Prevalence, Predictors and Prognosis of Post-Stroke Hyperglycaemia in Acute Stroke Trials: Individual Patient Data Pooled Analysis from the Virtual International Stroke Trials Archive (VISTA)

<br>Background: Post-stroke hyperglycaemia (PSH) is associated with higher mortality and dependence, but further data on predictors of PSH and its evolution over time are required. We examined the prevalence, predictors, and prognosis of acute PSH using data from well-characterised clinical trials in the VISTA database.</br> <br>Methods: Data were extracted for individual participants enrolled <24 h after stroke with ≥1 blood glucose readings documented. PSH was defined as glucose >7.0 mmol/l. Outcome measures were: (1) prevalence of PSH; (2) predictors of PSH by binary logistic regression; (3) mortality, and (4) favourable functional outcome [modified Rankin Scale (mRS) score <2] at day 90.</br> <br>Results: For 2,649 subjects treated at a median 5.5 h after admission, PSH was present in 1,126 (42.6%, 95% CI 40.7–44.5) on admission and within the first 48 h in 1,421 (53.7%, 95% CI 51.8–55.6). PSH developed between 24 and 48 h in 19.4% (95% CI 17.5–21.4) of initially normoglycaemic subjects. Admission and 48-hour PSH were predicted predominantly by a history of diabetes (for admission PSH: OR 7.40, 95% CI 5.60–9.79) and less clearly by stroke severity. Favourable outcome (mRS <2) at day 90 was less likely with PSH within the first 48 h, advanced age, and higher NIHSS score, and more likely with recombinant tissue plasminogen activator treatment.</br> <br>Conclusions: Over 40% of ischaemic stroke patients are hyperglycaemic on admission, and 20% of those who are initially normoglycaemic develop hyperglycaemia within 48 h. Diabetes is the strongest predictor of acute hyperglycaemia. Hyperglycaemia within the first 48 h is independently associated with higher mortality and poorer functional outcome, with an absolute increase of 12.9%.</br&gt

Engaging the postgraduate student voice for enhancement of learning and teaching

Postgraduate (PG) courses are undertaken for a variety of reasons and in many different formats across the three faculties (Faculty of Health Education and Society, Faculty of Business and Law and the Faculty of Art, Science and Technology) within the University of Northampton, (UON). PG students’ engagement, especially minority groups and part time students, are historically underrepresented with teaching and learning often devolved from undergraduate courses or professional doctorate courses. This underrepresented student body require a stronger network to engage, discuss and target their specific requirements within the university. Dissertation students’ satisfaction at UON in the latest PTES, (2022) survey is below the sector average.Postgraduate studies frequently occur when students are raising families, working full time and busy meeting personal objectives. During this life-phase, engagement with the university community is difficult. However, this student group have skills and knowledge to enhance their own learning and teaching requirements which may strengthen the student experience and promote engagement. Enhancing the student voice within the PG community and across faculties will aid communication and the objectives identified within the Access and Participation Plan (APP) relating to attainment, retention and progression by ethnicity and IMD/POLAR characteristics.This project concept was developed from the recommendations of a previously successful innovation bid, “Converting Willingness to Engagement” which targeted PG health professionals within FHES. It identified under representation within the professional postgraduate community. The Postgraduate student voice, particularly at Master's level (L7), has been nationally identified as under-represented (PTES, 2022). This project explored how these students, deemed at risk of unconscious bias, intersectional students, the ethnical diverse and part time students can create a student voice and provide practical outcomes in terms of recommendations for all faculties

Engaging the postgraduate student voice for enhancement of learning and teaching

Postgraduate (PG) courses are undertaken for a variety of reasons and in many different formats across the three faculties (Faculty of Health Education and Society, Faculty of Business and Law and the Faculty of Art, Science and Technology) within the University of Northampton, (UON). PG students’ engagement, especially minority groups and part time students, are historically underrepresented with teaching and learning often devolved from undergraduate courses or professional doctorate courses. This underrepresented student body require a stronger network to engage, discuss and target their specific requirements within the university. Dissertation students’ satisfaction at UON in the latest PTES, (2022) survey is below the sector average.Postgraduate studies frequently occur when students are raising families, working full time and busy meeting personal objectives. During this life-phase, engagement with the university community is difficult. However, this student group have skills and knowledge to enhance their own learning and teaching requirements which may strengthen the student experience and promote engagement. Enhancing the student voice within the PG community and across faculties will aid communication and the objectives identified within the Access and Participation Plan (APP) relating to attainment, retention and progression by ethnicity and IMD/POLAR characteristics.This project concept was developed from the recommendations of a previously successful innovation bid, “Converting Willingness to Engagement” which targeted PG health professionals within FHES. It identified under representation within the professional postgraduate community. The Postgraduate student voice, particularly at Master's level (L7), has been nationally identified as under-represented (PTES, 2022). This project explored how these students, deemed at risk of unconscious bias, intersectional students, the ethnical diverse and part time students can create a student voice and provide practical outcomes in terms of recommendations for all faculties

