Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children

Background: Almost half of global child deaths due to acute lower respiratory infections (ALRIs) occur in sub-Saharan Africa, where three-quarters of the population cook with solid fuels. This study aims to quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa, and to explore implications for public health interventions. Methods: Early-release World Health Survey data for the year 2003 were pooled for 16 African countries. Among 32 620 children born during the last 10 years, 1455 (4.46%) were reported to have died prior to their fifth birthday. Survival analysis was used to examine the impact of different cooking-related parameters on ALRI mortality, defined as cough accompanied by rapid breathing or chest indrawing based on maternal recall of symptoms prior to death. Results: Solid fuel use increases the risk of ALRI mortality with an adjusted hazard ratio of 2.35 (95% CI 1.22 to 4.52); this association grows stronger with increasing outcome specificity. Differences between households burning solid fuels on a well-ventilated stove and households relying on cleaner fuels are limited. In contrast, cooking with solid fuels in the absence of a chimney or hood is associated with an adjusted hazard ratio of 2.68 (1.38 to 5.23). Outdoor cooking is less harmful than indoor cooking but, overall, stove ventilation emerges as a more significant determinant of ALRI mortality. Conclusions: This study shows substantial differences in ALRI mortality risk among African children in relation to cooking practices, and suggests that stove ventilation may be an important means of reducing indoor air pollution

The Color Dipole Picture of low-x DIS: Model-Independent and Model-Dependent Results

We present a detailed examination of the color-dipole picture (CDP) of low-$x$ deep inelastic scattering. We discriminate model-independent results, not depending on a specific parameterization of the dipole cross section, from model-dependent ones. The model-independent results include the ratio of the longitudinal to the transverse photoabsorption cross section at large $Q^2$, or equivalently the ratio of the longitudinal to the unpolarized proton structure function, $F_L (x,Q^2)=0.27 F_2 (x, Q^2)$, as well as the low-$x$ scaling behavior of the total photoabsorption cross section $\sigma_{\gamma^*p} (W^2, Q^2)=\sigma_{\gamma^*p} (\eta (W^2, Q^2))$ as $\log (1 / \eta (W^2, Q^2))$ for $\eta (W^2, Q^2) <1$, and as $1/\eta (W^2, Q^2)$ for $\eta (W^2, Q^2) \gg 1$. Here, $\eta (W^2, Q^2)$ denotes the low-$x$ scaling variable, $\eta (W^2, Q^2)=(Q^2 + m^2_0) / \Lambda^2_{sat} (W^2)$ with $\Lambda^2_{sat} (W^2)$ being the saturation scale. The model-independent analysis also implies $\lim\limits_{W^2\rightarrow\infty, Q^2 {\rm fixed}} \sigma_{\gamma^*p} (W^2, Q^2) / \sigma_{\gamma p} (W^2) \rightarrow 1$ at any $Q^2$ for asymptotically large energy, $W$. Consistency with pQCD evolution determines the underlying gluon distribution and the numerical value of $C_2 = 0.29$ in the expression for the saturation scale, $\Lambda^2 (W^2) \sim (W^2)^{C_2}$. In the model-dependent analysis, by restricting the mass of the actively contributing $q \bar q$ fluctuations by an energy-dependent upper bound, we extend the validity of the color-dipole picture to $x \cong Q^2 / W^2 \le 0.1$. The theoretical results agree with the world data on DIS for $0.036 {\rm GeV}^2 \le Q^2 \le 316 {\rm GeV}^2$.Comment: 77 pages, 30 figure

Homeless drug users' awareness and risk perception of peer "Take Home Naloxone" use – a qualitative study

