Coordinated international economic expansion: are convoys or locomotives the answer?

International economic integration

Vitamin D status in healthy black African adults at a tertiary hospital in Nairobi, Kenya: a cross sectional study

Background: Vitamin D has been known since the twentieth Century for its benefits in bone health. Recent observational studies have demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few with vitamin D deficiency ranging from 5 to 91%. A few cut- offs have correlated vitamin D deficiency to physiological markers such as parathyroid hormone (PTH), calcium and phosphate with varying results. Methods: This was a cross sectional study carried out among blood donors at Aga Khan University hospital, Nairobi (AKUHN) from March to May 2015. Vitamin D (25(OH)D) levels were assayed and correlated with PTH, calcium and phosphate. Results: A total of 253 individuals were included in the final analysis. The proportion of study participants who had a 25(OH) D level of \u3c 20 ng/ml thus classified as vitamin D deficient was 17.4% (95% C.I 12.73–22.07). The 25(OH) D level that coincided with a significant increase in PTH was 30 ng/ml. Males were less likely to be vitamin D deficient (O.R 0.48 (C.I 0.233–0.993) p 0.04). Sunshine exposure for ≥3 h per day reduced the odds of being Vitamin D deficient though this was not statistically significant after multivariate regression analysis. Conclusions: We found a much lower prevalence of Vitamin D deficiency compared to many similar studies carried out in sub-Saharan Africa possibly due to the recruitment of healthy individuals and the proximity of Nairobi to the equator which allows for considerable exposure to sunshine. Vitamin D levels below 30 ng/mL was associated with a significant rise in PTH levels, suggesting that this cut off could be appropriate for defining Vitamin D deficiency in the population served by our laboratory

Carriage of sub-microscopic sexual and asexual Plasmodium falciparum stages in the dry season at Navrongo, Ghana

Background: We investigated the prevalence of sub-microscopic Plasmodium falciparum infections and gametocyte carriage in asymptomatic individuals in Navrongo in northern Ghana, an area of seasonal malaria transmission.Design: A cross sectional study of 209 randomly selected participants of all age-groups was conducted in February and March, 2015.Methods: Capillary blood samples collected from these individuals were used for the detection of both asexual and gametocyte stage parasites by microscopy, reverse transcriptase polymerase chain reaction (RT-PCR) and conventional nested PCR methods. The prevalence data as determined by microscopy and molecular methods were comparedusing chi-square tests.Results: Parasitaemia from these asymptomatic infections ranged from 40 to 3,520 parasites/l of blood (geometric mean parasitaemia = 732 parasites/l). The prevalence of asymptomatic P. falciparum carriage was 4.8% (10/209) and 13.9% (29/209) using microscopy and RT-PCR respectively. The overall prevalence of sub-microscopic infectionsin the total number of samples analysed was 9.1% (19/209) and 66% (19/29) of the asymptomatic infections. P. falciparum gametocytemia detected by microscopy was 1% (2/209) and 3.8% (8/209) by PCR.Conclusion: This is the first report of sub-microscopic asexual and gametocytes infections in the dry season in a seasonal malaria transmission area in Ghana. It has established that persistent latent malaria infections occur and that these could supply the source of parasites for the next transmission season. The findings highlight the presence of sub-microscopic infections and therefore the need for active case detection surveillance to eliminate "asymptomatic reservoir" parasites and consequently break the transmission of the disease in Ghana.Funding: Bill and Melinda Gates Foundation grant awarded to Noguchi Memorial Institute for Medical Research Postdoctoral and Postgraduate Training in Infectious Diseases Research (Global Health Grant # OPP52155); National Institutes of Health grant (NIH-NIAID RO1 # 1RO1AI099623) to MDW; European Developing Countries Clinical Trials Partnership (EDCTP)-West African Network of Excellence for Clinical Trials in TB, AIDS and Malaria (WANETAM) (Project code CB.07.41700.007).Keywords: Plasmodium falciparum, asymptomatic infections, sub-microscopic infections, microscopy, reverse transcriptase PCR, Navrong

Regional Development: Challenges, Methods, and Models

This Web Book reviews the challenges that the consideration of regions brings into economic analysis and provide an overview of some of the key methods and tools that can be used to gain a better understanding of how regional economies work, and through that, identify both the challenges and opportunities that they face. The exploration of these challenges begins with some consideration of the ways in which regional economies work to set the stage for subsequent sections that summarize a toolbox of methods and strategies that might be considered for evaluation of regional development initiatives. In contrast to past reviews of this field, this report presents an integration of more traditional regional macroeconomic modeling with new developments in spatial data analysis.https://researchrepository.wvu.edu/rri-web-book/1001/thumbnail.jp

Real-world heart rate norms in the Health eHeart study.

