Community resource centres to improve the health of women and children in Mumbai slums: study protocol for a cluster randomized controlled trial

Background: The trial addresses the general question of whether community resource centers run by a non-government organization improve the health of women and children in slums. The resource centers will be run by the Society for Nutrition, Education and Health Action, and the trial will evaluate their effects on a series of public health indicators. Each resource center will be located in a vulnerable Mumbai slum area and will serve as a base for salaried community workers, supervised by officers and coordinators, to organize the collection and dissemination of health information, provision of services, home visits to identify and counsel families at risk, referral of individuals and families to appropriate services and support for their access, meetings of community members and providers, and events and campaigns on health issues. Methods/design: A cluster randomized controlled trial in which 20 urban slum areas with resource centers are compared with 20 control areas. Each cluster will contain approximately 600 households and randomized allocation will be in three blocked phases, of 12, 12 and 16 clusters. Any resident of an intervention cluster will be able to participate in the intervention, but the resource centers will target women and children, particularly women of reproductive age and children under 5. The outcomes will be assessed through a household census after 2 years of resource center operations. The primary outcomes are unmet need for family planning in women aged 15 to 49 years, proportion of children under 5 years of age not fully immunized for their ages, and proportion of children under 5 years of age with weight for height less than 2 standard deviations below the median for age and sex. Secondary outcomes describe adolescent pregnancies, home deliveries, receipt of conditional cash transfers for institutional delivery, other childhood anthropometric indices, use of public sector health and nutrition services, indices of infant and young child feeding, and consultation for violence against women and children

Dynamics-based centrality for general directed networks

Determining the relative importance of nodes in directed networks is important in, for example, ranking websites, publications, and sports teams, and for understanding signal flows in systems biology. A prevailing centrality measure in this respect is the PageRank. In this work, we focus on another class of centrality derived from the Laplacian of the network. We extend the Laplacian-based centrality, which has mainly been applied to strongly connected networks, to the case of general directed networks such that we can quantitatively compare arbitrary nodes. Toward this end, we adopt the idea used in the PageRank to introduce global connectivity between all the pairs of nodes with a certain strength. Numerical simulations are carried out on some networks. We also offer interpretations of the Laplacian-based centrality for general directed networks in terms of various dynamical and structural properties of networks. Importantly, the Laplacian-based centrality defined as the stationary density of the continuous-time random walk with random jumps is shown to be equivalent to the absorption probability of the random walk with sinks at each node but without random jumps. Similarly, the proposed centrality represents the importance of nodes in dynamics on the original network supplied with sinks but not with random jumps.Comment: 7 figure

Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial.

Improving maternal and newborn health in low-income settings requires both health service and community action. Previous community initiatives have been predominantly rural, but India is urbanizing. While working to improve health service quality, we tested an intervention in which urban slum-dweller women's groups worked to improve local perinatal health

Autophagy gene haploinsufficiency drives chromosome instability, increases migration, and promotes early ovarian tumors.

Autophagy, particularly with BECN1, has paradoxically been highlighted as tumor promoting in Ras-driven cancers, but potentially tumor suppressing in breast and ovarian cancers. However, studying the specific role of BECN1 at the genetic level is complicated due to its genomic proximity to BRCA1 on both human (chromosome 17) and murine (chromosome 11) genomes. In human breast and ovarian cancers, the monoallelic deletion of these genes is often co-occurring. To investigate the potential tumor suppressor roles of two of the most commonly deleted autophagy genes in ovarian cancer, BECN1 and MAP1LC3B were knocked-down in atypical (BECN1+/+ and MAP1LC3B+/+) ovarian cancer cells. Ultra-performance liquid chromatography mass-spectrometry metabolomics revealed reduced levels of acetyl-CoA which corresponded with elevated levels of glycerophospholipids and sphingolipids. Migration rates of ovarian cancer cells were increased upon autophagy gene knockdown. Genomic instability was increased, resulting in copy-number alteration patterns which mimicked high grade serous ovarian cancer. We further investigated the causal role of Becn1 haploinsufficiency for oncogenesis in a MISIIR SV40 large T antigen driven spontaneous ovarian cancer mouse model. Tumors were evident earlier among the Becn1+/- mice, and this correlated with an increase in copy-number alterations per chromosome in the Becn1+/- tumors. The results support monoallelic loss of BECN1 as permissive for tumor initiation and potentiating for genomic instability in ovarian cancer