BACKGROUND Peer use of take home naloxone has the potential to reduce drug related deaths. There appears to be a paucity of research amongst homeless drug users on the topic. This study explores the acceptability and potential risk of peer use of naloxone amongst homeless drug users. From the findings the most feasible model for future treatment provision is suggested. METHODS In depth face-to-face interviews conducted in one primary care centre and two voluntary organisation centres providing services to homeless drug users in a large UK cosmopolitan city. Interviews recorded, transcribed and analysed thematically by framework techniques. RESULTS Homeless people recognise signs of a heroin overdose and many are prepared to take responsibility to give naloxone, providing prior training and support is provided. Previous reports of the theoretical potential for abuse and malicious use may have been overplayed. CONCLUSION There is insufficient evidence to recommend providing "over the counter" take home naloxone" to UK homeless injecting drug users. However a programme of peer use of take home naloxone amongst homeless drug users could be feasible providing prior training is provided. Peer education within a health promotion framework will optimise success as current professionally led health promotion initiatives are failing to have a positive impact amongst homeless drug users

Daphnias: from the individual based model to the large population equation

The class of deterministic 'Daphnia' models treated by Diekmann et al. (J Math Biol 61: 277-318, 2010) has a long history going back to Nisbet and Gurney (Theor Pop Biol 23: 114-135, 1983) and Diekmann et al. (Nieuw Archief voor Wiskunde 4: 82-109, 1984). In this note, we formulate the individual based models (IBM) supposedly underlying those deterministic models. The models treat the interaction between a general size-structured consumer population ('Daphnia') and an unstructured resource ('algae'). The discrete, size and age-structured Daphnia population changes through births and deaths of its individuals and throught their aging and growth. The birth and death rates depend on the sizes of the individuals and on the concentration of the algae. The latter is supposed to be a continuous variable with a deterministic dynamics that depends on the Daphnia population. In this model setting we prove that when the Daphnia population is large, the stochastic differential equation describing the IBM can be approximated by the delay equation featured in (Diekmann et al., l.c.)

Mobile health use predicts self-efficacy and self-management in adolescents with sickle cell disease

Sickle cell disease (SCD) is associated with significant health challenges that often worsen during adolescence. Living with SCD requires a substantial amount of self-management and mobile health (mHealth) holds considerable promise for assessing and changing behaviors to improve health outcomes. We integrated a mobile app as an adjunct to a group intervention (SCThrive) and hypothesized that more engagement with the mHealth app would increase self-management and self-efficacy for adolescents and young adults (AYA) with SCD. Twenty-six AYA ages 13–21 years (54% female; 46% HbSS genotype; all African-American/Black) received six weekly group sessions (three in-person, three online). Participants were provided with the mobile app (iManage for SCD) to record progress on their self-management goals and log pain and mood symptoms. The Transition Readiness Assessment Questionnaire (TRAQ-5) assessed self-management skills and the Patient Activation Measure (PAM-13) assessed self-efficacy at baseline and post-treatment. Logging on to the app more frequently was associated higher mood ratings (r = .54, CI[.18, .77], p = .006) and lower pain ratings (r = −.48, CI[−.77, −.02], p = .04). Regression analyses demonstrated that after controlling for scores at baseline, the number of logins to the app predicted self-management skills (p = .05, η2 = .17) and possibly self-efficacy (p = .08, η2 = .13). Our study findings indicate that it can be challenging to maintain engagement in mHealth for AYA with SCD, but for those who do engage, there are significant benefits related to self-management, self-efficacy, and managing pain and mood

Occupational therapists’ views of using a virtual reality interior design application within the pre-discharge home visit process

This article has been made available through the Brunel Open Access Publishing Fund.Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment, to enable patients to function independently after hospital-home discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualise changes prior to implementing them. Customised VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration if developed effectively and integrated into the PHV process. Objective: To explore the perceptions of occupational therapists with regards to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilising the think-aloud protocol and subsequent semi-structured interviews were carried out with seven Occupational Therapists who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centring around the parameters that impact upon the acceptance, adoption and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communications and patient involvement, and improved patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully, however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customisations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context

Molecular characterization of thioester-containing proteins in Biomphalaria glabrata and their differential gene expression upon Schistosoma mansoni exposure

