Hard Times in the Heartland: Health Care in Rural America

Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform

A resource planning analysis of district hospital surgical services in the Democratic Republic of the Congo.

BACKGROUND: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world\u27s poorest third reside, such as the Democratic Republic of the Congo (DRC). METHODS: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization\u27s (WHO\u27s) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well as in 2 of the 12 hospitals in which we conducted the situational analysis (Demba and Kabare District Hospitals). For the cost analysis, we used WHO\u27s integrated Healthcare Technology Package tool. RESULTS: Of the 32 surgical interventions surveyed, only 2 of the 12 hospitals provided all essential services. The deficits in procedures varied from no deficits to 17 services that could not be provided, with an average of 7 essential procedures unavailable. Many of the hospitals did not have basic infrastructure such as running water and electricity; 9 of 12 had no or interrupted water and 7 of 12 had no or interrupted electricity. On average, 21% of lifesaving surgical interventions were absent from the facilities, compared with the model normative hospital. According to the normative hospital, all surgical services would cost US$2.17 per inhabitant per year, representing 33.3$0.08 per inhabitant per year, and at Kabare Hospital, US$0.69 per inhabitant per year. CONCLUSION: A significant portion of the health problems addressed at Congolese district hospitals is surgical in nature, but there is a current inability to meet this surgical need. The deficient services and substandard capacity in the surveyed district hospitals are systemic in nature, representing infrastructure, supply, equipment, and human resource constraints. Yet surgical services are affordable and represent a minor portion of the total operating budget. Greater emphasis should be made to appropriately fund district hospitals to meet the need for lifesaving surgical services

Potential Role of Plant Growth Regulators in Administering Crucial Processes Against Abiotic Stresses

