Hepatitis B virus infection in the South Pacific : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science at Massey University

An exploratory study into the genetics of the hepatitis B virus and its human host in the South Pacific was undertaken to determine direction for future research. This virus is a serious health concern, especially for the indigenous people of this region. The DNA sequence of 14 complete and 2 partial virus genomes were obtained. The viral sequence mutations were investigated and compared with a collected database and current literature. Phylogenetic analysis of the viral sequences was carried out using version 4.64 of PAUP* and SplitsTree. Using the new sensitive method of sequence based typing, HLA-DPA1 allele's were typed in 51 unrelated Trobriand Islanders. The viral genomes displayed a great deal of variation with many interesting mutations. The results highlight the affect of quasi-species distribution within a host. Phylogenetic analysis identified two hepatitis B genotypes within the South Pacific, HBV-C and HBV-D. However, the genotype common in northern Europe (HBV-A) was not found. The phylogenetic analysis presented a pattern of evolution that resembled that of its human host. The Trobriand Islanders were found to be an extremely homogeneous population, with 86% homogenous for the HLA- DPA1*02022 allele. The study proved to be very informative, providing the directions of research we aimed for. The Hepatitis B samples demonstrated an interesting pattern of evolution that parallels that of its host supporting a co-evolutionary relationship between host and pathogen, thus hepatitis B appears to be indigenous in the South Pacific. We are presently establishing research to further investigate this pattern by analysing viral samples from Fiji. We have also established research that will investigate the rate of evolution of this virus. The sequenced based typing method proved to be very informative with the ability to detect new alleles. The allele frequency obtained from the Trobriand Islanders agreed with concurrent research and supports the fast-train model of migration into the Pacific. Further work in Fiji will continue with this theme of research as genetic analysis of Fiji has proved to be more complex

One health for neglected tropical diseases

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021–2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required.http://trstmh.oxfordjournals.orghj2021Veterinary Tropical Disease

The CATH Domain Structure Database and related resources Gene3D and DHS provide comprehensive domain family information for genome analysis

The CATH database of protein domain structures (http://www.biochem.ucl.ac.uk/bsm/cath/) currently contains 43 229 domains classified into 1467 superfamilies and 5107 sequence families. Each structural family is expanded with sequence relatives from GenBank and completed genomes, using a variety of efficient sequence search protocols and reliable thresholds. This extended CATH protein family database contains 616 470 domain sequences classified into 23 876 sequence families. This results in the significant expansion of the CATHHMMmodel library to include models built from the CATH sequence relatives, giving a10%increase in coveragefor detecting remote homologues. An improved Dictionary of Homologous superfamilies (DHS) (http://www.biochem.ucl.ac.uk/bsm/dhs/) containing specific sequence, structural and functional information for each superfamily in CATH considerably assists manual validation of homologues. Information on sequence relatives in CATH superfamilies, GenBank and completed genomes is presented in the CATH associated DHS and Gene3D resources. Domain partnership information can be obtained from Gene3D (http://www.biochem.ucl.ac.uk/bsm/cath/Gene3D/). A new CATH server has been implemented (http://www.biochem.ucl.ac.uk/cgi-bin/cath/CathServer.pl) providing automatic classification of newly determined sequences and structures using a suite of rapid sequence and structure comparison methods. The statistical significance of matches is assessed and links are provided to the putative superfamily or fold group to which the query sequence or structure is assigned

Examining the impact of audience response systems on student performance in anatomy education: a randomized controlled trial

Background and Aims: Electronic audience response systems (ARSs) offer the potential to enhance learning and improve performance. However, objective research investigating the use of ARSs in undergraduate education has so far produced mixed, inconclusive results. We investigated the impact of ARSs on short- and long-term test performance, as well as student perceptions of the educational experience, when integrated into undergraduate anatomy teaching. Methods and Results: A cohort of 70 undergraduate medical students were randomly allocated to one of two groups. Both groups received the same anatomy lecture, but one group experienced the addition of ARSs. Multiple-choice tests were conducted before, immediately after the lecture and again 10 weeks later. Self-perceived post-lecture subject knowledge, confidence and enjoyment ratings did not differ between groups. Test performance immediately following the lecture improved when compared against baseline and was modestly but significantly superior in the group taught with ARSs (mean test score of 17.3/20 versus 15.6/20 in the control group, p = 0.01). Tests conducted 10 weeks after the lecture showed no difference between groups (p = 0.61) although overall a small improvement from the baseline test was maintained (p = 0.02). Conclusions: Whilst ARSs offer opportunities to deliver novel education experiences to students, an initial superiority over standard methods does not necessarily translate into longer-term gains in student performance when employed in the context of anatomy education. Key words: medical education; education methodology; education technology; audience response systems; anatomy

Conversations about FGM in primary care : a realist review on how, why, and under what circumstances FGM is discussed in general practice consultations

Objectives Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients. Setting Primary care in England. Data sources Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients. Primary outcome measure This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated. Results 124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations. Conclusions There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation

Dual Users: Real Lessons from Reality Television

This study attempts to understand the differences in activity among an emergent television/Internet audience. The Internet has provided a new entertainment opportunity for producers of television programming. Those television viewers who have also reached out to their favorite television show websites have resulted in a new audience. Examining the programming genre of reality television, two constructs were developed and a written survey administered to a convenience sample of college freshmen. The construct dual users was created to examine the television audience that also visits television programming websites. Single users (those that only watch the television show) were compared to the self-reported levels of activity and involvement of dual users. Early findings suggest that the dual users are more involved during viewing of the television show and engaged in less secondary activity than the single users

Australia\u27s health 2002 : the eighth biennial report of the Australian Institute of Health and Welfare

Australia\u27s Health 2002 is the eighth biennial health report of the Australian Institute of Health and Welfare. It is the nation\u27s authoritative source of information on patterns of health and illness, determinants of health, the supply and use of health services, and health service costs and performance. Australia\u27s Health 2002 is an essential reference and information resource for all Australians with an interest in health

Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans.

BACKGROUND: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. METHODS: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. RESULTS: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. CONCLUSION: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension