Leveraging a Community-Based Research Approach to Explore Research Perceptions Among Suburban Poor and Underserved Populations

This qualitative study explored perceptions of research among a rapidly growing underserved population within a suburban community, a setting that has yet to be sufficiently explored using a community-based research (CBR) approach. We recruited community members from community health care agencies in DuPage County, Illinois, and 79 participants were enrolled in the study. Community researchers conducted nine focus groups comprised of agency clients and eight stakeholder interviews to collect community perspectives regarding the meaning of research and its community impact, current and desired channels of research information, and research motives, discrimination, and funding. Findings revealed four major themes: community members 1) often associate research with medical research or community engagement; 2) rely most heavily on the internet for research information; 3) perceive financial barriers, rather than racial or ethnic barriers, as a significant obstacle to receiving the benefits of research; and 4) trust research conducted by academic institutions

Appropriate Timing of Fluoxetine and Statin Delivery Reduces the Risk of Secondary Bleeding in Ischemic Stroke Rats

Background: Ongoing clinical trials are testing the effect of fluoxetine delivered post-stroke where a majority of patients are taking statins. This study determined the influence of the timing of administration of fluoxetine and statin on the final infarct volume and the risk of secondary bleeding in an animal model of ischemic stroke. Methods and findings: Ischemic strokes were induced by endothelin-1 injection into two cortical sites of 10-12 month old female rats, targeting the forelimb motor cortex. Combined medications (5 mg/kg fluoxetine and 1 mg/kg simvastatin) were orally administered either beginning 6-12 hours or 20-26 hours after stroke induction and continued daily for 90 days. Infarct volumes were assessed at poststroke day 91 using Nissl stained coronal brain sections. Control animals typically had 5-13 mm3 infarct volumes following endothelin-1 induced stroke. Animals that received fluoxetine and simvastatin (FS) beginning 20- 26 hours after stroke induction showed a strong trend of reduced infarct volume (3±0.3447 mm3 SEM, P=0.0563). Earlier drug delivery (6-12 hours after stroke) resulted in significantly larger infarct volumes (15.44.260 mm3 SEM, P=0.0157) when the drug groups were directly compared. Examination of the infarcts showed that earlier drug delivery induced secondary hemorrhagic infarcts, while later delivery did not (P=0.0427; Fisher’s exact test). Conclusion: There is a danger of secondary bleeding if fluoxetine and simvastatin are combined within 6-12 hours of ischemic stroke induction in rats resulting in larger infarct volumes. Delaying fluoxetine and simvastatin delivery to 20-26 hours after stroke induction in rats, however, reduces infarct volume and significantly lowers the risk of secondary hemorrhagic infarcts

Solutions for global marine litter pollution

Since the 1950s the amount of plastics in the marine environment has increased dramatically. Worldwide there is a growing concern about the risks and possible adverse effects of (micro) plastics. This paper reflects on the sources and effects of marine litter and the effects of policies and other actions taken worldwide. Current knowledge offers a solid basis for effective action. Yet, so far the effects of policies and other initiatives are still largely insufficient. The search for appropriate responses could be based on possible interventions and profound understanding of the context specific factors for success. Moreover, the scope, timeframe and dynamics of all initiatives are distinctly different and orchestration at all levels, in close cooperation with one another is currently lacking

A comprehensive approach to managing a neglected, neglected tropical disease; The Myanmar Snakebite Project (MSP)

