Perspectives on healthcare, chronic noncommunicable disease and healthworlds in an urban and rural setting

Background: This study is located within a complex network of paradigmatical methodological, and institutional relationships, and draws concepts from a range of scholastic traditions. The hermeneutical tradition within Sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. The concept of the lifeworld/ healthworld as a description of the complex of health beliefs and behaviours of individuals in relation to the ailing body is used to describe chronic illness and healthcare access, both as lived experience and as fields for public health intervention. Aim: To understand how women living with chronic illness experience their illness and access healthcare in an urban and rural context. Methods: This study is a mixed-methods comparative case study of the healthcare access experiences of women with chronic illness in an urban and rural area in South Africa. The core of the study methodology is a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The urban component of the study was conducted in Birth to Twenty (Bt20), a birth cohort study located in Johannesburg-Soweto. The rural component of the study was conducted in Agincourt, a sub-district of the Bushbuckridge district in Mpumalanga Province. The quantitative context for the Soweto case study uses secondary data collected by Bt20 to construct a historical overview of the use of formal and informal healthcare services in Soweto. It also uses the findings of a large scale cross sectional survey of the primary caregivers of the Bt20 cohort, conducted between November 2008 and June 2010. The rural case study is contextualised by a detailed review of research conducted in the Agincourt sub-district. For the qualitative case studies I employed a qualitative methodology incorporating serial narrative interviews to present an experience-based overview of concepts of disease causation, self treatment and coping. Results: The cross-sectional survey describes a low resource population with a high prevalence of chronic noncommunicable disease (NCDs). Over one third (37.3%) of the population in Soweto could be categorised as having a low socio-economic status, defined as access to only one or less of 5 socio-economic items. Slightly over half the respondents in Soweto (50.7%) reported having at least one chronic illness. Only around a third (33.3%) of the survey participants with chronic illnesses reported accessing formal healthcare services in the last 6 months. Similar trends were found in the review of research carried out in Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how the medicine from the clinic interacts with the body. The search for alternative remedies took place not as an attempt to cure disease, but to reach a deeper understanding of the diseased state of the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. In both study sites there is evidence that traditional healers were consulted for social purposes rather than health-related purposes. Discussion: Soweto and Agincourt share similar patterns of healthcare utilisation and healthcare belief. Both study sites were characterised by increasing trends in formalisation. At the same time, only a small portion of individuals in both study sites with chronic illness utilised formal healthcare services. A consideration of the findings suggests five broad themes for further research: (1) Processes of constructing body narratives; (2) Encounters with purposive-rational systems; (3) Encounters with traditional medicine; (4) Encounters with contemporary informal medicine; and (5) Religion and healthcare. These five themes constitute the beginning of a comprehensive map of the lifeworld/ healthworld schema. Such a schema has implications for healthcare policy and practice, particularly with regard to the development of integrative paradigms in South Africa as exemplified by Community Oriented Primary Care (COPC). Conclusion: The aims and objectives of the study were met through the development of an initial lifeworld/ healthworld schema, which suggests that the coexistence of diverse public healthcare concerns of high NCD prevalence and low formal healthcare utilisation is best addressed through the adoption of integrated healthcare approaches based on lifeworld/ healthworld rationalistion

First benchmark of the Unstructured Grid Adaptation Working Group

Unstructured grid adaptation is a technology that holds the potential to improve the automation and accuracy of computational fluid dynamics and other computational disciplines. Difficulty producing the highly anisotropic elements necessary for simulation on complex curved geometries that satisfies a resolution request has limited this technology's widespread adoption. The Unstructured Grid Adaptation Working Group is an open gathering of researchers working on adapting simplicial meshes to conform to a metric field. Current members span a wide range of institutions including academia, industry, and national laboratories. The purpose of this group is to create a common basis for understanding and improving mesh adaptation. We present our first major contribution: a common set of benchmark cases, including input meshes and analytic metric specifications, that are publicly available to be used for evaluating any mesh adaptation code. We also present the results of several existing codes on these benchmark cases, to illustrate their utility in identifying key challenges common to all codes and important differences between available codes. Future directions are defined to expand this benchmark to mature the technology necessary to impact practical simulation workflows

Query Processing for SPARQL Federations with Data Replication

Data replication and deployment of local SPARQL endpoints improve scalability and availability of public SPARQL endpoints, making the consumption of Linked Data a reality. This solution requires synchronization and specific query processing strategies to take advantage of replication. However, existing replication aware techniques in federations of SPARQL endpoints do not consider data dynamicity. We propose FEDRA, an approach for querying federations of endpoints that benefits from replication. Participants in FEDRA federations can copy fragments of data from several datasets, and describe them using provenance and views. These descriptions enable FEDRA to reduce the number of selected endpoints while satisfying user divergence requirements. Experiments on real-world datasets suggest savings of up to three orders of magnitude

Strategies Employed by Community-Based Service Providers to Address HIV-Associated Neurocognitive Challenges: A Qualitative Study

