Formative Evaluation of a Hepatitis C Virus Computer Assisted Instruction Tool or Communities of African Descent

Hepatitis C Virus (HCV) has become increasingly prevalent within traditionally undeserved communities. The paper describes the formative evaluation of a HCV Computer Assisted Instruction (CAI) tool. Specific aims are to describe the feasibility of a CAI tool with a high-risk population, and the use of Nigrescence Theory to develop targeted messages. Three participants, recruited at an all-male substance abuse halfway house, reviewed the CAI in a mini-focus group. A Health History/HCV Knowledge Questionnaire, The Cross Racial Identity Scale and a focus group question route were used to collect qualitative and quantitative data. The analysis plan utilized descriptive statistics, content analysis and profile analysis. Results suggested that the CAI was acceptable to this segment of the population, and Nigrescence Theory provided a context for targeting messages to differing segments of the target group. Recommendations are offered to health promotion programs targeting people of African descent

Culture Creates Bonds

The Culture Creates Bonds study defines key drivers, scenarios, and conditions that create natural human bonds, those of cultural activities and practices, in a residential or immediate neighbourhood. Historical and contemporary research indicates that cultural contexts, content, and activities act as mechanisms and factors that create a sense of identity, engagement, and relationships within and between communities. Research explores constraints as well as conditions that lead to successful bonding. The study applies a mixed methods approach that includes a literature review; interviews with stakeholders; an analysis of the data and results from the 2017 Culture Track Canada report, and a series of case studies

Exaggerated blood pressure response to dynamic exercise despite chronic refractory hypotension : results of a human case study

BACKGROUND: Chronic refractory hypotension is a rare but significant mortality risk in renal failure patients. Such aberrant physiology usually deems patient unfit for renal transplant surgery. Exercise stimulates the mechano-chemoreceptors in the skeletal muscle thereby modulating the sympathetic effects on blood pressure regulation. The haemodynamic response to dynamic exercise in such patients has not been previously investigated. We present a case with severe chronic hypotension who underwent exercise testing before and after renal transplantation, with marked differences in blood pressure response to exercise. CASE PRESENTATION: A 40-year old haemodialysis-dependent patient with a 2 year history of refractory hypotension (≤80/50 mmHg) was referred for living donor renal transplantation at our tertiary centre. Each dialysis session was often less than 2 h and 30 min due to symptomatic hypotension. As part of the cardiovascular assessment, she underwent haemodynamic evaluation with cardiopulmonary exercise testing. Blood pressure normalized during unloaded pedalling but was exaggerated at maximal workload whereby it rose from 82/50 mmHg to a peak of 201/120 mmHg. Transthoracic echocardiography, tonometric measure of central vascular compliance and myocardial perfusion scan were normal. She subsequently underwent an antibody-incompatible renal transplantation and was vasopressor reliant for 14 days during the post-operative period. Eight weeks following transplant, resting blood pressure was normal and a physiological exercise-haemodynamic response was observed during a repeat cardiopulmonary exercise testing. CONCLUSION: This case highlights the potential therapeutic role of unloaded leg cycling exercise during dialysis session to correct chronic hypotension, allowing patients to have greater tolerance to fluid shift. It also adds to existing evidence that sympathetic dysfunction is reversible with renal transplant. Furthermore chronic hypotension with preserved exercise-haemodynamic response and cardiovascular reserve should not preclude these patients from renal transplant surgery

Research for TRAN Committee – European Tourism Labelling

This study focusses on the current situation in the European Union regarding quality and sustainability labelling in tourism. There is concern that the existing volume and variety of labels has become a barrier to consumer choice, which in consequence may lead to lost opportunities to increase the competitiveness of the European tourism industry. The study analyses the possibility of the introduction of an EU standard(s) for tourism services through the initiation of a harmonised EU certification system and the potential for the establishment of a single European tourism label

A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial

Medical Research Council, UK Department for International Development, and Wellcome Trust

Pneumonia and exposure to household air pollution in children under the age of 5 years in rural Malawi findings from the Cooking And Pneumonia Study

Background Exposure to household air pollution is associated with an increased risk of pneumonia in children in low- and middle-income countries, however exposure-response data are limited and there are uncertainties around the extent to which biomass-fueled cookstoves can reduce these exposures. Research question What is the association between exposure to household air pollution and pneumonia in children under the age of 5 years in rural Malawi and what are the effects of a biomass-fueled cookstove intervention on personal exposure to household air pollution? Study design and methods We measured personal exposure to carbon monoxide (CO) [48 hours of continuous measurement and transcutaneous carboxyhemoglobin (COHb)] 6-monthly in children participating in a cluster-randomised controlled trial of a cleaner-burning biomass-fueled cookstove intervention to prevent pneumonia in children under the age of 5 years in rural Malawi – the Cooking And Pneumonia Study (CAPS). Exposure-response and multi-variable analyses were done. Results We recruited 1805 (928 intervention; 877 control) children (mean age 25.6 months, 50.6% female). We found no evidence of an association between exposure to CO (IRR=1.0 95% CI:0.967-1.014; p=0.53) or COHb (IRR=1.00 95% CI:0.993-1.003; p=0.41)) in children who experienced pneumonia versus those who did not. Median exposure to CO in the intervention and control groups was was 0.34 ppm (IQR 0.15-0.81) and 0.37 ppm (IQR 0.15-0.97), respectively. The group difference in means was 0.46 (95% CI:-0.95-0.012; p=0.06). Interpretation Exposure to CO in our population was low with no association seen between exposure to CO and pneumonia incidence and no effect of the CAPS intervention on these exposures. These findings suggest that CO may not be an appropriate measure of household air pollution exposure in settings like rural Malawi and that there is a need to develop ways to directly measure particulate matter exposures in young children instead

Tau accumulation in autosomal dominant Alzheimer’s disease: a longitudinal [18F]flortaucipir study

Cortical tau accumulation is a key pathological event that partly defines Alzheimer’s disease (AD) onset and is associated with cognitive decline and future disease progression. However, an improved understanding of the timing and pattern of early tau deposition in AD and how this may be tracked in vivo is needed. Data from 59 participants involved in two longitudinal cohort studies of autosomal dominant AD (ADAD) were used to investigate whether tau PET can detect and track presymptomatic change; seven participants were symptomatic, and 52 were asymptomatic but at a 50% risk of carrying a pathogenic mutation. All had baseline flortaucipir (FTP) PET, MRI and clinical assessments; 26 individuals had more than one FTP PET scan. Standardised uptake value ratios (SUVRs) in prespecified regions of interest (ROIs) were obtained using inferior cerebellar grey matter as the reference region. We compared the changes in FTP SUVRs between presymptomatic carriers, symptomatic carriers and non-carriers, adjusting for age, sex and study site. We also investigated the relationship between regional FTP SUVRs and estimated years to/from symptom onset (EYO). Compared to both non-carriers and presymptomatic carriers, FTP SUVRs were significantly higher in symptomatic carriers in all ROIs tested (p 0.05), although increased FTP signal uptake was seen posteriorly in some individuals around the time of expected symptom onset. When we examined the relationship of FTP SUVR with respect to EYO, the earliest significant regional difference between mutation carriers and non-carriers was detected within the precuneus prior to estimated symptom onset in some cases. This study supports preliminary studies suggesting that presymptomatic tau tracer uptake is rare in ADAD. In cases where early uptake was seen, there was often a predilection for posterior regions (the precuneus and post-cingulate) as opposed to the medial temporal lobe, highlighting the importance of examining in vivo tau uptake beyond the confines of traditional Braak staging

Green transformations in Vietnam's energy sector

Vietnam has experienced rapid economic growth over the past few decades, as well as growing environmental pressures. The country is therefore pursuing strategies for green transformations, which are the processes of restructuring to bring economies and societies within the planetary boundaries. This article addresses the opportunities, barriers, and trade‐offs for green transformations in Vietnam's energy sector and examines them from an energy justice perspective. The article draws on in‐depths expert interviews with representatives from government agencies, private firms, academic institutions, and multilateral institutions in Vietnam. The article finds that Vietnam is undergoing efforts to move away from business as usual by promoting renewable energy and energy efficiency, as well as aligning energy and climate plans with national development priorities such as energy security and economic growth. Yet there is a need for more coordinated, integrated approaches and policies that span across the 3 areas that address green transformations in Vietnam: green growth, sustainable development, and climate change. Finally, although key actors seem to be aware and may be critical of major trade‐offs such as land grabs for energy projects, the impacts on affected people need to be better understood and mitigated

"Cult of equity": actuaries and the transformation of pension fund investing, 1948–1960

This article examines the mid-twentieth-century transformation of U.K. pension fund investment policy known as the “cult of equity.” It focuses on the influence exercised by the Association of Superannuation and Pension Funds over actuarial and corporate governance standards, through actuaries who were members of its council. This intervention led to increasingly permissive actuarial valuations that reduced contributions for sponsors of pension funds investing in equities. Increased demand for equities required pension funds to adopt a more permissive approach to corporate governance than insurance companies and investment trusts, and contributed to declining standards of corporate governance