Snakebite is predominantly an occupational disease affecting poor rural farmers in tropical regions and was recently added to the World Health Organisation list of Neglected Tropical Diseases (NTD). We document an overview of methodologies developed and deployed in the Myanmar Snakebite Project, a foreign aid project largely funded by the Australian Government, with the core aim to “improve outcomes for snakebite patients”. A multidisciplinary team of experts was assembled that worked in a collaborative manner with colleagues in Myanmar, first to identify problems related to managing snakebite and then develop interventions aimed to improve selected problem areas. A broad approach was adopted, covering antivenom production, antivenom distribution and health system management of snakebite. Problems identified in antivenom production included poor snake husbandry resulting in poor survival of captive specimens, lack of geographical diversity; poor horse husbandry, resulting in high mortality, inadequate stock acquisition protocols and data collection, and inappropriate immunisation and bleeding techniques; and inadequate production capacity for freeze dried antivenoms and quality control systems. These problems were addressed in various ways, resulting in some substantial improvements. Antivenom distribution is being reorganised to achieve better availability and utilisation of stock. Health system management of snakebite was assessed across all levels within the area selected for the study, in Mandalay region. A comprehensive community survey indicated that hospital statistics substantially underestimated the snakebite burden, and that access to care by local villagers was delayed by transport and cost issues compounded by lack of antivenom at the most peripheral level of the health service. A health system survey confirmed under-resourcing at the local village level. Prospective case data collection initiated at tertiary hospitals indicated the extent of the snakebite burden on health resources. Interventions initiated or planned include training of health staff, development of a core of senior trainers who can “train the trainers” nationwide in a sustainable way, development and deployment of management guidelines and algorithms for snakebite and a distribution of solar powered fridges to remote health facilities to allow storage of antivenom and prompt treatment of snakebite cases before transfer to major hospitals, thereby reducing the “bite to needle” time.Julian White, Mohammad Afzal Mahmood, Sam Alfred, Khin Thida Thwin, Khin Maung Kyaw, Aung Zaw, David Warrell, Robert Cumming, John Moody Debbie Eagles, Keiran Ragas h, Nathan Dunstan, David Bacon, Plinio Hurtado, Chen Au Pe

Mapping Cumulative Environmental Risks: Examples from The EU NoMiracle Project

We present examples of cumulative chemical risk mapping methods developed within the NoMiracle project. The different examples illustrate the application of the concentration addition (CA) approach to pesticides at different scale, the integration in space of cumulative risks to individual organisms under the CA assumption, and two techniques to (1) integrate risks using data-driven, parametric statistical methods, and (2) cluster together areas with similar occurrence of different risk factors, respectively. The examples are used to discuss some general issues, particularly on the conventional nature of cumulative risk maps, and may provide some suggestions for the practice of cumulative risk mapping

Cellular Immune Responses to Nine Mycobacterium tuberculosis Vaccine Candidates following Intranasal Vaccination

BACKGROUND: The identification of Mycobacterium tuberculosis vaccines that elicit a protective immune response in the lungs is important for the development of an effective vaccine against tuberculosis. METHODS AND PRINCIPAL FINDINGS: In this study, a comparison of intranasal (i.n.) and subcutaneous (s.c.) vaccination with the BCG vaccine demonstrated that a single moderate dose delivered intranasally induced a stronger and sustained M. tuberculosis-specific T-cell response in lung parenchyma and cervical lymph nodes of BALB/c mice than vaccine delivered subcutaneously. Both BCG and a multicomponent subunit vaccine composed of nine M. tuberculosis recombinant proteins induced strong antigen-specific T-cell responses in various local and peripheral immune compartments. Among the nine recombinant proteins evaluated, the alanine proline rich antigen (Apa, Rv1860) was highly antigenic following i.n. BCG and immunogenic after vaccination with a combination of the nine recombinant antigens. The Apa-induced responses included induction of both type 1 and type 2 cytokines in the lungs as evaluated by ELISPOT and a multiplexed microsphere-based cytokine immunoassay. Of importance, i.n. subunit vaccination with Apa imparted significant protection in the lungs and spleen of mice against M. tuberculosis challenge. Despite observed differences in the frequencies and location of specific cytokine secreting T cells both BCG vaccination routes afforded comparable levels of protection in our study. CONCLUSION AND SIGNIFICANCE: Overall, our findings support consideration and further evaluation of an intranasally targeted Apa-based vaccine to prevent tuberculosis