Schistosomiasis is a disease caused by trematode parasites of the genus Schistosoma that affects approximately 200 million people worldwide. Schistosomiasis has been a persistent problem in endemic areas as there is no vaccine available, currently used anti-helmintic medications do not prevent reinfection, and most concerning, drug resistance has been documented in laboratory and field isolates. Thus, alternative approaches to curtail this human disease are warranted. Understanding the immunobiology of the obligate intermediate host of these parasites, which include the freshwater snail Biomphalaria glabrata, may facilitate the development of novel methods to stop or reduce transmission to humans. Molecules from the thioester-containing protein (TEP) superfamily have been shown to be involved in immunological functions in many animals including corals and humans. In this study we identified, characterized, and compared TEP transcripts and their expression upon S. mansoni exposure in resistant and susceptible strains of B. glabrata snails. Results showed the expression of 11 unique TEPs in B. glabrata snails. These transcripts present high sequence identity at the nucleotide and putative amino acid levels between susceptible and resistant strains. Further analysis revealed differences in several TEPs’ constitutive expression levels between resistant and susceptible snail strains, with C3-1, C3-3, and CD109 having higher constitutive expression levels in the resistant (BS90) strain, whereas C3-2 and TEP-1 showed higher constitutive expression levels in the susceptible (NMRI) strain. Furthermore, TEP-specific response to S. mansoni miracidia exposure reiterated their differential expression, with resistant snails upregulating the expression of both TEP-4 and TEP-3 at 2 h and 48 h post-exposure, respectively. Further understanding the diverse TEP genes and their functions in invertebrate animal vectors will not only expand our knowledge in regard to this ancient family of immune proteins, but also offer the opportunity to identify novel molecular targets that could aid in the efforts to develop control methods to reduce schistosomiasis transmission

Down-staging of breast cancer in the pre-screening era: Experiences from Chris Hani Baragwaneth Academic Hospital, Soweto, South Africa

We aimed to investigate the stage of breast cancer at first diagnosis and assess possible determinants of late-stage presentation. A consecutive series of women with newly diagnosed breast cancer at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa were analysed. We retrospectively reviewed electronic patient records. Data were extracted for: (i) stage and year at diagnosis; (ii) travel distance (estimated straight-line distance from GPS-coded residential address to CHBAH); (iii) receptor subtypes; and (iv) age of patient. Generalised linear models were applied to estimate risk ratios for late- v. early-stage disease.Of the patients (N=1 071) studied, the mean age was 55 years and 90% were black Africans. Patients who lived &gt;20 km from the hospital (n=347; 61.8%) presented with late-stage disease (stage 3/4) compared with 50.2% who lived ≤20 km from the hospital (n=724; p=0.02). The majority of patients (74%) &gt;70 years of age who lived &gt;20 km away presented with advanced breast cancer. However, in younger patients, age showed no clear association with stage at presentation. Travel distance was an important predictor of later-stage disease at diagnosis, which was more noticeable in elderly patients. Patients with more aggressive triple-negative and HER2+ tumours presented with later-stage disease

Observation of exotic meson production in the reaction π−p→η′π−p \pi^{-} p \to \eta^{\prime} \pi^- p at 18 GeV/c

An amplitude analysis of an exclusive sample of 5765 events from the reaction $\pi^{-} p \to \eta^{\prime} \pi^- p$ at 18 GeV/c is described. The $\eta^{\prime} \pi^-$ production is dominated by natural parity exchange and by three partial waves: those with $J^{PC} = 1^{-+}, 2^{++},$ and $4^{++}$. A mass-dependent analysis of the partial-wave amplitudes indicates the production of the $a_2(1320)$ meson as well as the $a_4(2040)$ meson, observed for the first time decaying to $\eta^{\prime}\pi^-$. The dominant, exotic (non-$q\bar{q})$ $1^{-+}$ partial wave is shown to be resonant with a mass of $1.597 \pm 0.010^{+0.045}_{-0.010}$ GeV/c^2 and a width of $0.340 \pm 0.040 \pm 0.050$ GeV/c^2 . This exotic state, the $\pi_1(1600)$, is produced with a $t$ dependence which is different from that of the $a_2(1320)$ meson, indicating differences between the production mechanisms for the two states.Comment: 5 pages with 4 figure