Wealth and inequality gradients for the detection and control of hypertension in older individuals in middle-income economies around 2007-2015

Socioeconomic inequalities in the detection and treatment of non-communicable diseases represent a challenge for healthcare systems in middle-income countries (MICs) in the context of population ageing. This challenge is particularly pressing regarding hypertension due to its increasing prevalence among older individuals in MICs, especially among those with lower socioeconomic status (SES). Using comparative data for China, Colombia, Ghana, India, Mexico, Russia and South Africa, we systematically assess the association between SES, measured in the form of a wealth index, and hypertension detection and control around the years 2007-15. Furthermore, we determine what observable factors, such as socio-demographic and health characteristics, explain existing SES-related inequalities in hypertension detection and control using a Blinder-Oaxaca decomposition. Results show that the prevalence of undetected hypertension is significantly associated with lower SES. For uncontrolled hypertension, there is evidence of a significant gradient in three of the six countries at the time the data were collected. Differences between rural and urban areas as well as lower and higher educated individuals account for the largest proportion of SES-inequalities in hypertension detection and control at the time. Improved access to primary healthcare in MICs since then may have contributed to a reduction in health inequalities in detection and treatment of hypertension. However, whether this indeed has been the case remains to be investigated

Uniaxial and biaxial soft deformations of nematic elastomers

We give a geometric interpretation of the soft elastic deformation modes of nematic elastomers, with explicit examples, for both uniaxial and biaxial nematic order. We show the importance of body rotations in this non-classical elasticity and how the invariance under rotations of the reference and target states gives soft elasticity (the Golubovic and Lubensky theorem). The role of rotations makes the Polar Decomposition Theorem vital for decomposing general deformations into body rotations and symmetric strains. The role of the square roots of tensors is discussed in this context and that of finding explicit forms for soft deformations (the approach of Olmsted).Comment: 10 pages, 10 figures, RevTex, AmsTe

Brain Activity During Paired and Individual Mindfulness Meditation: A Controlled EEG Study

Objective: In this study, we evaluated brain electroencephalographic (EEG) activity in healthy participants during the performance of paired and individual mindfulness meditation (MM). We hypothesized that EEG activity is differentially affected by meditation in pairs compared to individual meditation. Methods: A total of 20 healthy female university students (mean age 19.54 years, SD =1.53) with no prior experience in MM participated in this study. All participants had to perform a 5-minute MM task together and individually while the other participant was in rest or performing a concentration task (control condition). To exclude social interaction as main factor, participants were separated from their research partner by an opaque screen while instructions were given through headphones. Brain electroencephalographic (EEG) activity from each individual student was measured during all conditions. Results: The main findings indicate that left-frontal alpha and theta spectral EEG power was significantly higher during the paired MM condition compared to individual MM and control condition. Conclusions: This controlled MM study demonstrates differences in brain activity between practicing mindfulness in pairs compared to practicing it individually. We conclude that the increased alpha and theta EEG power during paired MM may be associated with social facilitation or the activation of theory of mind. The results invite further reflection on interpersonal communication and mindfulness

Brain Activity During Paired and Individual Mindfulness Meditation: A Controlled EEG Study

Objective: In this study, we evaluated brain electroencephalographic (EEG) activity in healthy participants during the performance of paired and individual mindfulness meditation (MM). We hypothesized that EEG activity is differentially affected by meditation in pairs compared to individual meditation. Methods: A total of 20 healthy female university students (mean age 19.54 years, SD =1.53) with no prior experience in MM participated in this study. All participants had to perform a 5-minute MM task together and individually while the other participant was in rest or performing a concentration task (control condition). To exclude social interaction as main factor, participants were separated from their research partner by an opaque screen while instructions were given through headphones. Brain electroencephalographic (EEG) activity from each individual student was measured during all conditions. Results: The main findings indicate that left-frontal alpha and theta spectral EEG power was significantly higher during the paired MM condition compared to individual MM and control condition. Conclusions: This controlled MM study demonstrates differences in brain activity between practicing mindfulness in pairs compared to practicing it individually. We conclude that the increased alpha and theta EEG power during paired MM may be associated with social facilitation or the activation of theory of mind. The results invite further reflection on interpersonal communication and mindfulness

Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Children with congenital hearing impairment benefit from early detection and management of their hearing loss. These and related considerations led to the recommendation of universal newborn hearing screening. In 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England. Objective of this study was to assess costs and effectiveness for hospital and community-based newborn hearing screening systems in England based on data from this first phase with regard to the effects of alterations to parameter values. METHODS: DESIGN: Clinical effectiveness analysis using a Markov Model. OUTCOME MEASURE: quality weighted detected child months (QCM). RESULTS: Both hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of 3,690,000 pound sterling per 100,000 screened children in hospital and 3,340,000 pound sterling in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community. CONCLUSION: This modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.This work was undertaken by the Evaluation Team for the Implementation Pilot of Newborn Hearing Screening in England which received funding from the Department of Health

Life cycle assessment and cost evaluation of emerging technologies at early stages: The case of continuous flow synthesis of Rufinamide

In the pharma and fine chemical industries, the development of continuous flow technologies is a process intensification step of primary importance towards the manufacturing of high‐quality products, while reducing the environmental impact and cost of production. The sustainability and profitability of a process can be measured through life cycle Assessment and cost evaluation. However, when applied to emerging technologies, these need to be performed at different stages of the process development in order to limit the uncertainties arising from the scale‐up, and hence providing high‐fidelity projections of environmental impacts and costs at larger scales. The output of the assessment can in fact vary significantly depending on the maturity of the technology and this translates into having different results at commercial scale compared to early estimations. Therefore, in this article, we perform an assessment at two different scales of production, lab and mini‐pilot scale, with the aim of quantifying the uncertainties of the assessment related to the scale‐up, identifying the hotspots of the system, and hence providing guidelines for the further steps of process development. The subject of the assessment is the continuous flow synthesis of Rufinamide. It is the first time that this synthesis is evaluated at pilot‐scale. The results show that low yields in the cycloaddition drastically affect the waste management and the production of precursors, and hence increases environmental impacts and cost of production. This calls for the need of prioritizing the optimization of this synthesis step in order to deploy a green and economically competitive production technology

Liquid Blood Phantoms to Validate NIRS Oximeters: Yeast Versus Nitrogen for Deoxygenation

Liquid blood phantoms are a tool to calibrate, test and compare near-infrared spectroscopy (NIRS) oximeters. They comprise a mixture of saline, blood and Intralipid, which is subsequently oxygenated and deoxygenated to assess the entire range of tissue oxygen saturation (StO) from 0% to 100%. The aim was to investigate two different deoxygenation methods: yeast versus nitrogen (N) bubbling. The phantom was oxygenated with pure O in both experiments, but deoxygenated by bubbling N in the first and by addition of yeast and glucose in the second experiment. A frequency domain NIRS instrument (OxiplexTS) was used as reference and to monitor changes in the reduced scattering coefficient (μ') of the phantom. Both deoxygenation methods yielded comparable StO values. The deoxygenation was slower by a factor 2.8 and μ' decreased faster when bubbling N. The constant bubbling of N mechanically stresses the Intralipid emulsion and causes a decrease in μ', probably due to aggregation of lipid droplets. Deoxygenation by N requires a more complex, air tight phantom. The gas flow cools the liquid and temperature needs to be monitored more closely. Consequently, we recommend using yeast for phantom deoxygenation