Barriers to obstetric fistula treatment in low-income countries: A systematic review

Obstetric fistula is a maternal morbidity condition that occurs in some low-income countries and is caused by prolonged obstructed labor that results in a hole between the vagina and the bladder or rectum through which urine or feces leak. Unrepaired fistula can lead to lifelong ostracism, stigma, and shame. Obstetric fistula is preventable and treatable, but women in these countries experience delays in seeking repair due to a number of factors including awareness of their condition as well as the potential for treatment, resources necessary for seeking care, lack of skilled fistula surgeons, and long hospital waiting times. UNFPA estimates that 2 to 3.5 million women are currently living with fistula worldwide. The true number may actually be higher. This review aims to identify and understand the barriers affecting women’s access to fistula repair, to inform the design of possible interventions that may be effective in addressing these barriers. This work may also identify research gaps surrounding fistula in low-income countries that require targeted formative research before interventions can be designed

Epidemic dynamics of respiratory syncytial virus in current and future climates.

A key question for infectious disease dynamics is the impact of the climate on future burden. Here, we evaluate the climate drivers of respiratory syncytial virus (RSV), an important determinant of disease in young children. We combine a dataset of county-level observations from the US with state-level observations from Mexico, spanning much of the global range of climatological conditions. Using a combination of nonlinear epidemic models with statistical techniques, we find consistent patterns of climate drivers at a continental scale explaining latitudinal differences in the dynamics and timing of local epidemics. Strikingly, estimated effects of precipitation and humidity on transmission mirror prior results for influenza. We couple our model with projections for future climate, to show that temperature-driven increases to humidity may lead to a northward shift in the dynamic patterns observed and that the likelihood of severe outbreaks of RSV hinges on projections for extreme rainfall

Working with and for social enterprises: the role of the volunteer ethnographer

Purpose – This paper considers the specific opportunities and challenges of engaging in ethnographic research with organisations in which the researcher participates as a volunteer ethnographer. Design/methodology/approach – The findings in this paper are based on four years of ethnographic research within a social enterprise. Findings – This paper finds that there are significant benefits of the role of the volunteer ethnographer and suggests ways to address some of the challenges. Research limitations/implications – As the field of social enterprise and ethnography grows and researchers engage with methodological discussions about participant observation, the authors suggest that attention should also be paid to the specifics of the role of the volunteer ethnographer. Originality/value – There is growing interest in the use of ethnography in social enterprises. This paper offers unique insight into how this methodology has been applied in the context of self-reliant groups and the importance of the engaging with discussion about the specific role of the volunteer ethnographer

The COBE DIRBE Point Source Catalog

We present the COBE DIRBE Point Source Catalog, an all-sky catalog containing infrared photometry in 10 bands from 1.25 microns to 240 microns for 11,788 of the brightest near and mid-infrared point sources in the sky. Since DIRBE had excellent temporal coverage (100 - 1900 independent measurements per object during the 10 month cryogenic mission), the Catalog also contains information about variability at each wavelength, including amplitudes of variation observed during the mission. Since the DIRBE spatial resolution is relatively poor (0.7 degrees), we have carefully investigated the question of confusion, and have flagged sources with infrared-bright companions within the DIRBE beam. In addition, we filtered the DIRBE light curves for data points affected by companions outside of the main DIRBE beam but within the `sky' portion of the scan. At high Galactic latitudes (|b| > 5 degrees), the Catalog contains essentially all of the unconfused sources with flux densities greater than 90, 60, 60, 50, 90, and 165 Jy at 1.25, 2.2, 3.5, 4.9, 12, and 25 microns, respectively, corresponding to magnitude limits of approximately 3.1, 2.6, 1.7, 1.3, -1.3, and -3.5. At longer wavelengths and in the Galactic Plane, the completeness is less certain because of the large DIRBE beam and possible contributions from extended emission. The Catalog also contains the names of the sources in other catalogs, their spectral types, variability types, and whether or not the sources are known OH/IR stars. We discuss a few remarkable objects in the Catalog. [abridged]Comment: Accepted for publication in the Astrophysical Journal Supplement. The full tables are available at http://www.etsu.edu/physics/bsmith/dirbe

Dynamic changes in lung microRNA profiles during the development of pulmonary hypertension due to chronic hypoxia and monocrotaline

<b>Objective</b>: MicroRNAs (miRNAs) are small noncoding RNAs that have the capacity to control protein production through binding "seed" sequences within a target mRNA. Each miRNA is capable of potentially controlling hundreds of genes. The regulation of miRNAs in the lung during the development of pulmonary arterial hypertension (PAH) is unknown.<p></p> <b>Methods and Results</b>: We screened lung miRNA profiles in a longitudinal and crossover design during the development of PAH caused by chronic hypoxia or monocrotaline in rats. We identified reduced expression of Dicer, involved in miRNA processing, during the onset of PAH after hypoxia. MiR-22, miR-30, and let-7f were downregulated, whereas miR-322 and miR-451 were upregulated significantly during the development of PAH in both models. Differences were observed between monocrotaline and chronic hypoxia. For example, miR-21 and let-7a were significantly reduced only in monocrotaline-treated rats. MiRNAs that were significantly regulated were validated by quantitative polymerase chain reaction. By using in vitro studies, we demonstrated that hypoxia and growth factors implicated in PAH induced similar changes in miRNA expression. Furthermore, we confirmed miR-21 downregulation in human lung tissue and serum from patients with idiopathic PAH.<p></p> <b>Conclusion</b>: Defined miRNAs are regulated during the development of PAH in rats. Therefore, miRNAs may contribute to the pathogenesis of PAH and represent a novel opportunity for therapeutic intervention.<p></p&gt

Reducing in-stent restenosis therapeutic manipulation of miRNA in vascular remodeling and inflammation

Background: Drug-eluting stents reduce the incidence of in-stent restenosis, but they result in delayed arterial healing and are associated with a chronic inflammatory response and hypersensitivity reactions. Identifying novel interventions to enhance wound healing and reduce the inflammatory response may improve long-term clinical outcomes. Micro–ribonucleic acids (miRNAs) are noncoding small ribonucleic acids that play a prominent role in the initiation and resolution of inflammation after vascular injury.<p></p> Objectives: This study sought to identify miRNA regulation and function after implantation of bare-metal and drug-eluting stents.<p></p> Methods: Pig, mouse, and in vitro models were used to investigate the role of miRNA in in-stent restenosis.<p></p> Results: We documented a subset of inflammatory miRNAs activated after stenting in pigs, including the miR-21 stem loop miRNAs. Genetic ablation of the miR-21 stem loop attenuated neointimal formation in mice post-stenting. This occurred via enhanced levels of anti-inflammatory M2 macrophages coupled with an impaired sensitivity of smooth muscle cells to respond to vascular activation.<p></p> Conclusions: MiR-21 plays a prominent role in promoting vascular inflammation and remodeling after stent injury. MiRNA-mediated modulation of the inflammatory response post-stenting may have therapeutic potential to accelerate wound healing and enhance the clinical efficacy of stenting

Inequitable distribution of plastic benefits and burdens on economies and public health

Plastic heterogeneously affects social systems – notably human health and local and global economies. Here we discuss illustrative examples of the benefits and burdens of each stage of the plastic lifecycle (e.g., macroplastic production, consumption, recycling). We find the benefits to communities and stakeholders are principally economic, whereas burdens fall largely on human health. Furthermore, the economic benefits of plastic are rarely applied to alleviate or mitigate the health burdens it creates, amplifying the disconnect between who benefits and who is burdened. In some instances, social enterprises in low-wealth areas collect and recycle waste, creating a market for upcycled goods. While such endeavors generate local socioeconomic benefits, they perpetuate a status quo in which the burden of responsibility for waste management falls on downstream communities, rather than on producers who have generated far greater economic benefits. While the traditional cost-benefit analyses that inform decision-making disproportionately weigh economic benefits over the indirect, and often unquantifiable, costs of health burdens, we stress the need to include the health burdens of plastic to all impacted stakeholders across all plastic life stages in policy design. We therefore urge the Intergovernmental Negotiating Committee to consider all available knowledge on the deleterious effects of plastic across the entire plastic lifecycle while drafting the upcoming international global plastic treaty.publishedVersio