How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review.

Background: We systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries. Methods: We searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools. Results: Of 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low. Discussion: Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers. PROSPERO registration number: CRD42018091088

Exploiting impacts of antenna selection and energy harvesting for massive network connectivity

As a new energy saving approach for green communications, energy harvesting (EH) could be suitable technique to facilitate massive connections for large number of devices in such networks. The spectrum shortage occurs in huge number of devices which access with small-cell and macro-cell networks. To tackle these challenges, we develop a tractable framework relying on prominent techniques such as non-orthogonal multiple access (NOMA), antenna selection and energy harvesting. In this paper, we aim at practical scenarios of small cell networks by jointly evaluating capable of interference management and EH. We benefit from transmission approaches including full duplex (FD) and bi-directional transmission to improve the main performance system metrics such as outage probability and throughput. Three useful schemes are explored by considering EH and inter-cell interference. We derive the closed-form and asymptotic expressions for system metrics. We then perform extensive simulations with different system configurations to confirm the effectiveness of the proposed small-cell NOMA systems

Block of death-receptor apoptosis protects mouse cytomegalovirus from macrophages and is a determinant of virulence in immunodeficient hosts.

The inhibition of death-receptor apoptosis is a conserved viral function. The murine cytomegalovirus (MCMV) gene M36 is a sequence and functional homologue of the human cytomegalovirus gene UL36, and it encodes an inhibitor of apoptosis that binds to caspase-8, blocks downstream signaling and thus contributes to viral fitness in macrophages and in vivo. Here we show a direct link between the inability of mutants lacking the M36 gene (ΔM36) to inhibit apoptosis, poor viral growth in macrophage cell cultures and viral in vivo fitness and virulence. ΔM36 grew poorly in RAG1 knockout mice and in RAG/IL-2-receptor common gamma chain double knockout mice (RAGγC(-/-)), but the depletion of macrophages in either mouse strain rescued the growth of ΔM36 to almost wild-type levels. This was consistent with the observation that activated macrophages were sufficient to impair ΔM36 growth in vitro. Namely, spiking fibroblast cell cultures with activated macrophages had a suppressive effect on ΔM36 growth, which could be reverted by z-VAD-fmk, a chemical apoptosis inhibitor. TNFα from activated macrophages synergized with IFNγ in target cells to inhibit ΔM36 growth. Hence, our data show that poor ΔM36 growth in macrophages does not reflect a defect in tropism, but rather a defect in the suppression of antiviral mediators secreted by macrophages. To the best of our knowledge, this shows for the first time an immune evasion mechanism that protects MCMV selectively from the antiviral activity of macrophages, and thus critically contributes to viral pathogenicity in the immunocompromised host devoid of the adaptive immune system

Decreased STARD10 expression is associated with defective insulin secretion in humans and mice

Genetic variants near ARAP1 (CENTD2) and STARD10 influence type 2 diabetes (T2D) risk. The risk alleles impair glucose-induced insulin secretion and, paradoxically but characteristically, are associated with decreased proinsulin:insulin ratios, indicating improved proinsulin conversion. Neither the identity of the causal variants nor the gene(s) through which risk is conferred have been firmly established. Whereas ARAP1 encodes a GTPase activating protein, STARD10 is a member of the steroidogenic acute regulatory protein (StAR)-related lipid transfer protein family. By integrating genetic fine-mapping and epigenomic annotation data and performing promoter-reporter and chromatin conformational capture (3C) studies in β cell lines, we localize the causal variant(s) at this locus to a 5 kb region that overlaps a stretch-enhancer active in islets. This region contains several highly correlated T2D-risk variants, including the rs140130268 indel. Expression QTL analysis of islet transcriptomes from three independent subject groups demonstrated that T2D-risk allele carriers displayed reduced levels of STARD10 mRNA, with no concomitant change in ARAP1 mRNA levels. Correspondingly, β-cell-selective deletion of StarD10 in mice led to impaired glucose-stimulated Ca2+ dynamics and insulin secretion and recapitulated the pattern of improved proinsulin processing observed at the human GWAS signal. Conversely, overexpression of StarD10 in the adult β cell improved glucose tolerance in high fat-fed animals. In contrast, manipulation of Arap1 in β cells had no impact on insulin secretion or proinsulin conversion in mice. This convergence of human and murine data provides compelling evidence that the T2D risk associated with variation at this locus is mediated through reduction in STARD10 expression in the β cell

Cdc42 promotes transendothelial migration of cancer cells through β1 integrin.

Cancer cells interact with endothelial cells during the process of metastatic spreading. Here, we use a small interfering RNA screen targeting Rho GTPases in cancer cells to identify Cdc42 as a critical regulator of cancer cell-endothelial cell interactions and transendothelial migration. We find that Cdc42 regulates β1 integrin expression at the transcriptional level via the transcription factor serum response factor (SRF). β1 integrin is the main target for Cdc42-mediating interaction of cancer cells with endothelial cells and the underlying extracellular matrix, as exogenous β1 integrin expression was sufficient to rescue the Cdc42-silencing phenotype. We show that Cdc42 was required in vivo for cancer cell spreading and protrusion extension along blood vessels and retention in the lungs. Interestingly, transient Cdc42 depletion was sufficient to decrease experimental lung metastases, which suggests that its role in endothelial attachment is important for metastasis. By identifying β1 integrin as a transcriptional target of Cdc42, our results provide new insight into Cdc42 function

Dynamics of multi-stage infections on networks

This paper investigates the dynamics of infectious diseases with a nonexponentially distributed infectious period. This is achieved by considering a multistage infection model on networks. Using pairwise approximation with a standard closure, a number of important characteristics of disease dynamics are derived analytically, including the final size of an epidemic and a threshold for epidemic outbreaks, and it is shown how these quantities depend on disease characteristics, as well as the number of disease stages. Stochastic simulations of dynamics on networks are performed and compared to output of pairwise models for several realistic examples of infectious diseases to illustrate the role played by the number of stages in the disease dynamics. These results show that a higher number of disease stages results in faster epidemic outbreaks with a higher peak prevalence and a larger final size of the epidemic. The agreement between the pairwise and simulation models is excellent in the cases we consider

Job satisfaction among anesthetists in Ethiopia-a national cross-sectional study

Background Ethiopia has substantially increased production of associate clinician anesthetists. This study aimed to determine the level of and factors that predict job satisfaction among a national sample of anesthetists. Methods A cross-sectional study conducted in 2014 sampled 252 anesthetists. Respondents rated 37 items related to job satisfaction and working and living conditions using a Likert scale, which ranged from 1 (strongly disagree) to 5 (strongly agree). Univariate and multivariable logistic regressions were used to determine factors associated with the main outcome variable, level of job satisfaction. Adjusted odds ratios and 95% confidence intervals were calculated to show the magnitude of associations. Results Less than half (n = 107, 42.5%) of anesthetists were satisfied with their job. Work environment (aOR = 1.87, 95% CI = 1.06, 3.31) and more than 10 years of experience working in the public health system (aOR = 4.96, 95% CI = 1.11, 22.13) were predictors of job satisfaction in the multivariable model. Conclusion Ethiopian anesthetists have low levels of job satisfaction, with work environment and years of experience being factors that predict their satisfaction positively. Motivation and retention of this cadre will require emphasis on creating a safe and conducive work environment, and interventions designed to motivate junior anesthetists

Scope and limitations of the irreversible thermodynamics and the solution diffusion models for the separation of binary and multi-component systems in reverse osmosis process

YesReverse osmosis process is used in many industrial applications ranging from solute-solvent to solvent-solvent and gaseous separation. A number of theoretical models have been developed to describe the separation and fluxes of solvent and solute in such processes. This paper looks into the scope and limitations of two main models (the irreversible thermodynamics and the solution diffusion models) used in the past by several researchers for solute-solvent feed separation. Despite the investigation of other complex models, the simple concepts of these models accelerate the feasibility of the implementation of reverse osmosis for different types of systems and variety of industries. Briefly, an extensive review of these mathematical models is conducted by collecting more than 70 examples from literature in this study. In addition, this review has covered the improvement of such models to make them compatible with multi-component systems with consideration of concentration polarization and solvent-solute-membrane interaction

Integrating microalgae production with anaerobic digestion: a biorefinery approach

This is the peer reviewed version of the following article: [Uggetti, E. , Sialve, B. , Trably, E. and Steyer, J. (2014), Integrating microalgae production with anaerobic digestion: a biorefinery approach. Biofuels, Bioprod. Bioref, 8: 516-529. doi:10.1002/bbb.1469], which has been published in final form at https://doi.org/10.1002/bbb.1469. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-ArchivingIn the energy and chemical sectors, alternative production chains should be considered in order to simultaneously reduce the dependence on oil and mitigate climate change. Biomass is probably the only viable alternative to fossil resources for production of liquid transportation fuels and chemicals since, besides fossils, it is one of the only available sources of carbon-rich material on Earth. Over recent years, interest in microalgae biomass has grown in both fundamental and applied research fields. The biorefinery concept includes different technologies able to convert biomass into added-value chemicals, products (food and feed) and biofuels (biodiesel, bioethanol, biohydrogen). As in oil refinery, a biorefinery aims at producing multiple products, maximizing the value derived from differences in biomass components, including microalgae. This paper provides an overview of the various microalgae-derived products, focusing on anaerobic digestion for conversion of microalgal biomass into methane. Special attention is paid to the range of possible inputs for anaerobic digestion (microalgal biomass and microalgal residue after lipid extraction) and the outputs resulting from the process (e.g. biogas and digestate). The strong interest in microalgae anaerobic digestion lies in its ability to mineralize microalgae containing organic nitrogen and phosphorus, resulting in a flux of ammonium and phosphate that can then be used as substrate for growing microalgae or that can be further processed to produce fertilizers. At present, anaerobic digestion outputs can provide nutrients, CO2 and water to cultivate microalgae, which in turn, are used as substrate for methane and fertilizer generation.Peer ReviewedPostprint (author's final draft

Feasibility of intensity-modulated and image-guided radiotherapy for locally advanced esophageal cancer

BACKGROUND:In this study the feasibility of intensity-modulated radiotherapy (IMRT) and tomotherapy-based image-guided radiotherapy (IGRT) for locally advanced esophageal cancer was assessed.METHODS:A retrospective study of ten patients with locally advanced esophageal cancer who underwent concurrent chemotherapy with IMRT (1) and IGRT (9) was conducted. The gross tumor volume was treated to a median dose of 70Gy (62.4-75Gy).RESULTS:At a median follow-up of 14months (1-39 months), three patients developed local failures, six patients developed distant metastases, and complications occurred in two patients (1 tracheoesophageal fistula, 1 esophageal stricture requiring repeated dilatations). No patients developed grade 3-4 pneumonitis or cardiac complications.CONCLUSIONS:IMRT and IGRT may be effective for the treatment of locally advanced esophageal cancer with acceptable complications.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]