Background: HIV-associated neurocognitive disorders and other causes of neurocognitive challenges experienced by people living with HIV (PLWH) persist as public health concerns in developed countries. Consequently, PLWH who experience neurocognitive challenges increasingly require social support and mental health services from community-based providers in the HIV sector. Methods: Thirty-three providers from 22 AIDS service organizations across Ontario, Canada, were interviewed to determine the strategies they used to support PLWH experiencing neurocognitive difficulties. Thematic analysis was conducted to determine key themes from the interview data. Results: Three types of strategies were identified: (a) intrapersonal, (b) interpersonal, and (c) organizational. Intrapersonal strategies involved learning and staying informed about causes of neurocognitive challenges. Interpersonal strategies included providing practical assistance, information, counseling, and/or referrals to PLWH. Organizational strategies included creating dedicated support groups for PLWH experiencing neurocognitive challenges, partnering with other organizations with services not available within their own organization, and advocating for greater access to services with expertise and experience working with PLWH. Conclusion: Through concerted efforts in the future, it is likely that empirically investigating, developing, and customizing these strategies specifically to address HIV-associated neurocognitive challenges will yield improved social support and mental health outcomes for PLWH

The clustering of galaxies in the SDSS-III Baryon Oscillation Spectroscopic Survey: single-probe measurements from CMASS anisotropic galaxy clustering

With the largest spectroscopic galaxy survey volume drawn from the SDSS-III Baryon Oscillation Spectroscopic Survey (BOSS), we can extract cosmological constraints from the measurements of redshift and geometric distortions at quasi-linear scales (e.g. above 50 $h^{-1}$Mpc). We analyze the broad-range shape of the monopole and quadrupole correlation functions of the BOSS Data Release 12 (DR12) CMASS galaxy sample, at the effective redshift $z=0.59$, to obtain constraints on the Hubble expansion rate $H(z)$, the angular-diameter distance $D_A(z)$, the normalized growth rate $f(z)\sigma_8(z)$, and the physical matter density $\Omega_mh^2$. We obtain robust measurements by including a polynomial as the model for the systematic errors, and find it works very well against the systematic effects, e.g., ones induced by stars and seeing. We provide accurate measurements $\{D_A(0.59)r_{s,fid}/r_s$ $\rm Mpc$, $H(0.59)r_s/r_{s,fid}$ $km s^{-1} Mpc^{-1}$, $f(0.59)\sigma_8(0.59)$, $\Omega_m h^2\}$ = $\{1427\pm26$, $97.3\pm3.3$, $0.488 \pm 0.060$, $0.135\pm0.016\}$, where $r_s$ is the comoving sound horizon at the drag epoch and $r_{s,fid}=147.66$ Mpc is the sound scale of the fiducial cosmology used in this study. The parameters which are not well constrained by our galaxy clustering analysis are marginalized over with wide flat priors. Since no priors from other data sets, e.g., cosmic microwave background (CMB), are adopted and no dark energy models are assumed, our results from BOSS CMASS galaxy clustering alone may be combined with other data sets, i.e., CMB, SNe, lensing or other galaxy clustering data to constrain the parameters of a given cosmological model. The uncertainty on the dark energy equation of state parameter, $w$, from CMB+CMASS is about 8 per cent. The uncertainty on the curvature fraction, $\Omega_k$, is 0.3 per cent. We do not find deviation from flat $\Lambda$CDM.Comment: 15 pages, 11 figures. The latest version matches and the accepted version by MNRAS. A bug in the first version has been identified and fixed in the new version. We have redone the analysis with newest data (BOSS DR12

Unstructured Grid Adaptation and Solver Technology for Turbulent Flows

Unstructured grid adaptation is a tool to control Computational Fluid Dynamics (CFD) discretization error. However, adaptive grid techniques have made limited impact on production analysis workflows where the control of discretization error is critical to obtaining reliable simulation results. Issues that prevent the use of adaptive grid methods are identified by applying unstructured grid adaptation methods to a series of benchmark cases. Once identified, these challenges to existing adaptive workflows can be addressed. Unstructured grid adaptation is evaluated for test cases described on the Turbulence Modeling Resource (TMR) web site, which documents uniform grid refinement of multiple schemes. The cases are turbulent flow over a Hemisphere Cylinder and an ONERA M6Wing. Adaptive grid force and moment trajectories are shown for three integrated grid adaptation processes with Mach interpolation control and output error based metrics. The integrated grid adaptation process with a finite element (FE) discretization produced results consistent with uniform grid refinement of fixed grids. The integrated grid adaptation processes with finite volume schemes were slower to converge to the reference solution than the FE method. Metric conformity is documented on grid/metric snapshots for five grid adaptation mechanics implementations. These tools produce anisotropic boundary conforming grids requested by the adaptation process

