Chondrogenesis of Human Infrapatellar Fat Pad Stem Cells on Acellular Dermal Matrix

Acellular dermal matrix (ADM) has been in clinical use for decades in numerous surgical applications. The ability for ADM to promote cellular repopulation, revascularisation and tissue regeneration is well documented. Adipose stem cells have the ability to differentiate into mesenchymal tissue types, including bone and cartilage. The aim of this study was to investigate the potential interaction between ADM and adipose stem cells in vitro using TGFβ3 and BMP6. Human infrapatellar fat pad-derived adipose stem cells (IPFP-ASC) were cultured with ADM derived from rat dermis in chondrogenic (TGFβ3 and BMP6) medium in vitro for 2 and 4 weeks. Histology, qPCR, and immunohistochemistry were performed to assess for markers of chondrogenesis (collagen Type II, SOX9 and proteoglycans). At 4 weeks, cell-scaffold constructs displayed cellular changes consistent with chondrogenesis, with evidence of stratification of cell layers and development of a hyaline-like cartilage layer superficially, which stained positively for collagen Type II and proteoglycans. Significant cell-matrix interaction was seen between the cartilage layer and the ADM itself with seamless integration between each layer. Real time qPCR showed significantly increased COL2A1, SOX9, and ACAN gene expression over 4 weeks when compared to control. COL1A2 gene expression remained unchanged over 4 weeks. We believe that the principles that make ADM versatile and successful for tissue regeneration are applicable to cartilage regeneration. This study demonstrates in vitro the ability for IPFP-ASCs to undergo chondrogenesis, infiltrate, and interact with ADM. These outcomes serve as a platform for in vivo modelling of ADM for cartilage repair

Expected survival with and without second-line palliative chemotherapy: who wants to know?

Background According to surveys, many patients with advancedcancer wish to receive survival information.Objective This study invest igated information preferences by offer-ing patients a decision aid (DA) with infor mation on expected sur-vival for two treatment options: supportive care with or withoutsecond-line palliative chemotherapy. Predicto rs of accepting sur-vival information were explored.Design Eligible patients in this multicentre prospective study wereoffered secon d-line chemotherapy for advanced breast or colorectalcancer. A nurse presented a DA on second-line treatment andasked patients whether they desired information on (i) adverseevents, (ii) tumour response and (iii) survival. Data on 50 clinicaland psychosocial patient characteristics were collected from inclu-sion forms and patient questionnaires.Results Seventy-seven patients received a DA; median age62 years (range 32–80), 61% female, 77% colorectal cancer. Fifty-seven patients (74%; 95% CI 64–84) desired survival information.Four psychosocial characteristics (e.g . deliberative decision style)independently predicted information desire. However, the use ofthese characteristics to predict information desire hardly outper-formed a simple prediction rule.Conclusions Many patients desired information on expected sur-vival when deciding about second-line treatment. However, ourexploratory analysis indicated that patients desiring this informa-tion could not be identified based on their clinical or psychosocialcharacteristics. These findings can help encourage candid discus-sions about expected survival. Health professionals should be care-ful not to make implicit assumptions of information desire based on patient characteristics, but to explicitly ask patients if survivalinformation is desired, and act accordingly

An assessment of validity and responsiveness of generic measures of health-related quality of life in hearing impairment

This article is made available through the Brunel Open Access Publishing Fund. This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.Purpose: This review examines psychometric performance of three widely used generic preference-based measures, that is, EuroQol 5 dimensions (EQ-5D), Health Utility Index 3 (HUI3) and Short-form 6 dimensions (SF-6D) in patients with hearing impairments. Methods: A systematic search was undertaken to identify studies of patients with hearing impairments where health state utility values were measured and reported. Data were extracted and analysed to assess the reliability, validity (known group differences and convergent validity) and responsiveness of the measures across hearing impairments. Results: Fourteen studies (18 papers) were included in the review. HUI3 was the most commonly used utility measures in hearing impairment. In all six studies, the HUI3 detected difference between groups defined by the severity of impairment, and four out of five studies detected statistically significant changes as a result of intervention. The only study available suggested that EQ-5D only had weak ability to discriminate difference between severity groups, and in four out of five studies, EQ-5D failed to detected changes. Only one study involved the SF-6D; thus, the information is too limited to conclude on its performance. Also evidence for the reliability of these measures was not found. Conclusion: Overall, the validity and responsiveness of the HUI3 in hearing impairment was good. The responsiveness of EQ-5D was relatively poor and weak validity was suggested by limited evidence. The evidence on SF-6D was too limited to make any judgment. More head-to-head comparisons of these and other preference measures of health are required.Medical Research Counci

How do Zimbabweans value health states?

