Prevalence and determinants of anxiety and depression in end stage renal disease (ESRD). A comparison between ESRD patients with and without coexisting diabetes mellitus

Objective: To compare anxiety and/or depressive symptoms between patients with end-stage renal disease with and without comorbid diabetes and identify factors associated with symptoms of distress in this population. Methods: Data from two studies (conducted between 2010 and 2014) were pooled. A total of 526 patients on hemodialysis (68.8% with diabetes) completed the Hospital Anxiety and Depression Scale (HADS). Elevated symptoms were defined as HADS-Anxiety or HADS-Depression ≥ 8. Univariate and multivariate logistic regressions were used to estimate associations between diabetic status, and other socio-demographic and clinical factors with baseline clinical anxiety and depression. Results: A total of 233 (45.4%) reported elevated anxiety symptoms and 256 (49.9%) reported elevated depressive symptoms sufficient for caseness. Rates were not different between patients with and without diabetes. Risk for clinical depression was higher in patients who were single/unpartnered (OR = 1.828), Chinese vs. Malay (OR = 2.05), or had lower albumin levels (OR = 0.932). None of the parameters were associated with anxiety caseness. Conclusion: Sociocultural factors rather than comorbid burden may help identify patients at risk for depression. The high rates of anxiety and depression underlie the importance for monitoring and intervention in dialysis care

A Circular Economy Framework based on Organic Wastes Upcycling for Biodiesel Production from Hermetia illucens

The present waste management practices have adverse environmental impacts at the same time costly. Approximately, 80 % of the Malaysian municipal wastes including organic wastes are usual disposed into landfills. Hence, transformation organic wastes not only providing economic and environmental benefits but has given waste a value. This study focused on synthesis of biodiesel from H. illucens pre-pupae fed with fruit waste and food waste. The objective was to evaluate interactions between the variables including catalyst loading, reaction time versus fatty acid methyl esters (FAME) yield (wt %), temperature and methanol to sample mass ratio. The response surface methodology (RSM) was used to investigate the bioconversion optimization process. Optimal biodiesel yield based on fruit waste achieved was 96.15 % at 51ºC; 8.3:1 methanol: mass ratio; 253 min and 15.1 % catalyst. Furthermore, the optimal yield obtained from the second set of optimization using lipids of pre-pupae derived from food waste was achieved at 94.63 %.  The optimum conditions for reaction temperature was 71°C, with methanol to mass ratio of 6.8:1, at reaction time of 254 min and catalyst loading of 7.0 v/v%. The properties of FAME produced were in accordance with EN 14214 and ASTM 6751 biodiesel standards

Economic interventions to improve population health: a scoping study of systematic reviews.

BACKGROUND: Recognizing the close relationship between poverty and health, national program managers, policy-makers and donors are increasingly including economic interventions as part of their core strategies to improve population health. However, there is often confusion among stakeholders about the definitions and operational differences between distinct types of economic interventions and financial instruments, which can lead to important differences in interpretation and expectations. METHODS: We conducted a scoping study to define and clarify concepts underlying key economic interventions - price interventions (taxes and subsidies), income transfer programs, incentive programs, livelihood support programs and health-related financial services - and map the evidence currently available from systematic reviews. RESULTS: We identified 195 systematic reviews on economic interventions published between 2005 and July 2015. Overall, there was an increase in the number of reviews published after 2010. The majority of reviews focused on price interventions, income transfer programs and incentive programs, with much less evidence available from systematic reviews on livelihood support programs and health-related financial services. We also identified a lack of evidence on: health outcomes in low income countries; unintended or perverse outcomes; implementation challenges; scalability and cost-effectiveness of economic interventions. CONCLUSIONS: We conclude that while more research is clearly needed to assess suitability and effectiveness of economic interventions in different contexts, before interventions are tested and further systematic reviews conducted, a consistent and accurate understanding of the fundamental differences in terminology and approaches is essential among researchers, public health policy makers and program planners

Local Structure of Multiferroic TbMn2O5: Evidence for an Anomalous Terbium Oxygen Distribution

The temperature dependent local structure of TbMn2O5 was determined by x-ray absorption spectroscopy. An anomalous Tb-O distribution is found. At high temperature it is broad but resolves into two distinct peaks below approximately 180 K. The distributions sharpen below the Tb magnetic ordering temperature (approximately 10 K). The distortions in the Tb-O distribution, away from the Pbam structure, are consistent with rotations of the MnOx polyhedra about the c-axis and suggest that Tb-O bond polarization may play a significant role in the observed ferroelectric properties of this system.Comment: 7 Figure

5-Year Follow-Up of a Telephone Intervention to Increase Fruit and Vegetable Consumption in Preschoolers: The ‘Healthy Habits’ Cluster Randomised Trial

