FACTORS INFLUENCING EXPECTANT MOTHERS' CONTINUED USE OF DIGITAL HEALTH INFORMATION

Background: Expectant women receive healthcare education at antenatal care (ANC) clinics, but it is noteworthy that expectant mothers tend to seek information from various sources beyond their primary healthcare providers. Aims: The study aims to investigate determinants influencing expectant mothers' continuous use of digital media for pregnancy information.  Methods: The study involves participants of expectant women who attend ANC clinics in five municipal hospitals. The hypotheses were tested with 580 responses using Structural Equation Modeling (SEM) via SmartPLS version 4. Results: The findings revealed that social media healthcare information usage, perceived severity, and emotional support on social media influence expectant mothers' decisions to continue using digital media for healthcare purposes. However, the effect of perceived vulnerability on social media healthcare information usage was insignificant.  Conclusion: This study concludes that expectant mothers will continue to adopt digital platforms to access healthcare information. The findings provide recommendations to help healthcare providers advance antenatal care. Keywords: Emotional support, healthcare, expectant women, SMHIC, social medi

Towards understanding the clinical significance of QT peak prolongation: a novel marker of myocardial ischemia independently demonstrated in two prospective studies

Background: QT peak prolongation identified patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with significant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In the first study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett’s formula (QTpc). QTpc prolongation to 360ms or more was 92% specific at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had significant myocardial ischaemia. Significant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without significant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% specific at diagnosing significant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of significant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of significant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI

Re-evaluating the effi cacy of the aqueous leaf extract of Bridelia ferrugenia and its potential combination with metformin in the management of diabetes mellitus

Herbal medicinal products play a significant role in the management of diabetes and other chronic diseaseseither as a monotherapy or in combination with allopathic treatments. The hypoglycemic activity of a Ghanaianherbal antidiabetic product (Bridelia Tea) prepared from the dried leaves of Bridelia ferrugenia [BRD] was reevaluatedin this study with the view of improving, its activity and explore the possible benefit of using theproduct in combination with metformin (MET). Male and female Sprague-Dawley rats (210-220 g) were renderedhyperglycemic by a single intraperitoneal administration of streptozocin (70 mg/kg) after an overnight fast. Thehyperglycemic rats then received one of the following treatments ([BRD 30 mg/kg or 300 mg/kg], [MET 250 mg/kgor 1000 mg/kg], [MET 250 mg/kg and BRD 30 mg/kg], [MET 1000 mg/kg and BRD 300 mg/kg]). The hypoglycemiceffect of BRD, MET, and the combination of the two products were not significantly different during an initial6 h of monitoring (P > 0.05). In the long-term study over 28 days, BRD 300 mg/kg had hypoglycemic effectscomparable to MET 1000 mg/kg p.o. and better than BDF 30 mg/kg p.o. (P < 0.05). However, the combination ofthe two products BRD and MET at the two doses reduced their therapeutic effect compared to animals receivingeither one of the two treatments alone

Ecosystem Health Education: Teaching Leadership Through Team-Based Assignments

The health and sustainability of humans, animals, and environments are interdependent. The relationship between climate change, disease emergence, and food security on sustainability of ecosystem services is embodied in the sustainable development goals (SDGs). A diverse workforce needs to be equipped with leadership skills to function in a transdisciplinary, team-based environment. Ecosystem health (ESH) provides a critical and innovative approach to solving these complex challenges and offers a toolbox to actualize SDGs. This article outlines the development of a course detailing the process of framing a new academic approach in ESH as a training pathway for undergraduate and graduate students

Registration evaluation of dynamic breast MR images

The interpretation of dynamic contrast-enhanced breast MR images is predicated on the assumption of minimal voxel movement during the time course of the image acquisition. Misalignment of the dynamic image sequence as a result of movement during image acquisition can lead to potentially misleading diagnostic conclusions. In this paper a new methodology is presented for assessing the degree of in-plane (intra-slice) movement in a dynamic image sequence. The method is demonstrated on data from six subjects. The conclusion is that the method makes it possible to quantitatively qualify the accuracy of computed enhancement curves and more importantly to identify unacceptably poor registration

Obesity is associated with higher complication rates in revision total hip arthroplasty

We examined differences in complication rates between obese and non-obese patients undergoing revision total hip arthroplasty. Sixty-five patients with a BMI ≥30 kg/m2 and 54 patients with a BMI of <30 kg/m2 were identified. Obese patients were 2.5 times more likely to suffer a complication than non-obese (38.4% cf 14.8%, p = 0.02). Obese patients were more likely to experience dislocation, leg length discrepancy, fracture, implant loosening, infection and pulmonary embolus. The obese group had a significantly higher revision rate (12.3% cf 1.8%, p = 0.039). Obese patients should be counselled pre-operatively on their elevated risk

Characterization of secreted sphingosine-1-phosphate lyases required for virulence and intracellular survival of <i>Burkholderia pseudomallei</i>

