Priority water research questions for South Africa developed through participatory processes

This paper describes a collaborative process of identifying and prioritising current and future water research questions from a wide range of water  specialists within South Africa. Over 1 600 questions were collected,  reduced in number and prioritised by specialists working in water research and practice. A total of 59 questions were finally proposed as an outcome of the study and are categorised under the themes of change, data, ecosystems, governance, innovation and resources. The questions range in scale, challenge and urgency, and are also aligned with prevailing  paradigms in water research. The majority of the questions dealt with relatively short- to medium-term research requirements and most focused on immediate issues such as water supply, service delivery and technical solutions. Formulations of long-term research questions were sparse,  partly because some of the principles and methods used in this study were difficult to apply in the South African context, and also because researchers are influenced by addressing what are believed to be the more immediate, short-term water-related challenges in South Africa. This is the first  initiative of its kind to produce a comprehensive and inclusive list of research priorities for water in South Africa.Keywords: research, questions, collaboration, prioritisation, South Afric

Evaluating the clinical and cost effectiveness of a behaviour change intervention for lowering cardiovascular disease risk for people with severe mental illnesses in primary care (PRIMROSE study):study protocol for a cluster randomised controlled trial

BACKGROUND: People with severe mental illnesses die up to 20 years earlier than the general population, with cardiovascular disease being the leading cause of death. National guidelines recommend that the physical care of people with severe mental illnesses should be the responsibility of primary care; however, little is known about effective interventions to lower cardiovascular disease risk in this population and setting. Following extensive peer review, funding was secured from the United Kingdom National Institute for Health Research (NIHR) to deliver the proposed study. The aim of the trial is to test the effectiveness of a behavioural intervention to lower cardiovascular disease risk in people with severe mental illnesses in United Kingdom General Practices. METHODS/DESIGN: The study is a cluster randomised controlled trial in 70 GP practices for people with severe mental illnesses, aged 30 to 75 years old, with elevated cardiovascular disease risk factors. The trial will compare the effectiveness of a behavioural intervention designed to lower cardiovascular disease risk and delivered by a practice nurse or healthcare assistant, with standard care offered in General Practice. A total of 350 people will be recruited and followed up at 6 and 12 months. The primary outcome is total cholesterol level at the 12-month follow-up and secondary outcomes include blood pressure, body mass index, waist circumference, smoking status, quality of life, adherence to treatments and services and behavioural measures for diet, physical activity and alcohol use. An economic evaluation will be carried out to determine the cost effectiveness of the intervention compared with standard care. DISCUSSION: The results of this pragmatic trial will provide evidence on the clinical and cost effectiveness of the intervention on lowering total cholesterol and addressing multiple cardiovascular disease risk factors in people with severe mental illnesses in GP Practices. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13762819 . Date of Registration: 25 February 2013. Date and Version Number: 27 August 2014 Version 5

COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

Background: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. Aims: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment. Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. Results: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. Conclusions: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches

Global patterns of sex- and age-specific variation in seabird bycatch

Fisheries bycatch is a major threat to seabird populations, and understanding sex- and age-biases in bycatch rates is important for assessing population-level impacts. We analysed 44 studies to provide the first global assessment of seabird bycatch by sex and age, and used generalised models to investigate the effects of region and fishing method. Bycatch was highly biased by sex (65% of 123 samples) and age (92% of 114 samples), with the majority of samples skewed towards males and adults. Bycatch of adults and males was higher in subpolar regions, whereas there was a tendency for more immatures and females to be killed in subtropical waters. Fishing method influenced sex- and age-ratios only in subpolar regions. Sex- and age-biases are therefore common features of seabird bycatch in global fisheries that appear to be associated largely with differences in at-sea distributions. This unbalanced mortality influences the extent to which populations are impacted by fisheries, which is a key consideration for at-risk species. We recommend that researchers track individuals of different sex and age classes to improve knowledge of their distribution, relative overlap with vessels, and hence susceptibility to bycatch. This information should then be incorporated in ecological risk assessments of effects of fisheries on vulnerable species. Additionally, data on sex, age and provenance of bycaught birds should be collected by fisheries observers in order to identify regions and fleets where bycatch is more likely to result in population-level impacts, and to improve targeting of bycatch mitigation and monitoring of compliance

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

End-of-life care for elderly within aged residential care facilities : views and perceptions from their next-of-kin : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science with an Endorsement in Health Psychology at Massey University, Manawatu Campus, New Zealand