Background Quality of life weights based on valuations of health states are often used in cost utility analysis and population health measures. This paper reports on an attempt to develop quality of life weights within the Zimbabwe context. Methods 2,384 residents in randomly selected small residential plots of land in a high-density suburb of Harare valued descriptors of 38 health states based on different combinations of the five domains of the EQ-5D (mobility, self-care, usual activities, pain or discomfort and anxiety or depression). The English version of the EQ-5D was used. The time trade-off method was used to determine the values, and 19,020 individual preferences for health states were analysed. A residual maximum likelihood linear mixed model was used to estimate a function for predicting the values of all possible combinations of levels on the five domains. The model was fit to a random subset of two-thirds of the observations, with the remaining observations reserved for analysis of predictive validity. The results were compared to a similar study undertaken in the United Kingdom. Results A credible model was developed to predict the values of states that were not valued directly. In the subset of observations reserved for validation, the mean absolute difference between predicted and observed values was 0.045. All domains of the EQ-5D were found to contribute significantly to the model, both at the moderate and severe levels. Severe pain was found to have the largest negative coefficient, followed by the inability to wash and dress oneself. Conclusion Despite a generally lower education level than their European counterparts, urban Zimbabweans appear to value health states in a consistent manner, and the determination of a global method of establishing quality of life weights may be feasible and valid. However, as the relative weightings of the different domains, although correlated, differed from the standard set of weights recommended by the EuroQol Group, the locally determined coefficients should be used within the Zimbabwean context

Fishers' Knowledge On The Coast Of Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Although fishers' knowledge has been recently considered into management programmes, there is still the need to establish a better understanding of fishers' perceptions and cognition. Fishers can provide novel information on the biology and ecology of species, which can potentially be used in the management of fisheries. The knowledge fishers have and how they classify nature is empirically based. It is common, for example, to observe that fishers' taxonomy is often represented by the generic level, one of the hierarchical categories of folk classification that is somewhat analogous to the Linnean genus, as it groups organisms of a higher rank than the folk species. In this study we compiled the knowledge fishers have on local fish, such as their folk names, diet and habitat. Methods: Five coastal communities widely distributed along the Brazilian coast were studied: two from the northeast (Porto Sauipe and Itacimirim, in Bahia State, n of interviewees = 34), two from the southeast (Itaipu at Niteroi and Copacabana at Rio de Janeiro, Rio de Janeiro State, n = 35) and one from the south coast (Pantano do Sul, in Santa Catarina State, n = 23). Fish pictures were randomly ordered and the same order was presented to all interviewees (n = 92), when they were then asked about the species name and classification and its habitat and diet preferences. Results: Fishers make clusters of fish species, usually hierarchically; fishers of the coast of Brazil use mostly primary lexemes (generic names) to name fish; and fishers did not differentiate between scientific species, since the same folk generic name included two different scientific species. Fishers provide information on species to which there is scarce or no information on diet and habitat, such as Rhinobatos percellens (chola guitarfish, arraia viola or cacao viola), Sphoeroides dorsalis (marbled puffer, baiacu), Mycteroperca acutirostris (comb grouper, badejo) and Dasyatis guttata (longnose stingray, arraia, arraia manteiga). Conclusions: fishers' knowledge on fish diet and fish habitat can be strategic to management, since their knowledge concentrates on the fishery target species, which are the ones under higher fishing pressure. Besides,12FAPESP [Fapesp 01/00718-1, 04/02301-9, Fapesp 14/16939-7, 14/24994-8]CNPQ[2014/24994-8]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Introducing the composite time trade-off: a test of feasibility and face validity

__Abstract__ __Introduction__ This study was designed to test the feasibility and face validity of the composite time trade-off (composite TTO), a new approach to TTO allowing for a more consistent elicitation of negative health state values. __Methods__ The new instrument combines a conventional TTO to elicit values for states regarded better than dead and a lead-time TTO for states worse than dead. __Results__ A total of 121 participants completed the composite TTO for ten EQ-5D-5L health states. Mean values ranged from −0.104 for health state 53555 to 0.946 for 21111. The instructions were clear to 98 % of the respondents, and 95 % found the task easy to understand, indicating feasibility. Further, the average number of steps taken in the iteration procedure to achieve the point of indifference in the TTO and the average duration of each task were indicative of a deliberate cognitive process. __Conclusion__ Face validity was confirmed by the high mean values for the mild health states (>0.90) and low mean values for the severe states (<0.42). In conclusion, this study demonstrates the feasibility and face validity of the composite TTO in a face-to-face standardized computer-assisted interview setting

