An investigation into the challenges and limitations of implementing universal pulse oximetry screening for critical congenital heart disease in asymptomatic newborns

Neonatal pulse oximetry has been identified as an important screening tool for critical congenital heart disease. This oximetry screening, although mandatory in many developed countries, is not routinely implemented in South African hospitals.The objective of this study was therefore to determine the feasibility of implementing pulse oximetry in a typical level 2 hospital in the province of KwaZulu-Natal. Challenges and limitations experienced in implementing the screening were documented.The study was an observational analytical descriptive study which was conducted in the postnatal ward of Addington Hospital, Durban. Nursing staff were educated regarding the importance of pulse oximetry screening and were subsequently trained to perform the procedure.A total of 2 453 newborns were admitted to the hospital from January to August 2016 with 599 of these being eligible for enrolment in the study. Consent and screening were initially performed by participating nursing staff. During the last 4 months, consent was obtained by a dedicated research assistant. Of the 599 eligible newborns, 22 were excluded resulting in 577 being available for analysis. There were 29 newborns who fulfilled criteria for a second screening, however, in 21 of these newborns, the protocol was not appropriately followed.This study suggests that while routine neonatal saturation monitoring appears to be a simple, cost-effective tool to detect critical congenital heart disease, several barriers to its implementation were detected. The main barriers were inadequate staffing and infrastructure. This, in turn, highlighted the need for appropriate human resource provision and training as well as adequate infrastructure. These may not be easily achievable in a resource constrained environment

Prevalence patterns and predictors of alcohol use and abuse among secondary school students in southern KwaZulu-Natal, South Africa: demographic factors and the influence of parents and peers

Background: The prevalence and predictors of alcohol use and abuse among school students were investigated with the aim of gaining insight to guide prevention interventions.Method: A cross-sectional, self-administered survey pertaining to a one-month period was conducted among students in grades 11 and 12 in purposively selected schools with mixed-race groups. Frequencies and ÷2 analyses were conducted and forward stepwise, conditional entry logistic regression models were fitted to determine the significant demographicpredictors and influence of peers and parents on students’ alcohol use and binge drinking.Results: About 54% of students had used alcohol before, while 14.5% had had their first drink before the age of 13. In the relevant month, 41% used alcohol and 32% engaged in binge drinking. Students who were more likely to have used alcohol in the preceding month were older [odds ratio (OR) = 1.44, P = 0.006], male (OR = 2.1, P < 0.001), white (OR = 5.1,P < 0.001), had often seen their fathers drunk (OR = 1.9, P < 0.001) and had friends who frequently use alcohol (OR = 3.5, P < 0.001). Students who were more likely to report binge drinking in the preceding month were older (OR = 1.6, P < 0.001), male (OR = 2.4, P < 0.001), white (OR = 1.6, P = 0.048), had often seen their fathers (OR = 1.5, P = 0.001) and mothers (OR = 1.4, P = 0.05) drunk and had friends who frequently use alcohol (OR = 3.6, P < 0.001).Conclusion: The long-term consequences of hazardous drinking patterns initiated during adolescence may have negative effects on achievement in life, health and general well-being, and therefore these patterns are in need of urgent address. While older, white male students are at particular risk, the significant influence of peer and parental alcohol use is  highlighted and should be considered when developing prevention interventions in schools

Infant feeding practices of teenage mothers attending a well-baby clinic in a public hospital in Umlazi, KwaZulu-Natal, South Africa