Little is known about the long-term impact of telephone-based interventions to improve child diet. This trial aimed to assess the long-term effectiveness (after 5 years) of a telephone-based parent intervention in increasing children’s fruit and vegetable consumption. Parents of 3–5 year olds were recruited from 30 Australian preschools to participate in a cluster randomised controlled trial. Intervention parents received four, weekly, 30-min support calls aimed at modifying the home food environment. Control parents received printed materials. Consumption was assessed using the Fruit and Vegetable subscale of the Children’s Dietary Questionnaire (F&V-CDQ) (children) and daily servings of fruit and vegetables (children and parents) via parent telephone interview. Of the 394 parents who completed baseline, 57% (99 intervention, 127 control) completed follow-up. After 5-years, higher intervention F&V-CDQ scores, bordering on significance, were found in complete-case (+1.1, p = 0.06) and sensitivity analyses (+1.1, p = 0.06). There was no difference in parent or child consumption of daily fruit servings. Complete-case analysis indicated significantly higher consumption of child vegetable servings (+0.5 servings; p = 0.02), which was not significant in sensitivity analysis (+0.5 servings; p = 0.10). This telephone-based parent intervention targeting the family food environment may yield promising improvements in child fruit and vegetable consumption over a 5-year period

Wall-to-wall stress induced in (6,5) semiconducting nanotubes by encapsulation in metallic outer tubes of different diameters: A resonance Raman study of individual C(60)-derived double-wall carbon nanotubes

We measure resonant Raman scattering from 11 individual C(60)-derived double-wall carbon nanotubes all having inner semiconducting (6,5) tubes and various outer metallic tubes. The Raman spectra show the radial breathing modes (RBM) of the inner and the outer tubes to be simultaneously in resonance with the same laser energy. We observe that an increase in the RBM frequency of the inner tubes is related to an increase in the RBM frequency of the outer tubes. The Raman spectra also contain a sharp G(-) feature that increases in frequency as the nominal diameter of the outer metallic tubes decreases. Finally, the one-phonon second-order D-band mode shows a two-way frequency splitting that decreases with decreasing nominal wall-to-wall distance. We suggest that the stress which increases with decreasing nominal wall-to-wall distance is responsible for the hardening that is observed in the frequencies of the RBM, D and G(-) modes of the inner (6,5) semiconducting tubes.ArticleNANOSCALE. 2(3):406-411 (2010)journal articl

The application of useless Japanese inventions for requirements elicitation in information security

Rules of requirements elicitation in security are broken through the use of Chindōgu, by designing impractical security countermeasures in the first instance, then using these to create usable security requirements. We present a process to conceive the requirements in Chindōgu form. We evaluate the usefulness of this process by applying it in three workshops with data gathered from a European rail company, and comparing requirements elicited by this process with a set of control requirements

P171Elevated free fetal haemoglobin threatens vasculoprotection in the fetal circulation of preeclamptic pregnancy

Placental up-regulation of free fetal haemoglobin (fHbF) occurs in preeclamptic (PE) pregnancy. Heme oxygenase-1 (HO-1) is an important vasculoprotective enzyme in the catabolism of the associated heme porphyrin structure. We have previously shown that fHbF negatively influences the vasculoprotective capacity of the fetal circulation. Here we study fHbF levels in the fetal cord blood of pregnancies complicated by PE; a pathology associated with dysregulated fetoplacental vascular tone. We have previously shown that fHbF binds nitric oxide (NO) to elicit elevated vascular resistance in the fetoplacental circulation, using ex vivo human dual placental perfusion and in vitro placental endothelial cell shear stress studies. Furthermore, fHbF causes morphological changes to the fetoplacental endothelium. Here we hypothesise that elevated levels of fHbF in fetal plasma associated with placental pathology contribute to fetoplacental hypertension. Purpose: To evaluate and derive a robust cord blood collection and processing protocol for the accurate measurement of fetal plasma fHbF levels in normal and PE pregnancies. Methods: Fetal venous cord blood was collected by syringe and needle, or Vacutainer method into either EDTA or citrate tubes, within 10 minutes of partum. Plasma recovery occurred immediately, or after 30 minutes, prior to centrifugation at 2000g x 10 min at room temperature. Following evaluation to reduce mechanical haemolysis, newly collected normal & PE plasma (n=13 & 6, respectively) was subjected to ELISAs for HbF and HO-1. Results: Venipuncture collection of cord venous blood taken from the cord-placenta insertion point by Vacutainer system with a 21G needle, into citrate collection tubes with immediate centrifugation prevented mechanical haemolysis. There was no difference in plasma HO-1 between groups (medians = 5.9 & 5.3 ng/mL; normal & PE, respectively; Mann-Whitney). Whilst there was no difference in fHbF between groups (Mann-Whitney), variability was high in the PE group and there were some very high values for fHbF compared to the normal range, whilst fHbF values in the control group were within a tighter lower range (medians & ranges = 45.9 & 0-206 and 118.8 & 29-640 μg/mL). Conclusion: Fetal plasma HO-1 levels appear stable in preeclamptic fetal plasma, permitting fHbF to remain unchecked in some cases. High pathophysiological levels of fHbF in some cases of PE pregnancies are capable of evoking elevated vascular resistance within the fetoplacental circulation, caused by nitric oxide sequestration and disruption to the endothelium. Further evaluation is require

Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya

Background: Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings: We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities