Prevalence of Trachomatous Trichiasis in Ten Evaluation Units of Embu and Kitui Counties, Kenya.

BACKGROUND: Late-stage blinding sequalae of trachoma such as trachomatous trichiasis (TT) typically take decades to develop and often do so in the absence of ongoing ocular Chlamydia trachomatis infection. This suggests that most TT risk accumulates in early life; as a result, population-level TT incidence and prevalence can remain high years after C. trachomatis transmission among children has decreased. In Embu and Kitui counties, Kenya, the prevalence of trachomatous inflammation - follicular is low in children. In this survey, we set out to determine the prevalence of TT in ten evaluation units (EUs) in these counties. METHODS: We undertook ten cross-sectional prevalence surveys for TT. In each EU, people aged ≥15 years were selected by a two-stage cluster sampling method and examined for TT. Those with TT were asked questions on whether they had been offered management for it. Prevalence was adjusted to the underlying age and gender structure of the population. RESULTS: A total of 18,987 people aged ≥15 years were examined. Per EU, the median number of examined participants was 1,656 (range: 1,451 - 3,016) and median response rate was 86% (range: 81 - 95%). The prevalence of TT unknown to the health system in people aged ≥15 years was above the threshold for elimination (≥0.2%) in all ten EUs studied (range: 0.2-0.7%). TT was significantly more common in older than younger individuals and in women than in men. DISCUSSION: Provision of surgical services should be strengthened in Embu and Kitui counties of Kenya to achieve the World Health Organization threshold for eliminating TT as a public health problem

Energy Consumption, Carbon Emissions and Global Warming Potential of Wolfberry Production in Jingtai Oasis, Gansu Province, China

During the last decade, China's agro-food production has increased rapidly and been accompanied by the challenge of increasing greenhouse gas (GHG) emissions and other environmental pollutants from fertilizers, pesticides, and intensive energy use. Understanding the energy use and environmental impacts of crop production will help identify environmentally damaging hotspots of agro-production, allowing environmental impacts to be assessed and crop management strategies optimized. Conventional farming has been widely employed in wolfberry (Lycium barbarum) cultivation in China, which is an important cash tree crop not only for the rural economy but also from an ecological standpoint. Energy use and global warming potential (GWP) were investigated in a wolfberry production system in the Yellow River irrigated Jingtai region of Gansu. In total, 52 household farms were randomly selected to conduct the investigation using questionnaires. Total energy input and output were 321,800.73 and 166,888.80 MJ ha−1, respectively, in the production system. The highest share of energy inputs was found to be electricity consumption for lifting irrigation water, accounting for 68.52%, followed by chemical fertilizer application (11.37%). Energy use efficiency was 0.52 when considering both fruit and pruned wood. Nonrenewable energy use (88.52%) was far larger than the renewable energy input. The share of GWP of different inputs were 64.52% electricity, 27.72% nitrogen (N) fertilizer, 5.07% phosphate, 2.32% diesel, and 0.37% potassium, respectively. The highest share was related to electricity consumption for irrigation, followed by N fertilizer use. Total GWP in the wolfberry planting system was 26,018.64 kg CO2 eq ha−1 and the share of CO2, N2O, and CH4 were 99.47%, 0.48%, and negligible respectively with CO2 being dominant. Pathways for reducing energy use and GHG emission mitigation include: conversion to low carbon farming to establish a sustainable and cleaner production system with options of raising water use efficiency by adopting a seasonal gradient water pricing system and advanced irrigation techniques; reducing synthetic fertilizer use; and policy support: smallholder farmland transfer (concentration) for scale production, credit (small- and low-interest credit) and tax breaks

Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access Article under the CC BY 4.0 license. Background: Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods: The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings: Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation: Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding: Bill & Melinda Gates Foundation

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Biallelic variants in the ectonucleotidase ENTPD1 cause a complex neurodevelopmental disorder with intellectual disability, distinct white matter abnormalities, and spastic paraplegia.

OBJECTIVE: Human genomics established that pathogenic variation in diverse genes can underlie a single disorder. For example, hereditary spastic paraplegia (HSP) is associated with over 80 genes with frequently only few affected individuals described for each gene. Herein, we characterize a large cohort of individuals with biallelic variation in ENTPD1, a gene previously linked to spastic paraplegia 64 (MIM# 615683). METHODS: Individuals with biallelic ENTPD1 variants were recruited worldwide. Deep phenotyping and molecular characterizations were performed. RESULTS: A total of 27 individuals from 17 unrelated families were studied; additional phenotypic information was collected from published cases. Twelve novel pathogenic ENTPD1 variants are described: c.398_399delinsAA; p.(Gly133Glu), c.540del; p.(Thr181Leufs* 18), c.640del; p.(Gly216Glufs* 75), c.185T>G; p.(Leu62*), c.1531T>C; p.(*511Glnext* 100), c.967C>T; p.(Gln323*), c.414-2_414-1del, and c.146 A>G; p.(Tyr49Cys) including four recurrent variants c.1109T>A; p.(Leu370* ), c.574-6_574-3del, c.770_771del; p.(Gly257Glufs*18), and c.1041del; p.(Ile348Phefs*19). Shared disease traits include: childhood-onset, progressive spastic paraplegia, intellectual disability (ID), dysarthria, and white matter abnormalities. In vitro assays demonstrate that ENTPD1 expression and function are impaired and that c.574-6_574-3del causes exon skipping. Global metabolomics demonstrates ENTPD1 deficiency leads to impaired nucleotide, lipid, and energy metabolism. INTERPRETATION: The ENTPD1 locus trait consists of childhood disease-onset, ID, progressive spastic paraparesis, dysarthria, dysmorphisms, and white matter abnormalities with some individuals showing neurocognitive regression. Investigation of an allelic series of ENTPD1: i) expands previously described features of ENTPD1-related neurological disease, ii) highlights the importance of genotype-driven deep phenotyping, iii) documents the need for global collaborative efforts to characterize rare AR disease traits, and iv) provides insights into the disease trait neurobiology. This article is protected by copyright. All rights reserved

Communication barriers from nurses’ and elderly patients’ points of views at medical-surgical wards

AbstractIntroduction: Communication is an inevitable aspect of nursing care of patients and the elderly and an essential factor in attaining positive aspect of treatment. Removing communication barriers can have a significant role in improving quality of care in the elderly and facilitating recovery of patients.  Purpose: This descriptive study was conducted to determine communication barriers from nurses’ and elderly patients’ points of views at medical-surgical wards of hospitals affiliated to Isfihan Medical University.   Materials and Methods:  A questionnaire completed by was used for data collection. Subjects included 110 nurses and 110 elderly patients. The nurses and patients were selected by randomization and convenience sampling methods respectively. Different statistical tests were used for data analysis.      Results: Communication barriers from nurses’ points of views included tiredness of nurses (%89.8), speaking too fast (%88.9), forgetfulness and weak memory of the elderly patient (%92.6), auditory and visual disorders (%89.8), badly injured patients in the wards (%97.2) and crowdedness of the wards. The points of views in the elderly patients mostly included lack of respect to their dignity (%98.2) and lack of attention to their questions (%93.6). Conclusion: With respect to the findings, nursing authorities should pay attention to the working condition of nurses and provide facilities for them. Nurses should be supported to be able to dedicate their time and energy for effective communication. In addition, continuing education programs regarding communication skills with the elderly and regular evaluation of these programs can be helpful. Geriatric nursing education should also be integrated in the baccalaureate program of nursing. Keywords: Communication barriers, Nurse, Patient, Old person. 

Blending of Hydrocarbon and Rosin Ester-basedResins to Study its Effect on the Physical andMechanical Properties of Thermoplastic Road Markings

In this study, the effect of hydrocarbon and rosin ester resins combination on the physical and mechanical properties of thermoplastic road markings were evaluated. At first, two basic thermoplastic road marking formulations based on hydrocarbon and rosin ester resins were prepared. Several samples of the blends of two basic formulations for thermoplastic road marking were characterized and compared by their softening points, abrasion resistance, color data changes, DMTA and tensile strength values. The results showed that hydrocarbon-based thermoplastic road markings have better weathering resistance and rosin ester based materials illustrated enhanced heat resistance. The inclusion of rosin ester thermoplastic road marking into the hydrocarbon-based formulations, improves compatibility of the hydrocarbon resin and dibutyl phthalate ()DBP)(, as well as their physical and mechanical properties. The unique properties of rosin arise from its hydrophobic chain skeleton and its hydrophilic carboxy groups which contribute to its excellent solubility and compatibility with a variety of other synthetic resins. The best performance was obtained with 50 wt % inclusion of rosin ester to hydrocarbon based compound. DMTA analysis revelation with combination of hydrocarbon and rosin ester-based road markings showed that the decreasing trend in elastic modulus is shifted to higher temperature, and as a result it keeps the hardness and ductile properties of thermoplastic road markings unchanged. More favored raw materials for compatibilization of compounds in road marking formulations lead to higher elongation- at-break and an increased toughness