The Global Burden of Air Pollution on Mortality: The Need to Include Exposure to Household Biomass Fuel–Derived Particulates

First paragraph: Anenberg et al. (2010) demonstrated that global mortality associated with outdoor ozone and particulate matter (PM) exposure has been underestimated and that anthropogenic atmospheric PM rather than ozone is the main contributor to death. Although we acknowledge that their investigation was concerned with outdoor air pollution alone, we feel that attention should be drawn to the burden of disease from household air pollution

Chronic Household Air Pollution Exposure Is Associated with Impaired Alveolar Macrophage Function in Malawian Non-Smokers

Background Household air pollution in low income countries is an important cause of mortality from respiratory infection. We hypothesised that chronic smoke exposure is detrimental to alveolar macrophage function, causing failure of innate immunity. We report the relationship between macrophage function and prior smoke exposure in healthy Malawians. Methods Healthy subjects exposed daily to cooking smoke at home volunteered for bronchoalveolar lavage. Alveolar macrophage particulate content was measured as a known correlate of smoke exposure. Phagocytosis and intraphagosomal function (oxidative burst and proteolysis) were measured by a flow cytometric assay. Cytokine responses in macrophages were compared following re-exposure in vitro to wood smoke, before and after glutathione depletion. Results Volunteers had a range of alveolar macrophage particulate loading. The macrophage capacity for phagosomal oxidative burst was negatively associated with alveolar macrophage particulate content (n = 29, r2 = 0.16, p = 0.033), but phagocytosis per se and proteolytic function were unaffected. High particulate content was associated with lower baseline CXCL8 release (ratio 0.51, CI 0.29–0.89) and lower final concentrations on re-exposure to smoke in vitro (ratio 0.58, CI 0.34–0.97). Glutathione depletion augmented CXCL8 responses by 1.49x (CI 1.02–2.17) compared with wood smoke alone. This response was specific to smoke as macrophages response to LPS were not modulated by glutathione. Conclusion Chronic smoke exposure is associated with reduced human macrophage oxidative burst, and dampened inflammatory cytokine responses. These are critical processes in lung defence against infection and likely to underpin the relationship between air pollution and pneumonia

Do third-year mental health nursing students feel prepared to assess physical health?

Background The life expectancy for people with mental health issues is significantly lower than the general population, however, their physical health needs are often unrecognised by health professionals. Aim To investigate whether third-year mental health nursing students are clinically prepared to undertake a pre-defined set of physical health checks. Method A 34-item questionnaire was completed by two cohorts of mental health nursing students in their third and final year. Participants self-reported on their competence to assess a range of physical health checks. 37 questionnaires were completed and analysed. Findings Three groups emerged: group 1 – 100% of students self-declared competence in assessments including temperature and pulse, group 2 – more than 50% of students self-declared competence in assessments including urinalysis and pulse oximetry, and group 3 – less than 50% of students self-declared competence in taking electrocardiograms and using the hydration assessment tool. Conclusion The student participants of this study were not adequately prepared to undertake a complete range of physical health assessments for people with mental health issues

Chronic lung disease in HIV-infected children established on antiretroviral therapy.

Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function, and exercise capacity among older children established on ART, and an age-matched HIV-uninfected group. A cross-sectional study in Zimbabwe of: 1) HIV-infected children aged 6-16 years receiving ART for over six months; 2) HIV-uninfected children attending primary health clinics from the same area. Standardised questionnaire, spirometry, Incremental Shuttle Walk Testing (ISWT), CD4 count, HIV viral load, and sputum culture for tuberculosis were performed. 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (IQR 2.8-7.5) and 6.1 years (IQR 3.6-8.4) respectively. Median CD4 count was 726 cells/μl, and 79% had HIV viral load<400copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children (n = 1 [0.7%]), but common in HIV-infected participants (51 [25%]), especially cough (30 [15%]) and dyspnoea (30 [15%]). HIV-infected participants were more commonly previously treated for tuberculosis (76 [38%] versus 1 [0.7%], p < 0.001), had lower exercise capacity (mean ISWT distance 771m versus 889m respectively, p < 0.001), and more frequently abnormal spirometry (43 [24.3%] versus 15 [11.5%], p = 0.003) compared to HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (p = 0.025). No participant tested positive for M. tuberculosis. In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required

Negotiations of minority ethnic rugby league players in the Cathar country of France