Plant growth regulators are naturally biosynthesized chemicals in plants that influence physiological processes. Their synthetic analogous trigger numerous biochemical and physiological processes involved in the growth and development of plants. Nowadays, due to changing climatic scenario, numerous biotic and abiotic stresses hamper seed germination, seedling growth, and plant development leading to a decline in biological and economic yields. However, plant growth regulators (PGRs) can potentially play a fundamental role in regulating plant responses to various abiotic stresses and hence, contribute to plant adaptation under adverse environments. The major effects of abiotic stresses are growth and yield disturbance, and both these effects are directly overseen by the PGRs. Different types of PGRs such as abscisic acid (ABA), salicylic acid (SA), ethylene (ET), and jasmonates (JAs) are connected to boosting the response of plants to multiple stresses. In contrast, PGRs including cytokinins (CKs), gibberellins (GAs), auxin, and relatively novel PGRs such as strigolactones (SLs), and brassinosteroids (BRs) are involved in plant growth and development under normal and stressful environmental conditions. Besides, polyamines and nitric oxide (NO), although not considered as phytohormones, have been included in the current review due to their involvement in the regulation of several plant processes and stress responses. These PGRs are crucial for regulating stress adaptation through the modulates physiological, biochemical, and molecular processes and activation of the defense system, upregulating of transcript levels, transcription factors, metabolism genes, and stress proteins at cellular levels. The current review presents an acumen of the recent progress made on different PGRs to improve plant tolerance to abiotic stress such as heat, drought, salinity, and flood. Moreover, it highlights the research gaps on underlying mechanisms of PGRs biosynthesis under stressed conditions and their potential roles in imparting tolerance against adverse effects of suboptimal growth conditions.Fil: Sabagh, Ayman EL. Kafrelsheikh University; EgiptoFil: Mbarki, Sonia. National Institute Of Research In Rural Engineering; TúnezFil: Hossain, Akbar. Bangladesh Agricultural Research Institute; BangladeshFil: Iqbal, Muhammad Aamir. University Of Poonch Rawalakot; PakistánFil: Islam, Mohammad Sohidul. Hajee Mohammad Danesh And Technology University; BangladeshFil: Raza, Ali. Fujian Agriculture And Forestry University; ChinaFil: Llanes, Analia Susana. Universidad Nacional de Rio Cuarto. Facultad de Cs.exactas Fisicoquimicas y Naturales. Instituto de Investigaciones Agrobiotecnologicas. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Cordoba. Instituto de Investigaciones Agrobiotecnologicas.; ArgentinaFil: Reginato, Mariana Andrea. Universidad Nacional de Rio Cuarto. Facultad de Cs.exactas Fisicoquimicas y Naturales. Instituto de Investigaciones Agrobiotecnologicas. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Cordoba. Instituto de Investigaciones Agrobiotecnologicas.; ArgentinaFil: Rahman, Md Atikur. Grassland And Forage Division National Institute; Corea del SurFil: Mahboob, Wajid. Nuclear Institute Of Agriculture,; PakistánFil: Singhal, Rajesh Kumar. Indian Council Of Agricultural Research; IndiaFil: Kumari, Arpna. Guru Nanak Dev University; IndiaFil: Rajendran, Arvind. Vellore Institute Of Technology; IndiaFil: Wasaya, Allah. Bahauddin Zakariya University; PakistánFil: Javed, Talha. Fujian Agriculture And Forestry University; JapónFil: Shabbir, Rubab. University Of Poonch Rawalakot; PakistánFil: Rahim, Junaid. University Of Çukurova; PakistánFil: Barutçular, Celaleddin. Institute Of Crop Science And Resource Conservation; AlemaniaFil: Habib Ur Rahman, Muhammad. Sichuan Agricultural University; ChinaFil: Raza, Muhammad Ali. Sichuan Agricultural University; ChinaFil: Ratnasekera, Disna. University Of Ruhuna; Sri LankaFil: Konuskan l, Ömer. Mustafa Kemal University; TurquíaFil: Hossain, Mohammad Anwar. Bangladesh Agricultural Research Institute; BangladeshFil: Meena, Vijay Singh. Indian Council Of Agricultural Research; IndiaFil: Ahmed, Sharif. Bangladesh Agricultural Research Institute; BangladeshFil: Ahmad, Zahoor. Bangladesh Wheat And Maize Research Institute; BangladeshFil: Mubeen, Muhammad. Sichuan Agricultural University; ChinaFil: Singh, Kulvir. Punjab Agricultural University; IndiaFil: Skalicky, Milan. Czech University Of Life Sciences Prague; República ChecaFil: Brestic, Marian. Slovak University Of Agriculture; EslovaquiaFil: Sytar, Oksana. Slovak University Of Agriculture; EsloveniaFil: Karademir, Emine. Siirt University; TurquíaFil: Karademir, Cetin. Siirt University; TurquíaFil: Erman, Murat. Siirt University; TurquíaFil: Farooq, Muhammad. College Of Agricultural And Marine Sciences Sultan; Omá

Real-time PCR assay and rapid diagnostic tests for the diagnosis of clinically suspected malaria patients in Bangladesh