Homeless in Dhaka: Violence, Sexual Harassment, and Drug-abuse

Bangladesh has experienced one of the highest urban population growth rates (around 7% per year) over the past three decades. Dhaka, the capital city, attracts approximately 320,000 migrants from rural areas every year. The city is unable to provide shelter, food, education, healthcare, and employment for its rapidly-expanding population. An estimated 3.4 million people live in the overcrowded slums of Dhaka, and many more live in public spaces lacking the most basic shelter. While a small but growing body of research describes the lives of people who live in urban informal settlements or slums, very little research describes the population with no housing at all. Anecdotally, the homeless population in Dhaka is known to face extortion, erratic unemployment, exposure to violence, and sexual harassment and to engage in high-risk behaviours. However, this has not been systematically documented. This cross-sectional, descriptive study was conducted to better understand the challenges in the lives of the homeless population in 11 areas of Dhaka during a 13-month period from June 2007 to June 2008. A modified cluster-sampling method was used for selecting 32 clusters of 14 female and male respondents, for a sample of 896. In addition to sociodemographic details, this paper focuses specifically on violence, drug-abuse, and sexual harassment. The findings showed that physical assaults among the homeless, particularly among women, were a regular phenomenon. Eighty-three percent of female respondents (n=372) were assaulted by their husbands, station masters, and male police officers. They were subjected to lewd gestures, unwelcome advances, and rape. Male respondents reported being physically assaulted while trying to collect food, fighting over space, or while stealing, by police officers, miscreants, or other homeless people. Sixty-nine percent of the male respondents (n=309) used locally-available drugs, such as marijuana and heroin, and two-thirds of injecting drug-users shared needles. The study determined that the homeless are not highly mobile but tend to congregate in clusters night after night. Income-generating activities, targeted education, gender-friendly community police programmes, shelters and crises centres, and greater community involvement are suggested as policy and programmatic interventions to raise the quality of life of this population. In addition, there is a need to reduce high rates of urban migration, a priority for Bangladesh

HIV-related Stigma in Rural and Tribal Communities of Maharashtra, India

Stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. This paper examines HIV-related stigma in rural and tribal communities of Maharashtra, an area of relatively high HIV prevalence in India. The study used a mix of qualitative and quantitative methods to compare adult women and adolescents in a rural area, women in a rural area, and women in a tribal area. The respondents included 494 married women and 186 adolescents in a rural community and 49 married women in six tribal villages. HIV-related stigma was prevalent in all communities and was the highest among tribal and older respondents. High-risk behaviour was reported in both areas, accompanied with denial of personal risk. Our findings suggest that HIV may be spreading silently in these communities. To our knowledge, this is the first community-based study to make an in-depth assessment of HIV-related stigma in rural and tribal areas of India. By situating our findings within the broader discourse on stigma in the national and state-level data, this study helps explain the nature and persistence of stigma and how to address it more effectively among subcultural groups in India

Near-infrared PbS quantum dots functionalized with affibodies and ZnPP for targeted imaging and therapeutic applications

We report a new theranostic device based on lead sulfide quantum dots (PbS QDs) with optical emission in the near infrared wavelength range decorated with affibodies (small 6.5 kDa protein-based antibody replacements) specific to the cancer biomarker human epidermal growth factor receptor 2 (HER2), and zinc(II) protoporphyrin IX (ZnPP) to combine imaging, targeting and therapy within one nanostructure. Colloidal PbS QDs were synthesized in aqueous solution with a nanocrystal diameter of ~ 5 nm and photoluminescence emission in the near infrared wavelength range. The ZHER2:432 affibody, mutated through the introduction of two cysteine residues at the C-terminus (Afb2C), was used as capping ligand to form Afb2C-PbS QDs which have a high binding affinity for HER2 which is overexpressed in several types of cancer including breast cancer. Afb2C-PbS QDs were further modified by conjugation with ZnPP, which acts as an anticancer agent. The biological activity of these QDs was tested against SKBR3 (HER2-positive) and MDA-MB-231 (HER2-normal) breast cancer cells, with results showing that ZnPP-Afb2C-functionalized PbS QDs were successfully targeted to the HER2-overexpressing cancer cells and induced cell apoptosis thanks to the conjugation with ZnPP. These results expand the use of the QD nanoplatform with the formulation of novel nanomaterials for targeted delivery and combined imaging and therapy via direct surface-protein interaction