This article is based on new empirical, qualitative research with minority ethnic rugby league players in the southwest of France. Drawing on similar research on rugby league in the north and the south of England, the article examines how rugby league, traditionally viewed as a white, working-class male game (Collins, 2006; Denham, 2004; Spracklen, 1995, 2001) has had to re-imagine its symbolic boundaries as they are constituted globally and locally to accommodate the needs of players from minority ethnic backgrounds. In particular, the article examines the sense in which experiences of minority ethnic rugby league players in France compare with those of their counterparts in England (Spracklen, 2001, 2007), how rugby league is used in France to construct identity, and in what sense the norms associated with the imaginary community of rugby league are replicated or challenged by the involvement of minority ethnic rugby league players in France. Questions about what it means to be (provincial, national) French (Kumar, 2006) are posed, questions that relate to the role of sport in the construction of Frenchness, and in particular the role of rugby league (and union). © Copyright ISSA and SAGE Publications

Energy Landscape and Global Optimization for a Frustrated Model Protein

The three-color (BLN) 69-residue model protein was designed to exhibit frustrated folding. We investigate the energy landscape of this protein using disconnectivity graphs and compare it to a Go model, which is designed to reduce the frustration by removing all non-native attractive interactions. Finding the global minimum on a frustrated energy landscape is a good test of global optimization techniques, and we present calculations evaluating the performance of basin-hopping and genetic algorithms for this system.Comparisons are made with the widely studied 46-residue BLN protein.We show that the energy landscape of the 69-residue BLN protein contains several deep funnels, each of which corresponds to a different β-barrel structure

What do adolescents perceive to be key features of an effective dementia education and awareness initiative?

The development of dementia friendly communities is a current global and national priority for the UK. As a response to policy, there have been a number of dementia awareness initiatives disseminated with the aim of reducing the stigma associated with a diagnosis of dementia. The inclusion of adolescents in such initiatives in imperative in order to sustain dementia friendly communities. With this is mind, the aim of this study was to establish the dementia education needs of adolescents and effective dissemination strategies to convey key messages. A total of 42 adolescents aged 12 to 18 years participated in eight focus group discussions. Key themes to emerge from discussions included: the importance of dementia awareness, topics of interest within dementia, preferred methods of learning, the inclusion of the person living with dementia and the use of social media. The findings of the study will enable the development of appropriate dementia awareness initiatives for adolescents and thus facilitate the sustainability of dementia friendly communities

The play is a prison : the discourse of Prison Shakespeare.

The relationship between Shakespeare and prison was brought into sharp focus during Shakespeare’s recent quad-centenary with a succession of works exploring Shakespeare’s value for the prison population. In this paper, we take this spike in activity as a point of departure for examining the discourse of Prison Shakespeare. This discourse, we argue, is underpinned by several intertwining and sometimes paradoxical accounts of social being: (i) psychoanalytic accounts; (ii) postmodern accounts; (iii) humanist accounts bound up with the idea of cultural unfolding; (iv) neoliberal accounts that champion heroic individualism. In our analysis, we respond to Pensalfini’s call for critical debate over the assumption that Shakespeare's plays have the power to both teach and liberate prisoners. We note how Prison Shakespeare is always in a struggle to escape the institutional power of both Shakespearean drama and the prison context itself, and the tendency of this work to provide a model of socialization into, rather than resistance against, what Bristol describes as the mode of subjectivity of the bourgeois political economy

The dimensions of responsiveness of a health system: a Taiwanese perspective

BACKGROUND: Responsiveness is an indicator used to measure how well a health system performs relative to non-health aspects. This study assessed whether seven dimensions proposed by the World Health Organization (WHO) to measure responsiveness (dignity, autonomy, confidentiality, prompt attention, social support, basic amenities, and choices of providers) are applicable in evaluating the health system of Taiwan. METHODS: A key informant survey and focus group research were used in this study. The translated WHO proposed questionnaire was sent to 205 nominated key informants by mail, and 132 (64.4%) were returned. We used principal component analysis to extract factors. Linear regression analysis was used to assess the relationship between the total score and the extracted factors. A qualitative content analysis was also carried out in focus group research. RESULTS: Principal component analysis produced five factors (respect, access, confidentiality, basic amenities, and social support) that explained 63.5% of the total variances. These five factors demonstrated acceptable internal consistency and four of them (except social support) were significantly correlated with the total responsiveness score. The focus group interviews revealed health providers' communication ability and medical ethics were also highly appraised by Taiwanese. CONCLUSION: When the performance of a health system is to be evaluated, elements of responsiveness proposed by WHO may have to be tailored to fit different cultural backgrounds. Four key features illustrate the uniqueness of Taiwanese perspectives: the idea of autonomy may not be conceptualized, prompt attention and choice of providers are on the same track, social support during care is trivially correlated to the total responsiveness score, and accountability of health providers is deemed essential to a health system

The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review.

Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs. A systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069. Of 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1-351 for SABAs, 2·6-340 for ICSs, and 24 for ICS-LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days' wages, ICSs 2-7 days, and ICS-LABAs at least 6 days. The included studies showed heterogeneity. Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids. WHO and Wellcome Trust