By 2051, the number of people aged 65 and over will account for 1.33 million of New Zealand’s population (Statistics New Zealand, 2006). This has created attention as to what current practices and facilities are available to this cohort of New Zealand’s population, and what more we can do to make sure we provide adequate services. Limited literature provides insight into what takes place within aged-residential care (ARC) facilities during end-of-life (EoL), especially within New Zealand, even though approximately 40% of those aged 85 and above in New Zealand do already die in ARC facilities (Gibb, 2014). This project investigates the experiences and perceptions of EoL care for elderly within ARC facilities, from the perspective of their next-of-kin (NoK)/family member. Eleven NoK/family members who experienced the passing of their elderly relative within an ARC facility, were recruited as participants. The study used a qualitative method with semi-structured interviews. The interviews were then transcribed, and analysed using thematic analysis on Dedoose, a web-based application, to draw themes from the data. Questions were kept broad and open, so that participants would be able to relay their story as openly as possible without interruptions. The findings are presented under ten major themes which includes; the occurrence of a ‘crisis’ for their elderly relative, the responsibility and adjustment to the role of NoK, changes in the elderly relative’s personality, the effort and kindness experienced within the ARC facility, reflection of the conversations participants had with their elderly relative, the multi-dimensional effect of pain, the process of letting go and anticipatory grief, expectations of the ‘good death’, the influence family has on the experience of being the responsible NoK/family member, and the participants experience of grief while managing the funeral. The interpretation of the results highlighted the extended period that is considered to be EoL and its care within an ARC facility, as opposed to only the last few days before death. This research enables an insight of what entails EoL care within the environment of the ARC facility, as well as allowing the NoK/family member to share the story of their experience

Cognition and daytime functioning in sleep-related breathing disorders

Sleep-relatedbreathingdisorders encompass a range of disorders in which abnormal ventilation occurs during sleep as a result of partial or complete obstruction of the upper airway, altered respiratory drive, abnormal chest wall movement, or respiratory muscle function. The most common of these is obstructive sleep apnea (OSA), occurring in both adults and children, and causing significant cognitive and daytime dysfunction and reduced quality of life. OSA patients experience repetitive brief cessation of breathing throughout the night, which causes intermittent hypoxemia (reductions in hemoglobin oxygen levels) and fragmented sleep patterns. These nocturnal events result in excessive daytime sleepiness, and changes in mood and cognition. Chronic excessive sleepiness during the day is a common symptom of sleep-relatedbreathingdisorders, which is assessed in sleep clinics both subjectively (questionnaire) and objectively (sleep latency tests). Mood changes are often reported by patients, including irritability, fatigue, depression, and anxiety. A wide range of cognitive deficits have been identified in untreated OSA patients, from attentional and vigilance, to memory and executive functions, and more complex tasks such as simulated driving. These changes are reflected in patient reports of difficulty in concentrating, increased forgetfulness, an inability to make decisions, and falling asleep at the wheel of a motor vehicle. These cognitive changes can also have significant downstream effects on daily functioning. Moderate to severe cases of the disorder are at a higher risk of having a motor vehicle accident, and may also have difficulties at work or school. A number of comorbidities may also influence the cognitive changes in OSA patients, including hypertension, diabetes, and stroke. These diseases can cause changes to neural vasculature and result in neural damage, leading to cognitive impairments. Examination of OSA patients using neuroimaging techniques such as structural magnetic resonance imaging and proton magnetic resonance spectroscopy has observed significant changes to brain structure and metabolism. The downstream effects of neural, cognitive, and daytime functional impairments can be significant if left untreated. A better understanding of the cognitive effects of these disorders, and development of more effective assessment tools for diagnosis, will aid early intervention and improve quality of life of the patient

The Religious Imagination of E. Nesbit (1858-1924)

The Religious Imagination of E. Nesbit (1858-1942) investigates the
 influence of Christian ideas and values across the oeuvre of Edith Nesbit (1858-
 1924). A committed Socialist, Nesbit was a highly regarded author of adventure
 and fantasy stories for children, and she is best known to this day for this work.
 However, she also published gothic and romance novels, wrote multiple
 collections of poetry, and delivered lectures and wrote a book on child
 development. The contemporary view of Nesbit is as a children’s author,
 specialising in humorous fantasy adventures, an author shaped by Edwardian
 rejection of Victorian mores, and one strongly influenced by her Socialist
 connections. However, as this thesis will argue, religious ideas were central to her
 work: they shaped her imagination and motivated her ideological concerns, which
 she explored using forms traditionally found in religious or pietistic texts. This
 thesis uses a variety of historical-critical, literary critical and biographical
 approaches to explore the impact of religious thinking in Nesbit’s oeuvre.
 Accordingly, this study is developed through close reading of selected examples of
 her work from several moments across her career: her poetry, her prose, her
 children’s writing. In doing so, the thesis demonstrates how religious thinking
 provides a crucial yet underexamined lens for understanding Nesbit’s imaginative
 and moral vision, a vision shaping and shaped by her political commitments and
 her concern for and attentiveness to childhood as a crucial moment of moral
 formation. Operating within a distinctly theological framework, Nesbit’s depiction
 of the supernatural, the fantastic and the magical form is a particular focus of this
 thesis allowing a reassessment of a Victorian author who defies simplistic
 categorisation in terms of religious adherence and expression