A study to assess COPD Symptom-based Management and to Optimise treatment Strategy in Japan (COSMOS-J) based on GOLD 2011

Background and objective: The Global initiative for chronic Obstructive Lung Disease(GOLD) Committee has proposed a chronic obstructive pulmonary disease (COPD) assessment framework focused on symptoms and on exacerbation risk. This study will evaluate a symptom and exacerbation risk-based treatment strategy based on GOLD in a real-world setting in Japan. Optimal management of COPD will be determined by assessing symptoms using the COPD Assessment Test (CAT) and by assessing the frequency of exacerbations. Methods: This study (ClinicalTrials.gov identifier: NCT01762800) is a 24-week, multicenter, randomized, double-blind, double-dummy, parallel-group study. It aims to recruit 400 patients with moderate-to-severe COPD. Patients will be randomized to receive treatment with either salmeterol/fluticasone propionate (SFC) 50/250μg twice daily or with tiotropium bromide 18μg once daily. Optimal management of patients will be assessed at four-weekly intervals and, if patients remain symptomatic, as measured using the CAT, or experience an exacerbation, they have the option to step up to treatment with both drugs, ie, SFC twice daily and tiotropium once daily (TRIPLE therapy). The primary endpoint of the study will be the proportion of patients who are able to remain on the randomized therapy. Results: No data are available. This paper summarizes the methodology of the study in advance of the study starting. Conclusion: The results of this study will help physicians to understand whether TRIPLE therapy is more effective than either treatment strategy alone in controlling symptoms and exacerbations in patients with moderate-to-severe COPD. It will also help physicians to understand the GOLD recommendation work in Japan

A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa

Cognitive remediation therapy (CRT) for anorexia nervosa (AN) was developed as an adjuvant treatment to target set-shifting and central coherence inefficiencies important in AN and to ultimately improve clinical outcomes of those with AN. The primary aim of this preliminary systematic review and meta-analysis was to determine the effect of CRT for AN relative to control treatments in randomized-controlled trials (RCTs) on neuropsychological inefficiencies at end-of-treatment. Secondary aims were to assess the effect of CRT for AN on dropout, eating-disorder-related, and other psychological outcomes at end-of-treatment. Systematic review and meta-analytic procedures were conducted in accordance with PRISMA Guidelines. RCTs evaluating CRT for AN compared to a control treatment were identified via ProQuest, PsycINFO, PubMed, and SCOPUS. Seven RCTs and one quasi-RCT of CRT for AN were included. RCT quality ratings ranged from fair (n = 3) to good (n = 4). Random-effects meta-analysis was conducted using Hedge's g. Study heterogeneity was assessed using I2 and publication bias was assessed with Begg's adjusted-rank correlation and the trim-and-fill method. CRT was not associated with improvement in central coherence compared to control treatments at end-of-treatment (g = 0.25, 95% CI = −0.35, 0.85, k = 3). Set-shifting outcomes were mixed due to heterogeneity of set-shifting measures across studies. CRT may prevent dropout; yet, more studies are needed to draw conclusions. CRT did not confer advantage over control treatments for eating-disorder-related and other psychological outcomes at end-of-treatment. Future RCTs of CRT for AN should use precise measures to assess constructs (particularly for set shifting), increase sample size, and implement longitudinal follow-up. (Word Count: 247 words)

One novel virus, different beliefs as playmakers towards disease spread in Africa: looking at COVID-19 from a religious lens.

Religious and spiritual observances that draw large people together are pervasive in many parts of the world, including Africa. With the recent emergence of COVID-19, these mass religious gatherings may pose significant threats to human health. Given the compromised healthcare systems in many parts of Africa, faith-based institutions have a huge responsibility towards the management of the potential spread of the virus through effective organizational strategies or interventions. This essay sheds light on what the novel virus has to do with religion, the role of religious practices in inhibiting or spreading COVID-19, and what appropriate evidence-based interventions religious or faith-based organizations could adopt to help prevent the spread of the disease in Africa through a unity of thoughts for religious action

Africa's COVID-19 Situation in Focus and Recent Happenings: A Mini Review.