<p>Abstract</p> <p>Background</p> <p>More than 95% of total malaria cases in Bangladesh are reported from the 13 high endemic districts. <it>Plasmodium falciparum </it>and <it>Plasmodium vivax </it>are the two most abundant malaria parasites in the country. To improve the detection and management of malaria patients, the National Malaria Control Programme (NMCP) has been using rapid diagnostic test (RDT) in the endemic areas. A study was conducted to establish a SYBR Green-based modified real-time PCR assay as a gold standard to evaluate the performance of four commercially-available malaria RDTs, along with the classical gold standard- microscopy.</p> <p>Methods</p> <p>Blood samples were collected from 338 febrile patients referred for the diagnosis of malaria by the attending physician at Matiranga</p> <p>Upazila Health Complex (UHC) from May 2009 to August 2010. Paracheck RDT and microscopy were performed at the UHC. The blood samples were preserved in EDTA tubes. A SYBR Green-based real-time PCR assay was performed and evaluated. The performances of the remaining three RDTs (Falcivax, Onsite Pf and Onsite Pf/Pv) were also evaluated against microscopy and real-time PCR using the stored blood samples.</p> <p>Result</p> <p>In total, 338 febrile patients were enrolled in the study. Malaria parasites were detected in 189 (55.9%) and 188 (55.6%) patients by microscopy and real-time PCR respectively. Among the RDTs, the highest sensitivity for the detection of <it>P. falciparum </it>(including mixed infection) was obtained by Paracheck [98.8%, 95% confidence interval (CI) 95.8-99.9] and Falcivax (97.6%, 95% CI 94.1-99.4) compared to microscopy and real-time PCR respectively. Paracheck and Onsite Pf/Pv gave the highest specificity (98.8%, 95% CI 95.7-99.9) compared to microscopy and Onsite Pf/Pv (98.8, 95% CI 95.8-99.9) compared to real-time PCR respectively for the detection of <it>P. falciparum</it>. On the other hand Falcivax and Onsite Pf/Pv had equal sensitivity (90.5%, 95% CI 69.6-98.8) and almost 100% specificity compared to microscopy for the detection of <it>P. vivax</it>. However, compared to real-time PCR assay RDTs and microscopy gave low sensitivity (76.9%, 95% CI 56.4-91) in detecting of <it>P. vivax </it>although a very high specificity was obtained (99- 100%).</p> <p>Conclusion</p> <p>The results of this study suggest that the SYBR Green-based real-time PCR assay could be used as an alternative gold standard method in a reference setting. Commercially-available RDTs used in the study are quite sensitive and specific in detecting <it>P. falciparum</it>, although their sensitivity in detecting <it>P. vivax </it>was not satisfactory compared to the real-time PCR assay.</p

Elevated CO₂ Concentration Improves Heat-Tolerant Ability in Crops

The rising concentration of atmospheric carbon dioxide (aCO2) and increasing temperature are the main reasons for climate change, which are significantly affecting crop production systems in this world. However, the elevated carbon dioxide (CO2) concentration can improve the growth and development of crop plants by increasing photosynthetic rate (higher availability of photoassimilates). The combined effects of elevated CO2 (eCO2) and temperature on crop growth and carbon metabolism are not adequately recognized, while both eCO2 and temperature triggered noteworthy changes in crop production. Therefore, to increase crop yields, it is important to identify the physiological mechanisms and genetic traits of crop plants which play a vital role in stress tolerance under the prevailing conditions. The eCO2 and temperature stress effects on physiological aspects as well as biochemical profile to characterize genotypes that differ in their response to stress conditions. The aim of this review is directed the open-top cavities to regulate the properties like physiological, biochemical, and yield of crops under increasing aCO2, and temperature. Overall, the extent of the effect of eCO2 and temperature response to biochemical components and antioxidants remains unclear, and therefore further studies are required to promote an unperturbed production system

Oligodendroglial neoplasms with ganglioglioma-like maturation: a diagnostic pitfall

Although oligodendroglial neoplasms are traditionally considered purely glial, increasing evidence suggests that they are capable of neuronal or neurocytic differentiation. Nevertheless, ganglioglioma-like foci (GGLF) have not been previously described. Herein, we report seven examples where the primary differential diagnosis was a ganglioglioma with an oligodendroglial component. These five male and two female patients ranged in age from 29 to 63 (median 44) years at initial presentation and neuroimaging features were those of diffuse gliomas in general. At presentation, the glial component was oligodendroglioma in six and oligoastrocytoma in one; one was low-grade and six were anaplastic. A sharp demarcation from adjacent GGLF was common, although some intermingling was always present. The GGLF included enlarged dysmorphic and occasionally binucleate ganglion cells, Nissl substance, expression of neuronal antigens, GFAP-positive astrocytic elements, and low Ki-67 labeling indices. In contrast to classic ganglioglioma, however, cases lacked eosinophilic granular bodies and CD34-positive tumor cells. Scattered bizarre astrocytes were also common and one case had focal neurocytic differentiation. By FISH analysis, five cases showed 1p/19q codeletion. In the four cases with deletions and ample dysmorphic ganglion cells for analysis, the deletions were found in both components. At last follow-up, two patients suffered recurrences, one developed radiation necrosis mimicking recurrence, and one died of disease 7.5 years after initial surgery. We conclude that GGLF represents yet another form of neuronal differentiation in oligodendroglial neoplasms. Recognition of this pattern will prevent a misdiagnosis of ganglioglioma with its potential for under-treatment