Molten Carbonate Fuel Cell Combined Heat, Hydrogen and Power System: Feedstock Analysis

AbstractBiogas is an untapped potential in regards to an alternative energy source. This immediately available resource will allow countries to reduce their greenhouse gas emissions, energy consumption, and reliance on fossil fuels. This energy source is created by anaerobic digestion of feedstock. Sources for feedstock include organic and inorganic waste, agricultural waste, animal by-products, and industrial waste. All of these sources of biogas are a renewable energy source. Specifically a fuel cell can utilize the methane present in biogas using integrated heat, power, and hydrogen systems. A study was performed concerning energy flow and resource availability to ascertain the type and source of feedstock to run a fuel cell system unceasingly while maintaining maximum capacity. After completion of this study and an estimation of locally available fuel, the FuelCell Energy 1500 unit (a molten carbonate fuel cell) was chosen to be used on campus. This particular fuel cell will provide electric power, thermal energy to heat the anaerobic digester, hydrogen for transportation, auxiliary power to the campus, and myriad possibilities for more applications. In conclusion, from the resource assessment study, a FuelCell Energy DFC1500TM unit was selected for which the local resources can provide 91% of the fuel requirements

Null cone preserving maps, causal tensors and algebraic Rainich theory

A rank-n tensor on a Lorentzian manifold V whose contraction with n arbitrary causal future directed vectors is non-negative is said to have the dominant property. These tensors, up to sign, are called causal tensors, and we determine their general properties in dimension N. We prove that rank-2 tensors which map the null cone on itself are causal. It is known that, to any tensor A on V there is a corresponding ``superenergy'' (s-e) tensor T{A} which always has the dominant property. We prove that, conversely, any symmetric rank-2 tensor with the dominant property can be written in a canonical way as a sum of N s-e tensors of simple forms. We show that the square of any rank-2 s-e tensor is proportional to the metric if N<5, and that this holds for the s-e tensor of any simple form for arbitrary N. Conversely, we prove that any symmetric rank-2 tensor T whose square is proportional to the metric must be, up to sign, the s-e of a simple p-form, and that the trace of T determines the rank p of the form. This generalises, both with respect to N and the rank p, the classical algebraic Rainich conditions, which are necessary and sufficient conditions for a metric to originate in some physical field, and has a geometric interpretation: the set of s-e tensors of simple forms is precisely the set of tensors which preserve the null cone and its time orientation. It also means that all involutory Lorentz transformations (LT) can be represented as s-e tensors of simple forms, and that any rank-2 s-e tensor is the sum of at most N conformally involutory LT. Non-symmetric null cone preserving maps are shown to have a causal symmetric part and are classified according to the null eigenvectors of the skew-symmetric part. We thus obtain a complete classification of all conformal LT and singular null cone preserving maps on V.Comment: 36 pages, no figures, LaTeX fil

Major bleeding during negative pressure wound/V.A.C.® - therapy for postsurgical deep sternal wound infection - a critical appraisal

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.®) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate) decrease in the incidence of deep sternal wound infection. If more insight is to be gained from fewer clinical cases, then various potentially confounding factors should be fully disclosed before complications can be attributed to the technique itself or improvements to negative-pressure wound therapy for deep sternal wound infection can be accepted as evidence-based and the guidelines for its use adapted. The authors propose the adoption of a simple checklist in such cases