Given that COVID-19 (SARS-CoV-2) has crept into Africa, a major public health crisis or threat continues to linger on the continent. Many local governments and various stakeholders have stepped up efforts for early detection and management of COVID-19. This mini review highlights the current trend in Africa, history and general epidemiological information on the virus. Current ongoing efforts (e.g., improving testing capacity) and some effective ways (e.g., intensified surveillance, quick detection, contact tracing, isolation measures [e.g., quarantine], and social distancing) of preventing and managing COVID-19 in Africa are described. The review concludes by emphasizing the need for public health infrastructure development (e.g., laboratories, infectious disease centers, regional hospitals) and human capacity building for combating COVID-19 and potential future outbreaks. Additionally, regular public health educational campaigns are urgently required. Future epidemiological studies to ascertain case fatality and mortality trends across the continent for policy directions are necessary

COVID-19 Pandemic Worsening Gender Inequalities for Women and Girls in Sub-Saharan Africa

Pandemics such as COVID-19 have often resulted in international, national and sub-regional crises, with considerable inequities across many societies. With the already existing structural and socio-economic inequalities in sub-Saharan Africa, the stay-at-home orders, lockdowns, and shutdowns across the sub-regional states could worsen and have a tremendous impact on vulnerable groups. Numerous studies across a variety of contexts have well-documented gender, and cultures on varied health outcomes. However, these have not been contextualized in sub-Saharan Africa in the light of the COVID-19 pandemic. This mini review discusses the ways by which COVID-19 has impacted the lives of girls and women across sub-Saharan Africa and the strategies that can help mitigate these challenges. The mini review specifically shares light on a wide array of dimensions where the inequities exist. These include the disproportionate areas affected by COVID-19; household inequities; educational inequalities; work/employment inequalities; disparities related to healthcare, sexual and reproductive health as well as housing inequities. Conclusively, the review accentuates the need for sub-Saharan African countries to adopt low-cost preventive measures such as discouraging mass gatherings (e.g., local community gatherings), and face masking with non-medical cloth like masks for the local populace as these are crucial in managing the spread of the virus among disproportionate women population. For localities with limited access to handwashing facilities, alternative strategies like alcohol-based hand rub solutions could be deployed. The complex interrelated disparities require a broad set of policy actions to lessen the current burden faced by many women in sub-Saharan Africa

Linking Female Adolescents’ Knowledge, Attitudes and Use of Contraceptives to Adolescent Pregnancy in Ghana: A Baseline Data for Developing Sexuality Education Programmes

(1) Background: Nearly one out of ten Ghanaian female adolescents aged 15–19 has experienced childbearing in urban settlements compared to twice this number in the rural populations due to unintended pregnancies. This study assessed the linkages between knowledge, attitudes, and use of contraceptives and adolescent pregnancy in one of the highly affected Municipalities (i.e., Komenda-Edina-Eguafo Abrem [KEEA]) in Ghana. (2) Methods: Employing a facility-based sampling method, 378 female adolescents aged 15–19 were selected. Unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CI) and p-values were used for significant variables at p < 0.05. (3) Results: Pregnant adolescents were 2 times more likely to indicate that the procedure of procuring contraceptives is quite uncomfortable (aOR = 2.42, 95% CI = [1.29–4.55]; p = 0.006). Also, pregnant adolescents were 5 times more likely to have ever used traditional contraceptive methods than their non-pregnant counterparts (aOR = 5.02, 95% CI = [2.60–9.71]; p < 0.001). On the contrary, pregnant adolescents had lower odds of indicating that contraceptives are for only married people (aOR = 0.38, 95% CI = [0.20–0.70]; p = 0.002) and that it feels bad to receive contraceptive information from parents and relatives than non-pregnant adolescents (aOR = 0.42, 95% CI = [0.24–0.74]; p = 0.003). Pregnant adolescents were less likely to use modern contraceptives than their non-pregnant adolescents (aOR = 0.18, 95% CI = [0.11–0.31]; p < 0.001). (4) Conclusions: The findings indicate that female adolescents’ use of traditional contraceptives is associated with the risk of pregnancy in KEEA Municipality within the Central Region of Ghana. However, adolescents who had the perception that contraceptives are for married people and those who used modern contraceptives were less likely to get pregnant. Government and non-governmental organizations in Ghana should implement educational policies and programmes aimed at educating sexually-active female adolescents on modern contraceptives and the need to use them to prevent pregnancies. The basis for such policies and programmes should be based on evidence that compared to traditional contraceptives, modern contraceptives are more effective. In addition, there is the need to provide accurate information regarding the use of contraceptives to adolescents that will help change their attitudes towards the use of contraceptives

Spatially Resolved Mapping of Local Polarization Dynamics in an Ergodic Phase of Ferroelectric Relaxor

Spatial variability of polarization relaxation kinetics in relaxor ferroelectric 0.9Pb(Mg1/3Nb2/3)O3-0.1PbTiO3 is studied using time-resolved Piezoresponse Force Microscopy. Local relaxation attributed to the reorientation of polar nanoregions is shown to follow stretched exponential dependence, exp(-(t/tau)^beta), with beta~~0.4, much larger than the macroscopic value determined from dielectric spectra (beta~~0.09). The spatial inhomogeneity of relaxation time distributions with the presence of 100-200 nm "fast" and "slow" regions is observed. The results are analyzed to map the Vogel-Fulcher temperatures on the nanoscale.Comment: 23 pages, 4 figures, supplementary materials attached; to be submitted to Phys. Rev. Let

Understanding the linkages between male circumcision and multiple sexual partnership among married Ghanaian men: Analysis of data from the 2014 Ghana demographic and health survey.

IntroductionThis current study sought to investigate the association between male circumcision status and engaging in multiple sexual partnership among men in Ghana.MethodsData from this study come from the men's file of the 2014 Ghana demographic and health survey. Both descriptive and inferential statistics were conducted among 1, 948 men and the level of statistical significance was pegged at p ResultsResults revealed that men who have been circumcised were more likely to engage in multiple sexual partnership (AOR = 3.36; CI:1.14-9.89), compared to those who have not been circumcised. With the covariates, men with primary level of education were more likely to have multiple sexual partners (AOR = 2.01; CI:1.10-3.69), compared to those with no education. With wealth status, men with richest (AOR = 2.27; CI:1.04-4.97), richer (AOR = 2.05; CI: 1.03-4.08), and middle wealth status (AOR = 1.83; CI:1.01-3.34) had the highest likelihood of having multiple sexual partners, compared to those with poorest wealth status. Conversely, men who professed the Islamic faith were less likely to engage in multiple sexual partnership (AOR = 0.58; CI: 0.36-0.94), compared to Christians. Similarly, men who resided in the Brong Ahafo (AOR = 0.51; CI: 0.26-0.99), Upper East (AOR = 0.41; CI:0.19-0.89), and Ashanti regions (AOR = 0.39; CI: 0.20-0.78) were less likely to engage in multiple sexual partnership.ConclusionBased on the current findings, educational campaigns by stakeholder groups (e.g., Ministry of Health in collaboration with the National Commission on Civic Education, civil society, educational institutions) should sensitize the sexually active population at the community level to consistently use condoms, especially when they have multiple sexual partners, even when a man is circumcised. Campaign messages must clearly emphasize that male circumcision should not substitute precautionary measures such as delay in the onset of sexual relationships, averting penetrative sex, reducing the number of sexual partners as well as correct and consistent use of male or female condoms regardless one's social standing

Vortex Glass and Vortex Liquid in Oscillatory Media

We study the disordered, multi-spiral solutions of two-dimensional homogeneous oscillatory media for parameter values at which the single spiral/vortex solution is fully stable. In the framework of the complex Ginzburg-Landau (CGLE) equation, we show that these states, heretofore believed to be static, actually evolve on ultra-slow timescales. This is achieved via a reduction of the CGLE to the evolution of the sole vortex position and phase coordinates. This true defect-mediated turbulence occurs in two distinct phases, a vortex liquid characterized by normal diffusion of individual spirals, and a slowly relaxing, intermittent, ``vortex glass''.Comment: 4 pages, 2 figures, submitted to Physical Review Letter