Emerging technology allows patients to measure and record their heart rate (HR) remotely by photoplethysmography (PPG) using smart devices like smartphones. However, the validity and expected distribution of such measurements are unclear, making it difficult for physicians to help patients interpret real-world, remote and on-demand HR measurements. Our goal was to validate HR-PPG, measured using a smartphone app, against HR-electrocardiogram (ECG) measurements and describe out-of-clinic, real-world, HR-PPG values according to age, demographics, body mass index, physical activity level, and disease. To validate the measurements, we obtained simultaneous HR-PPG and HR-ECG in 50 consecutive patients at our cardiology clinic. We then used data from participants enrolled in the Health eHeart cohort between 1 April 2014 and 30 April 2018 to derive real-world norms of HR-PPG according to demographics and medical conditions. HR-PPG and HR-ECG were highly correlated (Intraclass correlation = 0.90). A total of 66,788 Health eHeart Study participants contributed 3,144,332 HR-PPG measurements. The mean real-world HR was 79.1 bpm ± 14.5. The 95th percentile of real-world HR was ≤110 in individuals aged 18-45, ≤100 in those aged 45-60 and ≤95 bpm in individuals older than 60 years old. In multivariable linear regression, the number of medical conditions, female gender, increasing body mass index, and being Hispanic was associated with an increased HR, whereas increasing age was associated with a reduced HR. Our study provides the largest real-world norms for remotely obtained, real-world HR according to various strata and they may help physicians interpret and engage with patients presenting such data

Reconciling conflicting electrophysiological findings on the guidance of attention by working memory

Abstract Maintaining a representation in working memory has been proposed to be sufficient for the execution of topdown attentional control. Two recent electrophysiological studies that recorded event-related potentials (ERPs) during similar paradigms have tested this proposal, but have reported contradictory findings. The goal of the present study was to reconcile these previous reports. To this end, we used the stimuli from one stud

Social Security Financing

The Old-Age and Survivors Insurance (OASI) program, the largest of the social security programs, will not have sufficient resources to meet its benefit payments on time in July 1983. Even if the program were permitted to continue to borrow from the other social security programs, the financial the shortfall would re-emerge in 1984

Cough and reflux esophagitis in children: their co-existence and airway cellularity

BACKGROUND: There are no prospective studies that have examined for chronic cough in children without lung disease but with gastroesophageal reflux (GER). In otherwise healthy children undergoing flexible upper gastrointestinal endoscopy (esophago-gastroscopy), the aims of the study were to (1) define the frequency of cough in relation to symptoms of GER, (2) examine if children with cough and reflux esophagitis (RE) have different airway cellularity and microbiology in bronchoalveolar lavage (BAL) when compared to those without. METHODS: Data specific for chronic cough (>4-weeks), symptoms of GER and cough severity were collected. Children aged <16-years (n = 150) were defined as 'coughers' (C+) if a history of cough in association with their GER symptoms was elicited before BAL were obtained during elective esophago-gastroscopy. Presence of esophagitis on esophageal biopsies was considered reflux esophagitis positive (E+). RESULTS: C+ (n = 69) were just as likely as C- (n = 81) to have esophagitis, odds ratio 0.87 (95%CI 0.46, 1.7). Median neutrophil percentage in BAL was significantly different between groups; highest in C+E- (7, IQR 28) and lowest in C-E+ (5, IQR 6). BAL positive bacterial culture occurred in 20.7% and were more likely present in current coughers (OR 3.37, 95%CI 1.39, 8.08). Airway neutrophilia (median 20%, IQR 34) was significantly higher in those with BAL positive bacterial cultures than those without (5%, 4; p = 0.0001). CONCLUSION: In children without lung disease, the common co-existence of cough with symptoms of GER is independent of the occurrence of esophagitis. Airway neutrophilia when present in these children is more likely to be related to airway bacterial infection and not to esophagitis

What not to look for: Electrophysiological evidence that searchers prefer positive templates

To-be-attended information can be specified either with positive cues (I'll be wearing a blue shirt) or with negative cues (I won't be wearing a red shirt). Numerous experiments have found that positive cues help search more than negative cues. Given that negative cues produce smaller benefits compared to positive cues, it stands to reason that searchers may choose to use positive templates instead of negative templates if given the opportunity. Here, we evaluate this possibility with behavioral measures as well as by directly measuring the formation of positive and negative templates with event-related potentials. Analysis of the contralateral delay activity (CDA) elicited by cues revealed that positive and negative templates relied on working memory to the same extent, even when negative working memory templates could have been circumvented by relying on long-term memories of target colors. Whereas the CDA did not discriminate positive and negative templates, a CNV-like potential did, suggesting cognitive differences between positive and negative templates beyond visual working memory. However, when both positive and negative information were presented in each cue, participants preferred to make use of the positive cues, as indicated by a CDA contralateral to the positive color in negative cue blocks, and a lack of search benefits for positive- and negative-color cues relative to positive-color cues alone. Our results show that searchers elect to selectively encode only positive information into visual working memory when both positive and negative information are available