CD133 antigen expression in ovarian cancer

<p>Abstract</p> <p>Background</p> <p>Much attention has been recently focused on the role of cancer stem cells (CSCs) in the initiation and progression of solid malignancies. Since CSCs are able to proliferate and self-renew extensively, thus sustaining tumor growth, the identification of CSCs through their antigenic profile might have relevant clinical implications. In this context, CD133 antigen has proved to be a marker of tumor cells with stemness features in several human malignancies.</p> <p>The aim of the study was to investigate the clinical role of the immunohistochemically assessed expression of CD133 in a large single Institution series of ovarian cancer patients.</p> <p>Methods</p> <p>The study included 160 cases admitted to the Gynecologic Oncology Unit, Catholic University of Campobasso and Rome. CD133 antigen was identified by the monoclonal mouse anti-CD133-1 antibody (clone CD133 Miltenyi biotec).</p> <p>Results</p> <p>In the overall series CD133 positive tumor cells were observed in 50/160 (31.2%) cases. A <it>diffuse cytoplasmic </it>pattern was identified in 30/50 (60.0%), while an <it>apical cytoplasmic </it>pattern was found in 20/50 (40.0%) of CD133 positive tumors.</p> <p>As of September 2008, the median follow up was 37 months (range: 2–112). During the follow up period, progression and death of disease were observed in 123 (76.9%), and 88 (55.0%) cases, respectively. There was no difference in TTP between cases with negative (median TTP = 23 months) versus positive CD133 expression (median TTP = 24 months) (p value = 0.3). Similar results were obtained for OS. When considering the TTP and OS curves according to the pattern of CD133 expression, a trend to a worse prognosis for cases with <it>diffuse cytoplasmic </it>versus the <it>apical cytoplasmic </it>pattern was documented, although the statistical significance was not reached.</p> <p>Conclusion</p> <p>The immunohistochemical assessment of CD133 expression seems not to provide additional prognostic information in ovarian cancer patients. The role of the different pattern of CD133 immunoreaction deserves further investigation in a larger series.</p

Colorectal and other cancer risks for carriers and noncarriers from families with a DNA mismatch repair gene mutation: A Prospective Cohort Study

To determine whether cancer risks for carriers and noncarriers from families with a mismatch repair (MMR) gene mutation are increased above the risks of the general population. We prospectively followed a cohort of 446 unaffected carriers of an MMR gene mutation (MLH1, n = 161; MSH2, n = 222; MSH6, n = 47; and PMS2, n = 16) and 1,029 their unaffected relatives who did not carry a mutation every 5 years at recruitment centers of the Colon Cancer Family Registry. For comparison of cancer risk with the general population, we estimated country-, age-, and sex-specific standardized incidence ratios (SIRs) of cancer for carriers and noncarriers. Over a median follow-up of 5 years, mutation carriers had an increased risk of colorectal cancer (CRC; SIR, 20.48; 95% CI, 11.71 to 33.27; P < .001), endometrial cancer (SIR, 30.62; 95% CI, 11.24 to 66.64; P < .001), ovarian cancer (SIR, 18.81; 95% CI, 3.88 to 54.95; P < .001), renal cancer (SIR, 11.22; 95% CI, 2.31 to 32.79; P < .001), pancreatic cancer (SIR, 10.68; 95% CI, 2.68 to 47.70; P = .001), gastric cancer (SIR, 9.78; 95% CI, 1.18 to 35.30; P = .009), urinary bladder cancer (SIR, 9.51; 95% CI, 1.15 to 34.37; P = .009), and female breast cancer (SIR, 3.95; 95% CI, 1.59 to 8.13; P = .001). We found no evidence of their noncarrier relatives having an increased risk of any cancer, including CRC (SIR, 1.02; 95% CI, 0.33 to 2.39; P = .97). We confirmed that carriers of an MMR gene mutation were at increased risk of a wide variety of cancers, including some cancers not previously recognized as being a result of MMR mutations, and found no evidence of an increased risk of cancer for their noncarrier relatives