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Sphingosine-1-phosphate (S1P), a bioactive sphingolipid metabolite, plays a critical role in the orchestration of immune responses. S1P levels within the mammalian host are tightly regulated, in part through the activity of S1P lyase (S1PL) which catalyses its irreversible degradation. Herein we describe the identification and characterization of secreted S1PL orthologues encoded by the facultative intracellular bacteria Burkholderia pseudomallei and Burkholderia thailandensis. These bacterial orthologues exhibited S1PL enzymatic activity, functionally complemented an S1PL-deficient yeast strain, and conferred resistance to the antimicrobial sphingolipid D-erythro-sphingosine. We report that secretion of these bacterial S1PLs is pH-dependent, and is observed during intracellular infection. S1PL-deficient mutants displayed impaired intracellular replication in murine macrophages (associated with an inability to evade the maturing phagosome) and were significantly attenuated in murine and larval infection models. Furthermore, treatment of Burkholderia-infected macrophages with either S1P or a selective agonist of S1P receptor 1 enhanced bacterial colocalisation with LAMP-1 and reduced their intracellular survival. In summary, our studies confirm bacterial-encoded S1PL as a critical virulence determinant of B. pseudomallei and B. thailandensis, further highlighting the pivotal role of S1P in host-pathogen interactions. In addition, our data suggest that S1P pathway modulators have potential for the treatment of intracellular infection.We thank HL Ho & K Haynes (University of Exeter) for provision of strains and relevant vectors for yeast complementation studies. This work was supported by the Defence Science 26 and Technology Laboratory under contract DSTLX-1000060221 (WP1). CJM was funded by the EASTBIO Doctoral Training Partnership. The funders had no role in study design, data collection and analysis, or preparation of the manuscript

Human candidate gene polymorphisms and risk of severe malaria in children in Kilifi, Kenya: a case-control association study

Background: Human genetic factors are important determinants of malaria risk. We investigated associations between multiple candidate polymorphisms—many related to the structure or function of red blood cells—and risk for severe Plasmodium falciparum malaria and its specific phenotypes, including cerebral malaria, severe malaria anaemia, and respiratory distress. Methods: We did a case-control study in Kilifi County, Kenya. We recruited as cases children presenting with severe malaria to the high-dependency ward of Kilifi County Hospital. We included as controls infants born in the local community between Aug 1, 2006, and Sept 30, 2010, who were part of a genetics study. We tested for associations between a range of candidate malaria-protective genes and risk for severe malaria and its specific phenotypes. We used a permutation approach to account for multiple comparisons between polymorphisms and severe malaria. We judged p values less than 0·005 significant for the primary analysis of the association between candidate genes and severe malaria. Findings: Between June 11, 1995, and June 12, 2008, 2244 children with severe malaria were recruited to the study, and 3949 infants were included as controls. Overall, 263 (12%) of 2244 children with severe malaria died in hospital, including 196 (16%) of 1233 with cerebral malaria. We investigated 121 polymorphisms in 70 candidate severe malaria-associated genes. We found significant associations between risk for severe malaria overall and polymorphisms in 15 genes or locations, of which most were related to red blood cells: ABO, ATP2B4, ARL14, CD40LG, FREM3, INPP4B, G6PD, HBA (both HBA1 and HBA2), HBB, IL10, LPHN2 (also known as ADGRL2), LOC727982, RPS6KL1, CAND1, and GNAS. Combined, these genetic associations accounted for 5·2% of the variance in risk for developing severe malaria among individuals in the general population. We confirmed established associations between severe malaria and sickle-cell trait (odds ratio [OR] 0·15, 95% CI 0·11–0·20; p=2·61 × 10−58), blood group O (0·74, 0·66–0·82; p=6·26 × 10−8), and –α3·7-thalassaemia (0·83, 0·76–0·90; p=2·06 × 10−6). We also found strong associations between overall risk of severe malaria and polymorphisms in both ATP2B4 (OR 0·76, 95% CI 0·63–0·92; p=0·001) and FREM3 (0·64, 0·53–0·79; p=3·18 × 10−14). The association with FREM3 could be accounted for by linkage disequilibrium with a complex structural mutation within the glycophorin gene region (comprising GYPA, GYPB, and GYPE) that encodes for the rare Dantu blood group antigen. Heterozygosity for Dantu was associated with risk for severe malaria (OR 0·57, 95% CI 0·49–0·68; p=3·22 × 10−11), as was homozygosity (0·26, 0·11–0·62; p=0·002). Interpretation: Both ATP2B4 and the Dantu blood group antigen are associated with the structure and function of red blood cells. ATP2B4 codes for plasma membrane calcium-transporting ATPase 4 (the major calcium pump on red blood cells) and the glycophorins are ligands for parasites to invade red blood cells. Future work should aim at uncovering the mechanisms by which these polymorphisms can result in severe malaria protection and investigate the implications of these associations for wider health. Funding: Wellcome Trust, UK Medical Research Council, European Union, and Foundation for the National Institutes of Health as part of the Bill &amp; Melinda Gates Grand Challenges in Global Health Initiative

When “perverts” were religious: the Protestant sexualisation of asceticism in nineteenth-century Britain, India and Ireland

Anti-Catholic polemics from the mid-nineteenth century made frequent comparison between religious practices in Britain, Ireland and India. The supposed atrocities taking place at locations such as Lough Dearg in Country Donegal and at ‘Juggernaut’ (Jagganath) at Puri were denounced in terms which hinted strongly at a striking combination of extreme asceticism and perverse sexual enjoyment. In the same period the word ‘perversion’, which had hitherto referred to apostasy, started to develop connotations of sexual deviance. Protestant sexualised readings of Catholic and Hindu asceticism appear to have been an important site for the development of conceptions of deviant sexuality in general and masochism in particular