Urbanisation and asthma in low-income and middle-income countries: a systematic review of the urban-rural differences in asthma prevalence.

BACKGROUND: Urbanisation has been associated with temporal and geographical differences in asthma prevalence in low-income and middle-income countries (LMICs). However, little is known of the mechanisms by which urbanisation and asthma are associated, perhaps explained by the methodological approaches used to assess the urbanisation-asthma relationship. OBJECTIVE: This review evaluated how epidemiological studies have assessed the relationship between asthma and urbanisation in LMICs, and explored urban/rural differences in asthma prevalence. METHODS: Asthma studies comparing urban/rural areas, comparing cities and examining intraurban variation were assessed for eligibility. Included publications were evaluated for methodological quality and pooled OR were calculated to indicate the risk of asthma in urban over rural areas. RESULTS: Seventy articles were included in our analysis. Sixty-three compared asthma prevalence between urban and rural areas, five compared asthma prevalence between cities and two examined intraurban variation in asthma prevalence. Urban residence was associated with a higher prevalence of asthma, regardless of asthma definition: current-wheeze OR:1.46 (95% CI:1.22 to 1.74), doctor diagnosis OR:1.89 (95% CI:1.47 to 2.41), wheeze-ever OR:1.44 (95% CI:1.15 to 1.81), self-reported asthma OR:1.77 (95% CI:1.33 to 2.35), asthma questionnaire OR:1.52 (95% CI:1.06 to 2.16) and exercise challenge OR:1.96 (95% CI:1.32 to 2.91). CONCLUSIONS: Most evidence for the relationship between urbanisation and asthma in LMICs comes from studies comparing urban and rural areas. These studies tend to show a greater prevalence of asthma in urban compared to rural populations. However, these studies have been unable to identify which specific characteristics of the urbanisation process may be responsible. An approach to understand how different dimensions of urbanisation, using contextual household and individual indicators, is needed for a better understanding of how urbanisation affects asthma. PROSPERO REGISTRATION NUMBER: CRD42017064470

Phenotypes and Clinical Genotypes of Bruxism Patients: A Systematic Review

Background. Bruxism is a phenomenon where psychological and exogenous biological factors act in greater percentage. Several genetic polymorphisms have been described in GABAA receptors, and some have been associated with motor limitations, such as the rs1805057 polymorphism of the GABRB1 gene (GABAA), which found a haplotype associated with a lower limitation in movement in acute pain processes. The aim to identify the clinical phenotypes in bruxism patients. Eligibility criteria were as follows: observational studies, case control studies, odds ratios, bruxism, patients, and a keyword search that included [[bruxism]], OR [[temporomandibular joint disorders]] OR [[sleep bruxism]], OR [[awake bruxism]], OR [[polymorphism]] or [[GABAA]], or [[serotonin]] , using the Boolean operators AND, OR and NOT. Were included 210 identified records in databases; 50 records from other sources; 117 records were deleted after determining they were duplicates; 42 studies were included in qualitative synthesis ; finally, who met inclusion requirements 5 studies were included in synthesis. The comparison of global DNA methylation profiles in patients with bruxism shows a possible genetic influence on their etiology, indicating that patients with HTR2A rs2770304 alleles are at increased risk. the HTR2A rs2770304 allele leads to an increased risk of bruxism

Exploring the transcriptomic data of the Australian paralysis tick, Ixodes holocyclus

Ixodes holocyclus is the paralysis tick commonly found in Australia. I. holocyclus does not cause paralysis in the primary host – bandicoots, but markedly affects secondary hosts such as companion animals, livestock and humans. Holocyclotoxins are the neurotoxin molecules in I. holocyclus responsible for paralysis symptoms. There is a limited understanding of holocyclotoxins due to the difficulties in purifying and expressing these toxins in vitro. Next-generation sequencing technologies were utilised for the first time to generate transcriptome data from two cDNA samples –salivary glands samples collected from female adult ticks engorged on paralysed companion animals and on bandicoots. Contigencoded proteins in each library were annotated according to their best BLAST match against several databases and functionally assigned into six protein categories: housekeeping, transposable elements, pathogen-related, hypothetical, secreted and novel. The “secreted protein” category is comprised of ten protein families: enzymes, protease inhibitors, antigens, mucins, immunity-related, lipocalins, glycinerich, putative secreted, salivary and toxin-like. Comparisons of contig representation between the two libraries reveal the differential expression of tick proteins collected from different hosts. This study provides a preliminary description of the I. holocyclus tick salivary gland transcriptome

Exploring the Transcriptomic Data of the Australian Paralysis Tick, Ixodes Holocyclus

Ixodes holocyclus is the paralysis tickcommonly found in Australia. I. holocyclus does notcause paralysis in the primary host – bandicoots, butmarkedly affects secondary hosts such as companionanimals, livestock and humans. Holocyclotoxins are theneurotoxin molecules in I. holocyclus responsible forparalysis symptoms. There is a limited understanding ofholocyclotoxins due to the difficulties in purifying andexpressing these toxins in vitro. Next-generationsequencing technologies were utilised for the first time togenerate transcriptome data from two cDNA samples –salivary glands samples collected from female adult ticksengorged on paralysed companion animals and onbandicoots. Contig-encoded proteins in each librarywere annotated according to their best BLAST matchagainst several databases and functionally assigned intosix protein categories: housekeeping, transposableelements, pathogen-related, hypothetical, secreted andnovel. The “secreted protein” category is comprised often protein families: enzymes, protease inhibitors,antigens, mucins, immunity-related, lipocalins, glycinerich,putative secreted, salivary and toxin-like.Comparisons of contig representation between the twolibraries reveal the differential expression of tickproteins collected from different hosts. This studyprovides a preliminary description of the I. holocyclustick salivary gland transcriptome

A prospective study to evaluate the accuracy of pulse power analysis to monitor cardiac output in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Intermittent measurement of cardiac output may be performed using a lithium dilution technique (LiDCO). This can then be used to calibrate a pulse power algorithm of the arterial waveform which provides a continuous estimate of this variable. The purpose of this study was to examine the duration of accuracy of the pulse power algorithm in critically ill patients with respect to time when compared to measurements of cardiac output by an independent technique.</p> <p>Methods</p> <p>Pulse power analysis was performed on critically ill patients using a proprietary commercial monitor (PulseCO). All measurements were made using an in-dwelling radial artery line and according to manufacturers instructions. Intermittent measurements of cardiac output were made with LiDCO in order to validate the pulse power measurements. These were made at baseline and then following 1, 2, 4 and 8 hours. The LiDCO measurement was considered the reference for comparison in this study. The two methods of measuring cardiac output were then compared by linear regression and a Bland Altman analysis. An error rate for the limits of agreement (LOA) between the two techniques of less than 30% was defined as being acceptable for this study.</p> <p>Results</p> <p>14 critically ill medical and surgical patients were enrolled over a three month period. At baseline patients showed a wide range of cardiac output (median 7.5 L/min, IQR 5.1 -9.0 L/min). The bias and limits of agreement between the two techniques was deemed acceptable for the first four hours of the study with percentage errors being 29%, 22%, and 285 respectively. The percentage error at eight hours following calibration increased to 36%. The ability of the PulseCo to detect changes in cardiac output was assessed with a similar analysis. The PulseCO tracked the changes in cardiac output with adequate accuracy for the first four hours with percentage errors being 20%, 24% and 25%. However at eight hours the error had increased to 43%.</p> <p>Conclusion</p> <p>The agreement between lithium dilution cardiac output and the pulse power algorithm in the PulseCO monitor remains acceptable for up to four hours in critically ill patients.</p

Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage Extended Follow-up of the RESTART Randomized Clinical Trial

Importance: The Restart or Stop Antithrombotics Randomized Trial (RESTART) found that antiplatelet therapy appeared to be safe up to 5 years after intracerebral hemorrhage (ICH) that had occurred during antithrombotic (antiplatelet or anticoagulant) therapy. Objectives: To monitor adherence, increase duration of follow-up, and improve precision of estimates of the effects of antiplatelet therapy on recurrent ICH and major vascular events. Design, Setting and Participants: From May 22, 2013, through May 31, 2018, this prospective, open, blinded end point, parallel-group randomized clinical trial studied 537 participants at 122 hospitals in the UK. Participants were individuals 18 years or older who had taken antithrombotic therapy for the prevention of occlusive vascular disease when they developed ICH, discontinued antithrombotic therapy, and survived for 24 hours. After initial follow-up ended on November 30, 2018, annual follow-up was extended until November 30, 2020, for a median of 3.0 years (interquartile range [IQR], 2.0-5.0 years) for the trial cohort. Interventions: Computerized randomization that incorporated minimization allocated participants (1:1) to start or avoid antiplatelet therapy. Main Outcomes and Measures: Participants were followed up for the primary outcome (recurrent symptomatic ICH) and secondary outcomes (all major vascular events) for up to 7 years. Data from all randomized participants were analyzed using Cox proportional hazards regression, adjusted for minimization covariates. Results: A total of 537 patients (median age, 76.0 years; IQR, 69.0-82.0 years; 360 [67.0%] male; median time after ICH onset, 76.0 days; IQR, 29.0-146.0 days) were randomly allocated to start (n = 268) or avoid (n = 269 [1 withdrew]) antiplatelet therapy. The primary outcome of recurrent ICH affected 22 of 268 participants (8.2%) allocated to antiplatelet therapy compared with 25 of 268 participants (9.3%) allocated to avoid antiplatelet therapy (adjusted hazard ratio, 0.87; 95% CI, 0.49-1.55; P = .64). A major vascular event affected 72 participants (26.8%) allocated to antiplatelet therapy compared with 87 participants (32.5%) allocated to avoid antiplatelet therapy (hazard ratio, 0.79; 95% CI, 0.58-1.08; P = .14). Conclusions and Relevance: Among patients with ICH who had previously taken antithrombotic therapy, this study found no statistically significant effect of antiplatelet therapy on recurrent ICH or all major vascular events. These findings provide physicians with some reassurance about the use of antiplatelet therapy after ICH if indicated for secondary prevention of major vascular events

Investigating the experience of Moodle adoption through expert voices

Virtual learning environments (VLEs) such as Moodle are now widely used in universities and other organisations. One crucial factor in the successful employment of such platforms is the ability and commitment of teaching staff to adopt the system. Despite the importance of this role, there has been little work to examine the experience of using VLEs in practice. This paper presents initial, qualitative research aimed at understanding how Moodle is being used and the different experiences and perspectives of the staff involved. To generate themes and areas of interest for future investigation this paper uses interview data from two “expert witnesses” who have a deep understanding of how the platform is used. Emergent themes include: divergence between confident and basic users; the spread of usage within an academic community; lack of progression to innovative teaching methods