Interpreting the First CMS and ATLAS SUSY Results

The CMS and the ATLAS Collaborations have recently reported on the search for supersymmetry with 35 pb$^{-1}$ of data and have put independent limits on the parameter space of the supergravity unified model with universal boundary conditions at the GUT scale for soft breaking, i.e., the mSUGRA model. We extend this study by examining other regions of the mSUGRA parameter space in $A_0$ and $\tan\beta$. Further, we contrast the reach of CMS and ATLAS with 35 pb$^{-1}$ of data with the indirect constraints, i.e., the constraints from the Higgs boson mass limits, from flavor physics and from the dark matter limits from WMAP. Specifically it is found that a significant part of the parameter space excluded by CMS and ATLAS is essentially already excluded by the indirect constraints and the fertile region of parameter space has yet to be explored. We also emphasize that gluino masses as low as 400 GeV but for squark masses much larger than the gluino mass remain unconstrained and further that much of the hyperbolic branch of radiative electroweak symmetry breaking, with low values of the Higgs mixing parameter $\mu$, is essentially untouched by the recent LHC analysis.Comment: 3 figure panels, 10 plot

The 10th Biennial Hatter Cardiovascular Institute workshop: cellular protection—evaluating new directions in the setting of myocardial infarction, ischaemic stroke, and cardio-oncology

Due to its poor capacity for regeneration, the heart is particularly sensitive to the loss of contractile cardiomyocytes. The onslaught of damage caused by ischaemia and reperfusion, occurring during an acute myocardial infarction and the subsequent reperfusion therapy, can wipe out upwards of a billion cardiomyocytes. A similar program of cell death can cause the irreversible loss of neurons in ischaemic stroke. Similar pathways of lethal cell injury can contribute to other pathologies such as left ventricular dysfunction and heart failure caused by cancer therapy. Consequently, strategies designed to protect the heart from lethal cell injury have the potential to be applicable across all three pathologies. The investigators meeting at the 10th Hatter Cardiovascular Institute workshop examined the parallels between ST-segment elevation myocardial infarction (STEMI), ischaemic stroke, and other pathologies that cause the loss of cardiomyocytes including cancer therapeutic cardiotoxicity. They examined the prospects for protection by remote ischaemic conditioning (RIC) in each scenario, and evaluated impasses and novel opportunities for cellular protection, with the future landscape for RIC in the clinical setting to be determined by the outcome of the large ERIC-PPCI/CONDI2 study. It was agreed that the way forward must include measures to improve experimental methodologies, such that they better reflect the clinical scenario and to judiciously select combinations of therapies targeting specific pathways of cellular death and injury

LPS-TLR4 Pathway mediates ductular cell expansion in alcoholic hepatitis.

Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease for which there are no effective therapies. Patients with AH show impaired hepatocyte proliferation, expansion of inefficient ductular cells and high lipopolysaccharide (LPS) levels. It is unknown whether LPS mediates ductular cell expansion. We performed transcriptome studies and identified keratin 23 (KRT23) as a new ductular cell marker. KRT23 expression correlated with mortality and LPS serum levels. LPS-TLR4 pathway role in ductular cell expansion was assessed in human and mouse progenitor cells, liver slices and liver injured TLR4 KO mice. In AH patients, ductular cell expansion correlated with portal hypertension and collagen expression. Functional studies in ductular cells showed that KRT23 regulates collagen expression. These results support a role for LPS-TLR4 pathway in promoting ductular reaction in AH. Maneuvers aimed at decreasing LPS serum levels in AH patients could have beneficial effects by preventing ductular reaction development

Data on administration of cyclosporine, nicorandil, metoprolol on reperfusion related outcomes in ST-segment Elevation Myocardial Infarction treated with percutaneous coronary intervention

Mortality and morbidity in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) are still high [1]. A huge amount of the myocardial damage is related to the mitochondrial events happening during reperfusion [2]. Several drugs directly and indirectly targeting mitochondria have been administered at the time of the PCI and their effect on fatal (all-cause mortality, cardiovascular (CV) death) and non fatal (hospital readmission for heart failure (HF)) outcomes have been tested showing conflicting results [3]; [4]; [5]; [6]; [7]; [8]; [9]; [10]; [11]; [12]; [13]; [14]; [15] ; [16]. Data from 15 trials have been pooled with the aim to analyze the effect of drug administration versus placebo on outcome [17]. Subgroup analysis are here analyzed: considering only randomized clinical trial (RCT) on cyclosporine or nicorandil [3]; [4]; [5]; [9]; [10] ; [11], excluding a trial on metoprolol [12] and comparing trial with follow-up length <12 months versus those with longer follow-up [3]; [4]; [5]; [6]; [7]; [8]; [9]; [10]; [11]; [12]; [13]; [14]; [15] ; [16]. This article describes data related article titled “Clinical Benefit of Drugs Targeting Mitochondrial Function as an Adjunct to Reperfusion in ST-segment Elevation Myocardial Infarction: a Meta-Analysis of Randomized Clinical Trials” [17]