Listeria innocua Dps as a nanoplatform for bioluminescence based photodynamic therapy utilizing Gaussia princeps luciferase and zinc protoporphyrin IX

Listeria innocua DNA binding protein from starved cells (LiDps) belongs to the ferritin family and provides a promising self-assembling spherical 12-mer protein scaffold for the generation of functional nanomaterials. We report the creation of a Gaussia princeps luciferase (Gluc)-LiDps fusion protein, with chemical conjugation of Zinc (II)-protoporphyrin IX (ZnPP) to lysine residues on the fusion protein (giving Gluc-LiDps-ZnPP). The Gluc-LiDps-ZnPP conjugate is shown to generate reactive oxygen species (ROS) via Bioluminescence Resonance Energy Transfer (BRET) between the Gluc (470-490 nm) and ZnPP. In vitro, Gluc-LiDps-ZnPP is efficiently taken up by tumorigenic cells (SKBR3 and MDA-MB-231 breast cancer cells). In the presence of coelenterazine, this construct inhibits the proliferation of SKBR3 due to elevated ROS levels. Following exposure to Gluc-LiDps-ZnPP, migration of surviving SKBR3 cells is significantly suppressed. These results demonstrate the potential of the Gluc-LiDps-ZnPP conjugate as a platform for future development of an anticancer photodynamic therapy agent

Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England

Objective: To determine the absolute and relative risk of acute appendicitis during the antepartum and postpartum periods compared with the time outside pregnancy among women of childbearing age. Background: Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy. Estimates of the incidence of acute appendicitis in pregnancy remain imprecise and inconsistent. Methods: All potential fertile women aged 15 to 44 years registered within Clinical Practice Research Datalink with linkages to the Hospital Episodes Statistics between 1997 and 2012 were identified. Absolute rates of acute appendicitis were calculated during the antepartum and postpartum periods and were compared with the time outside pregnancy in terms of incidence rate ratio (IRR) using a Poisson regression model. Results: Among 1,624,804 women, there were 362,219 pregnancies resulting in live or stillbirths. Compared with the time outside pregnancy, the rate of acute appendicitis was 35% lower during the antepartum period [IRR, 0.65; 95% confidence interval (CI), 0.55–0.76], with the lowest rate reported during the third trimester (IRR, 0.47; 95% CI, 0.35–0.64) for all ages; no increased risk of acute appendicitis was observed in the postpartum period compared with the time outside pregnancy among women aged 15 to 34 years but an 84% increased risk for women older than 35 years (IRR, 1.84; 95% CI, 1.18–2.86). The highest and lowest rates of negative appendectomy were encountered in the second and the third trimesters, respectively. Conclusions: Pregnant women are less likely to be diagnosed with acute appendicitis than nonpregnant women, with the lowest risk reported during the third trimester

Shonjibon cash and counselling : a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh

Background: Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months. Method: The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes. Discussion: The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. Trial registration: The study has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12618001975280)

Synchronized tissue-scale vasculogenesis and ubiquitous lateral sprouting underlie the unique architecture of the choriocapillaris

The choriocapillaris is an exceptionally high density, two-dimensional, sheet-like capillary network, characterized by the highest exchange rate of nutrients for waste products per area in the organism. These unique morphological and physiological features are critical for supporting the extreme metabolic requirements of the outer retina needed for vision. The developmental mechanisms and processes responsible for generating this unique vascular network remain, however, poorly understood. Here we take advantage of the zebrafish as a model organism for gaining novel insights into the cellular dynamics and molecular signaling mechanisms involved in the development of the choriocapillaris. We show for the first time that zebrafish have a choriocapillaris highly similar to that in mammals, and that it is initially formed by a novel process of synchronized vasculogenesis occurring simultaneously across the entire outer retina. This initial vascular network expands by un-inhibited sprouting angiogenesis whereby all endothelial cells adopt tip-cell characteristics, a process which is sustained throughout embryonic and early post-natal development, even after the choriocapillaris becomes perfused. Ubiquitous sprouting was maintained by continuous VEGF-VEGFR2 signaling in endothelial cells delaying maturation until immediately before stages where vision becomes important for survival, leading to the unparalleled high density and lobular structure of this vasculature. Sprouting was throughout development limited to two dimensions by Bruch's membrane and the sclera at the anterior and posterior surfaces respectively. These novel cellular and molecular mechanisms underlying choriocapillaris development were recapitulated in mice. In conclusion, our findings reveal novel mechanisms underlying the development of the choriocapillaris during zebrafish and mouse development. These results may explain the uniquely high density and sheet-like organization of this vasculature