Restoring community livelihoods and food security through livestock asset during drought disasters: case study of Mwingi, Kenya

Some of the world’s poor and most disaster-vulnerable communities are also those most reliant on livestock. Whenever disasters strike, in addition to the immediate devastation, food insecurity and loss of life, the loss of livestock can leave a secondary legacy of economic instability, debt and dependency. In 2011, a collaborative approach to mitigate both immediate and long-term effects of the devastating drought affecting Kenya’s livestock and people was conducted in Mwingi. In that year, East Africa had suffered the worst drought in 60 years following three years of poor or failed rains. More than 11 million people faced starvation in the region and in Kenya alone, 3.5 million people were affected by the crisis, which was declared a national disaster. For the people of Mwingi in Kenya, the keeping of livestock – including cattle, goats, sheep and camels – is the primary source of livelihoods and forms the basis of the regional economy. As the drought continued, daily life of Mwingi people became a struggle for survival for both people and their animals. Of their estimated animals thought to have been affected, in some areas, up to 45 per cent of the animal population died. A strategy to mitigate the effects of the drought was designed through participatory drought analysis and needs assessment. Subsequently, a drought response team was deployed in the region targeting to secure and restore valued asset of the people of Mwingi - the livestock. Management of livestock during that crisis helped to safeguard livelihoods and food security of the affected region. By the end of the disaster management there were perceived benefits in terms of improved body condition of the animals, avoided animal mortalities and indirect benefits derived from surviving livestock. With resumption of rains, farmers were able to continue depending upon their secured animals assets for livelihood. The cost-benefit analysis indicated the intervention generated $2.74 of benefits in the form of avoided losses for every$1 spent. If the time period was extended to 3 years, the benefit-cost ratio increases to $6.69 in benefits for every$1 spent. This case demonstrates that interventions on drought crisis focusing on actions aimed at animal welfare could help maintain and restore the livestock as a livelihoods asset of the regions’ farmers and help to enhance their food security. Key words: Drought, Livestock, Livelihoods, Food Securit

A Methodological Framework for the Evaluation of Syndromic Surveillance Systems: A Case Study of England

Background: Syndromic surveillance complements traditional public health surveillance by collecting and analysing health indicators in near real time. The rationale of syndromic surveillance is that it may detect health threats faster than traditional surveillance systems permitting more timely, and hence potentially more effective public health action. The effectiveness of syndromic surveillance largely relies on the methods used to detect aberrations. Very few studies have evaluated the performance of syndromic surveillance systems and consequently little is known about the types of events that such systems can and cannot detect. Methods: We introduce a framework for the evaluation of syndromic surveillance systems that can be used in any setting based upon the use of simulated scenarios. For a range of scenarios this allows the time and probability of to be determined and uncertainty is fully incorporated. In addition, we demonstrate how such a framework can model the benefits of increases in the number of centres reporting syndromic data and also determine the minimum size of outbreaks that can or cannot be detected. Here, we demonstrate its utility using simulations of national influenza outbreaks and localised outbreaks of cryptosporidiosis. Results: Influenza outbreaks are consistently detected with larger outbreaks being detected in a more timely manner. Small cryptosporidiosis outbreaks (<1000 symptomatic individuals) are unlikely to be detected. We also demonstrate the advantages of having multiple syndromic data streams (e.g. emergency attendance data, telephone helpline data, general practice consultation data) as different streams are able to detect different types outbreaks with different efficacy (e.g. emergency attendance data are useful for the detection of pandemic influenza but not for outbreaks of cryptosporidiosis). We also highlight that for any one disease, the utility of data streams may vary geographically, and that the detection ability of syndromic surveillance varies seasonally (e.g. an influenza outbreak starting in July is detected sooner than one starting later in the year). We argue that our framework constitutes a useful tool for public health emergency preparedness in multiple settings. Conclusions: The proposed framework allows the exhaustive evaluation of any syndromic surveillance system and constitutes a useful tool for emergency preparedness and response

Collaboration barriers in the implementation of design for environment: case studies from small and medium UK enterprises

This paper considers product development interaction and collaboration issues in the implementation of design for environment (DfE). The research used a multiple case study methodology to investigate collaboration and relationships within product development teams. Interviews within a multiple case study research were used to identify the links between poor adoption of DfE principles, communication, collaboration and knowledge management. The study was carried out across the product development teams of twenty British small and medium sized companies. The paper presents an overview of the preliminary findings drawn from an ongoing comparative analysis of these case studies to highlight the impacts of organisational factors on DfE implementation within product development teams. It is argued that further research should focus on how knowledge acquisition and transfer within small and medium enterprises can better support the necessary collaboration in DfE