An investigation into the formations of the internal microstructures of solid dispersions prepared by hot melt extrusion

Hot melt extrusion (HME) is a widely used manufacturing process for pharmaceutical solid dispersions. The complexity of the HME formulations and the number of excipients used in the process are increasing with the advancement of the relevant knowledge. However, one of the areas that is still significantly lacking understanding is the control of internal microstructure of extrudates. Internal microstructure, consisting of voids, in hot melt extruded amorphous solid dispersions is often observed without the causes having been systemically investigated in the literature. In this study, we investigated a range of factors that demonstrated their impacts on the formation of the voids. These include the effect of the types of the materials (i.e. drug, polymer and additive) used in the formulation, the quantity of the drug and the additives used, the key extrusion processing parameters, the type of extruder, and the drying of the raw materials prior to extrusion. The results indicate that the appropriate viscosity and the presence of phase-separated particulates are essential for the formation of the voids. The particulates act as nuclei for the entrapped gas bubbles and the viscosity of the mixture during extrusion governs the collapse/escape of the bubbles. To minimise void formation, the results of this study indicate that slow screw speed, low moisture content of the raw materials, fewer particulates and the addition of lubricants, such as low melting lipid excipients, could be beneficial. This study systematically examines the mechanism of void formation in HME extrudates and generates new strategies that can be used to manage such void formations

MMP-9, uPAR and Cathepsin B Silencing Downregulate Integrins in Human Glioma Xenograft Cells In Vitro and In Vivo in Nude Mice

Involvement of MMP-9, uPAR and cathepsin B in adhesion, migration, invasion, proliferation, metastasis and tumor growth has been well established. In the present study, MMP-9, uPAR and cathepsin B genes were downregulated in glioma xenograft cells using shRNA plasmid constructs and we evaluated the involvement of integrins and changes in their adhesion, migration and invasive potential.MMP-9, uPAR and cathepsin B single shRNA plasmid constructs were used to downregulate these molecules in xenograft cells. We also used MMP-9/uPAR and MMP-9/cathepsin B bicistronic constructs to evaluate the cumulative effects. MMP-9, uPAR and cathepsin B downregulation significantly inhibits xenograft cell adhesion to several extracellular matrix proteins. Treatment with MMP-9, uPAR and cathepsin B shRNA of xenografts led to the downregulation of several alpha and beta integrins. In all the assays, we noticed more prominent effects with the bicistronic plasmid constructs when compared to the single plasmid shRNA constructs. FACS analysis demonstrated the expression of alphaVbeta3, alpha6beta1 and alpha9beta1 integrins in xenograft cells. Treatment with bicistronic constructs reduced alphaVbeta3, alpha6beta1 and alpha9beta1 integrin expressions in xenograft injected nude mice. Migration and invasion were also inhibited by MMP-9, uPAR and cathepsin B shRNA treatments as assessed by spheroid migration, wound healing, and Matrigel invasion assays. As expected, bicistronic constructs further inhibited the adhesion, migration and invasive potential of the xenograft cells as compared to individual treatments.Downregulation of MMP-9, uPAR and cathespin B alone and in combination inhibits adhesion, migration and invasive potential of glioma xenografts by downregulating integrins and associated signaling molecules. Considering the existence of integrin inhibitor-resistant cancer cells, our study provides a novel and effective approach to inhibiting integrins by downregulating MMP-9, uPAR and cathepsin B in the treatment of glioma