PastoralScape : an environment-driven model of vaccination decision making within pastoralist groups in East Africa

Economic and cultural resilience among pastoralists in East Africa is threatened by the interconnected forces of climate change and contagious diseases spread. A key factor in the resilience of livestock dependent communities is human decision making regarding vaccination against preventable diseases such as Rift Valley fever and Contagious Bovine Pleuropneumonia. The relationship between healthy and productive livestock and economic development of poor households and communities is mediated by human decision making. This paper describes a coupled human and natural systems agent-based model that focuses on One Health. Disease propagation and animal nutritional health are driven by historical GIS data that captures changes in foraging condition. The results of a series of experiments are presented that demonstrate the sensitivity of a transformed Random Field Ising Model of human decision making to changes in human memory and rationality parameters. Results presented communicate that convergence in the splitting of households between vaccinating or not is achieved for combinations of memory and rationality. The interaction of these cognition parameters with public information and social networks of opinions is detailed. This version of the PastoralScape model is intended to form the basis upon which richer economic and human factor models can be built. © 2021, University of Surrey. All rights reserved

Human Rights and Humanitarian Law in Collision: A Study of the Case of Omar Khadr, a Child Soldier Detained at Guantanamo

Omar Khadr, age 15 and a citizen of Canada, was given emergency medical care for near-fatal gun-shot wounds and taken into custody by U.S. forces in Afghanistan on July 27, 2002. U.S. military forces had been in that country since October of 2001, only a month after the devastating attacks on the United States of September 11. Omar Khadr was, without doubt, a child on the date of his detention and all prior dates of his alleged criminal conduct. He was, however, caught up on that July day in a prolonged military encounter with deaths on both sides including, very nearly, his own. Some would thus first characterize him not as a child but as a combatant – “child soldier” is the term most often applied in such situations, but the more neutral “child in armed conflict” is generally used here

Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study

Objective : To compare the characteristics of patients with cerebrovascular disease in primary care with those of the participants in the PROGRESS trial, on which national guidelines for blood pressure lowering are based. Design : Population based cross sectional survey of patients with confirmed stroke or transient ischaemic attack. Setting : Seven general practices in South Birmingham, England. Participants : All patients with a validated history of stroke (n = 413) or transient ischaemic attack (n = 107). Main outcome measures Patient characteristics: age, sex, time since last cerebrovascular event, blood pressure, and whether receiving antihypertensive treatment. Results : Patients were 12 years older than the participants in PROGRESS and twice as likely to be women. The median time that had elapsed since their cerebrovascular event was two and a half years, compared with eight months in PROGRESS. The systolic blood pressure of 315 (61%) patients was over 140 mm Hg, and for 399 (77%) it was over 130 mm Hg. One hundred and forty seven (28%) patients were receiving a thiazide diuretic, and 136 (26%) were receiving an angiotensin converting enzyme inhibitor. Conclusions : Important differences exist between the PROGRESS trial participants and a typical primary care stroke population, which undermine the applicability of the trial’s findings. Research in appropriate populations is urgently needed before the international guidelines are implemented in primary care

Bostonia. Volume 4

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Tidal breathing parameters measured by structured light plethysmography in children aged 2-12 years recovering from acute asthma/wheeze compared with healthy children

© 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.Peer reviewedPublisher PD

The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design.

BACKGROUND: Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge. All patients with suspected heart failure should be diagnosed using objective tests such as echocardiography, but it is expensive, often delayed, and limited by the significant skill shortage of trained echocardiographers. Alternative approaches for diagnosing heart failure are currently limited. Clinical decision tools that combine clinical signs, symptoms or patient characteristics are designed to be used to support clinical decision-making and validated according to strict methodological procedures. The REFER Study aims to determine the accuracy and cost-effectiveness of our previously derived novel, simple clinical decision rule, a natriuretic peptide assay, or their combination, in the triage for referral for echocardiography of symptomatic adult patients who present in general practice with symptoms suggestive of heart failure. METHODS/DESIGN: This is a prospective, Phase II observational, diagnostic validation study of a clinical decision rule, natriuretic peptides or their combination, for diagnosing heart failure in primary care. Consecutive adult primary care patients 55 years of age or over presenting to their general practitioner with a chief complaint of recent new onset shortness of breath, lethargy or peripheral ankle oedema of over 48 hours duration, with no obvious recurrent, acute or self-limiting cause will be enrolled. Our reference standard is based upon a three step expert specialist consensus using echocardiography and clinical variables and tests. DISCUSSION: Our clinical decision rule offers a potential solution to the diagnostic challenge of providing a timely and accurate diagnosis of heart failure in primary care. Study results will provide an evidence-base from which to develop heart failure care pathway recommendations and may be useful in standardising care. If demonstrated to be effective, the clinical decision rule will be of interest to researchers, policy makers and general practitioners worldwide. TRIAL REGISTRATION: ISRCTN17635379.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the Avon Longitudinal Study of Parents and Children (ALSPAC) geographically defined childhood population

Objective: To determine whether early ear and upper respiratory signs are associated with the development of high levels of autistic traits or diagnosed autism. Design: Longitudinal birth cohort: Avon Longitudinal Study of Parents and Children (ALSPAC). Setting: Area centred on the city of Bristol in Southwest England. Eligible pregnant women resident in the area with expected date of delivery between April 1991 and December 1992 inclusive. Participants: 10 000+ young children followed throughout their first 4 years. Their mothers completed three questionnaires between 18-42 months recording the frequency of nine different signs and symptoms relating to the upper respiratory system, as well as ear and hearing problems. Outcome measures: Primary-high levels of autism traits (social communication, coherent speech, sociability, and repetitive behaviour); secondary-diagnosed autism. Results: Early evidence of mouth breathing, snoring, pulling/poking ears, ears going red, hearing worse during a cold, and rarely listening were associated with high scores on each autism trait and with a diagnosis of autism. There was also evidence of associations of pus or sticky mucus discharge from ears, especially with autism and with poor coherent speech. Adjustment for 10 environmental characteristics made little difference to the results, and substantially more adjusted associations were at p Conclusions: Very young children exhibiting common ear and upper respiratory signs appear to have an increased risk of a subsequent diagnosis of autism or demonstrated high levels of autism traits. Results suggest the need for identification and management of ear, nose and throat conditions in autistic children and may provide possible indicators of causal mechanisms