG levels was significantly associated with lower logmedium LDL and logsmall LDL concentrations even after consideration of visceral and hepatic adiposity and insulin resistance as represented by the homeostasis model assessment of insulin resistance (HOMA-IR). Among men, lower logSHBG was also associated with smaller logLDL peak diameter size and higher logtriglycerides and logVLDL, even after adjustment for HOMA-IR and adiposity. Relationships between sex steroids and lipid subfractions were not significant among women. Among men, higher total testosterone was associated with higher logHDL and logLDL particle size, and lower logtriglycerides and logVLDL, but these associations were partially attenuated with adjustment for adiposity and HOMA-IR.ConclusionsAmong Asian Indians, SHBG is associated with more favorable lipid subfraction concentrations, independent of hepatic and visceral fat

Clustering of red galaxies around the z=1.53 quasar 3C270.1

In the paradigm of hierarchical galaxy formation, luminous radio galaxies mark mass assembly peaks that should contain clusters of galaxies. Observations of the z=1.53 quasar 3C270.1 with the Spitzer Space Telescope at 3.6-24 micron and with the 6.5-m MMT in the z'- and Y-bands allow detection of potential cluster members via photometric redshifts. Compared with nearby control fields, there is an excess of 11 extremely red objects (EROs) at 1.33 < z_phot < 1.73, consistent with a proto-cluster around the quasar. The spectral energy distributions (SEDs) of 3/4 of the EROs are better fitted with passive elliptical galaxies than withdust-reddened starbursts, and of four sources well-detected on an archival HST snapshot image, all have undisturbed morphologies. However, one ERO, not covered by the HST image, is a double source with 0.8" separation on the z' image and a marginal (2sigma) 24 micron detection indicating a dust-enshrouded starburst. The EROs are more luminous than L* (H = -23.6 AB mag at z=1.5).Comment: 12 pages, 7 figures, accepted by Ap

Characterization and Management of Food Loss and Waste in North America

Policies and programs on food loss and waste (FLW) are gaining momentum across North America as awareness of the issue continues to grow. The Commission for Environmental Cooperation (CEC) established the North American Initiative on Food Waste Reduction and Recovery as part of its Green Economy and Climate Change project areas. This white paper characterizes FLW in Canada, Mexico and the United States and identifies opportunities for the industrial, commercial and institutional (ICI) sector, governments, and nongovernmental organizations (NGOs) to take action across the three countries. The scope of this research included post-harvest to pre-consumer stages of the food supply chain (i.e., post-harvest food production; processing; distribution; retail; and food service). Pre-harvest food production and the consumer stages of the food supply chain are beyond the scope of this study. This project complements the CEC's North American Initiative on Organic Waste Diversion and Processing, which examines composting, anaerobic digestion, and other industrial processes (e.g. rendering, biofuel) for FLW and other organic waste. The content of this white paper was compiled from primary and secondary sources of information in Canada, Mexico, the United States and countries outside of North America. Primary sources included interviews and email exchanges with 167 stakeholders representing various locations, organization types and sizes, and stages of the food supply chain. Secondary sources included reports, white papers, academic papers, news articles, media recordings and government databases, as well as a review of on-the-ground programs and projects implemented by the ICI sector, governments and NGOs. North American and international experts on the subject matter also vetted key findings during a three-day stakeholder session held in Canada, in February 2017

Near- and mid-infrared photometry of high-redshift 3CR sources

Using the Spitzer Space Telescope, we have obtained 3.6--24 micron photometry of 38 radio galaxies and 24 quasars from the 3CR catalog at redshift 1<z<2.5. This 178 MHz-selected sample is unbiased with respect to orientation and therefore suited to study orientation-dependent effects in the most powerful active galactic nuclei (AGN). Quasar and radio galaxy subsamples matched in isotropic radio luminosity are compared. The quasars all have similar spectral energy distributions (SEDs), nearly constant in nu F_nu through the rest 1.6-10 micron range, consistent with a centrally heated dust distribution which outshines the host galaxy contribution. The radio galaxy SEDs show larger dispersion, but the mean radio galaxy SED declines from rest 1.6 to 3 micron and then rises from 3 to 8 micron. The radio galaxies are on average a factor 3-10 less luminous in this spectral range than the quasars. These characteristics are consistent with composite emission from a heavily reddened AGN plus starlight from the host galaxy. The mid-infrared colors and radio to mid-infrared spectral slopes of individual galaxies are also consistent with this picture. Individual galaxies show different amounts of extinction and host galaxy starlight, consistent with the orientation-dependent unified scheme.Comment: 11 pages, 5 figures, accepted by Ap

The Code of Protest. Images of Peace in the West German Peace Movements, 1945-1990

The article examines posters produced by the peace movements in the Federal Republic of Germany during the ColdWar, with an analytical focus on the transformation of the iconography of peace in modernity. Was it possible to develop an independent, positive depiction of peace in the context of protests for peace and disarmament? Despite its name, the pictorial selfrepresentation of the campaign ‘Fight against Nuclear Death’ in the late 1950s did not draw on the theme of pending nuclear mass death. The large-scale protest movement in the 1980s against NATO’s 1979 ‘double-track’ decision contrasted female peacefulness with masculine aggression in an emotionally charged pictorial symbolism. At the same time this symbolism marked a break with the pacifist iconographic tradition that had focused on the victims of war. Instead, the movement presented itself with images of demonstrating crowds, as an anticipation of its peaceful ends. Drawing on the concept of asymmetrical communicative ‘codes’ that has been developed in sociological systems theory, the article argues that the iconography of peace in peace movement posters could not develop a genuinely positive vision of peace, since the code of protest can articulate the designation value ‘peace’ only in conjunction with the rejection value ‘war’