Objective: This study aimed to determine the breastfeeding practices of urban, predominantly isiZulu speaking, South African teenage mothers, and to examine factors associated with breastfeeding.Study Design and Methods: A cross-sectional study was conducted with 73 mothers (aged 15 to 19 years) who were attending a well-baby clinic for their infant’s scheduled 14-week immunisation visit. A face-to-face interview was conducted with each mother in isiZulu (n = 66) or English (n = 7) by a trained research assistant. Close ended questions included; socio-demographic characteristics; obstetric history; and, breastfeeding practices while open-ended questions explored reasons for early cessation of breastfeeding, and perceptions of how the family, health care workers, and the school could support teenage mothers with breastfeeding.Results: All 73 mothers had initiated breastfeeding; however, by the time of the interview, 31.5% had stopped breastfeeding. A multivariate logistic regression model was used to predict the likelihood of early breastfeeding cessation. The odds ratio of early breastfeeding cessation for teenage mothers below the age of ≤ 17 years was 17.3% higher compared to teenage mothers older than 17 years (OR 1.17, 95% CI:0.617–2.269); 8.6% higher for teenage mothers who completed their grade 11 and above compared those who did not complete grade 11 and above (OR 1.17, 95% CI:0.617–2.269); and, 79.5% (OR 1.795, 95% CI:0.565– 5.739) higher for teenage mothers who experienced breastfeeding problems compared to mothers without breastfeeding problems. However, since the 95% CI for these odds ratios spanned the null value (1.0), the increased odds were not statistically significant.Conclusion: The elevated odds of early breastfeeding cessation were associated with a young maternal age (≤ 17 years) and experiencing breastfeeding problems. This highlights the importance of targeting adolescent mothers for support and promotion of breastfeeding, noting the influence of society and peer pressure. It is also clear that the healthcare workers, schools and communities have an important role to play in supporting breastfeeding teenage mothers, especially in providing accurate information and support for the prevention of breastfeeding problems.Keywords: infant feeding practices, teenage mothers, well-baby clini

Crystal structural analysis of human serum albumin complexed with hemin and fatty acid

BACKGROUND: Human serum albumin (HSA) is an abundant plasma protein that binds a wide variety of hydrophobic ligands including fatty acids, bilirubin, thyroxine and hemin. Although HSA-heme complexes do not bind oxygen reversibly, it may be possible to develop modified HSA proteins or heme groups that will confer this ability on the complex. RESULTS: We present here the crystal structure of a ternary HSA-hemin-myristate complex, formed at a 1:1:4 molar ratio, that contains a single hemin group bound to subdomain IB and myristate bound at six sites. The complex displays a conformation that is intermediate between defatted HSA and HSA-fatty acid complexes; this is likely to be due to low myristate occupancy in the fatty acid binding sites that drive the conformational change. The hemin group is bound within a narrow D-shaped hydrophobic cavity which usually accommodates fatty acid; the hemin propionate groups are coordinated by a triad of basic residues at the pocket entrance. The iron atom in the centre of the hemin is coordinated by Tyr161. CONCLUSION: The structure of the HSA-hemin-myristate complex (PDB ID 1o9x) reveals the key polar and hydrophobic interactions that determine the hemin-binding specificity of HSA. The details of the hemin-binding environment of HSA provide a structural foundation for efforts to modify the protein and/or the heme molecule in order to engineer complexes that have favourable oxygen-binding properties

Improved prediction equations for estimating height in adults from ethnically diverse backgrounds

Background & aims When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice. Methods Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180). Results UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (H p) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (H p (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was −0.6 (−2.4, +1.2); Asian women, (H p = 3.26 UL + 77.62), mean difference +0.5 (−1.4, 2.4) cm. For Black men, H p = 3.14 UL + 85.80, −0.4 (−2.4, 1.7); Black women, H p = 3.14 UL + 79.55, −0.8 (−2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height. Conclusions The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations

Immune sensing of Candida albicnas

Candida albicans infections range from superficial to systemic and are one of the leading causes of fungus-associated nosocomial infections. The innate immune responses during these various infection types differ, suggesting that the host environment plays a key role in modulating the host–pathogen interaction. In addition, C. albicans is able to remodel its cell wall in response to environmental conditions to evade host clearance mechanisms and establish infection in niches, such as the oral and vaginal mucosa. Phagocytes play a key role in clearing C. albicans, which is primarily mediated by Pathogen Associated Molecular Pattern (PAMP)–Pattern Recognition Receptor (PRR) interactions. PRRs such as Dectin-1, DC-SIGN, and TLR2 and TLR4 interact with PAMPs such as β-glucans, N-mannan and O-mannan, respectively, to trigger the activation of innate immune cells. Innate immune cells exhibit distinct yet overlapping repertoires of PAMPs, resulting in the preferential recognition of particular Candida morphotypes by them. The role of phagocytes in the context of individual infection types also differs, with neutrophils playing a prominent role in kidney infections, and dendritic cells playing a prominent role in skin infections. In this review, we provide an overview of the key receptors involved in the detection of C. albicans and discuss the differential innate immune responses to C. albicans seen in different infection types such as vulvovaginal candidiasis (VVC) and oral candidiasis

'You were quiet - I did all the marching': Research processes involved in hearing the voices of South Asian girls

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.This article provides insights into the outcomes of reflection following two interview approaches used to explore narratives of the lived, individual experiences of South-Asian girls living in West London. In attempting to illuminate and re-present the cultural experiences as told by these girls, the choice of interview approach became critical in allowing the voices to be effectively heard (Rogers, 2005). This article therefore considers how a semi-structured interview approach offered valuable insights into the girls' experiences but became constraining for both researcher and participant in unveiling the complexity and depth of their lives. These constraints emerged through reflection by both participants and researcher. As a result of reflexivity during the research process, the researcher moved towards the use of research conversations during the second phase of the study. Ultimately the study revealed how the girls felt empowered by the opportunity to narrate their individual experiences and tell of their lives. In narrating their reflections on being part of the research, there was a clear recognition that the process facilitated the articulation of new voices and ‘multi-voicedness’ (Moen, 2006

Delineating ethnic and religious identities in research with British South Asians

The present essay presents a rationale for delineating ethnic and religious identities in empirical research into self-identification among British South Asians. It is argued that the delineation of these identities is important in order to (i) predict and explain the identificatory possibilities available to these individuals; (ii) explore the differential values attributed to these identities; (iii) the level of psychological 'connectedness' between the identities; and (iv) the inter-relations between these identities, particularly in relation to psychological coherence. It is argued that a systematic delineation of these identities may have favourable theoretical, empirical and practical outcomes

Interaction of anticancer reduced Schiff base coumarin derivatives with human serum albumin investigated by fluorescence quenching and molecular modeling

The specific binding of five reduced Schiff base derived 7-amino-coumarin compounds with antitumor activity to human serum albumin, the principal binding protein of blood, was studied by fluorescence spectroscopy. Their conditional binding constants were computed and the reversible binding at the Sudlow’s site I was found to be strong (KD ~ 0.03-2.09 M). Based on the data albumin can provide a depot for the compounds and is responsible for their biodistribution and transport processes. The experimental data is complemented by protein– ligand docking calculations for two representatives which support the observations. The proton dissociation constants of the compounds were also determined by UV-Vis spectrophotometric and fluorometric titrations to obtain the actual charges and distribution of the species in the various protonation states at physiological pH

Exploratory investigation of drivers of attainment in ethnic minority adult learners

There is evidence that ethnic minority learners in further education in England either under-achieve or are under-represented because they face various inhibitors connected to their ethnicity. Motivators may be in place, however, which increase attainment specifically for some ethnic groups. This exploratory study intends to examine what works and what does not among South Asian (Pakistani and Bangladeshi heritage) females and black male adult learners in FE. A mixed-method study was carried out using questionnaires and focus groups with 68 ethnic minority students in three further education colleges in England. The combination of the results showed that being a member of a minority culture and/or religion may increase feelings of isolation in academic settings; teaching staff who are knowledgeable about the student’s culture increase feelings of inclusion; and role models are crucially important. Results are discussed in light of British data of school experiences of ethnic minority learners