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Social determinants of health and knowledge, attitude and practice studies on antimicrobial resistance-an evidence review and future direction
No full textBackground
Antimicrobial resistance (AMR) intersects with social determinants of health (SDoH) influencing individual and population infectious disease exposure, spread and outcomes. A decade after the WHO recommended global AMR awareness campaigns to assess people’s knowledge, attitude and practices (KAP), we reviewed existing KAP studies conducted among populations considered vulnerable, marginalized or deprived by SDoH indicators.
Methods
We conducted a sub-analysis of KAP studies from a broader systematic review that explored the intersection of SDoH, AMR, infections and vulnerable populations. We searched Ovid MEDLINE, Ovid Embase, the Cochrane Library, PsycINFO and Scopus for studies published in English between 2000 and 2022. Titles, abstracts and full texts were screened, and qualitative analysis performed using thematic coding. Key findings were synthesized using a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework.
Results
Of the 126 papers included in the original review, 40 KAP studies met the inclusion criteria for this sub-analysis. Studies reported limited public knowledge about AMR and widespread practices of antibiotic self-medication. Existing recommendations emphasized continued health education. Although KAP studies describe ‘what’ antibiotic use behaviours are prevalent, they rarely address ‘why’ these behaviours occur—particularly in the context of SDoH and cultural norms. There is a pressing need to shift the research focus toward upstream drivers of behaviour, rather than solely on individual actions.
Conclusions
Current KAP studies prioritize individual behaviours without adequately considering the broader social, structural and environmental determinants. While these upstream factors remain unaddressed, the practice of sub-optimal self-medication is likely to persist, despite ongoing education efforts
Economic modelling of providing “spare” adrenaline autoinjectors to all schools to improve the management of anaphylaxis
No full textObjective To analyse NHS health datasets to estimate the cost of providing emergency adrenaline [epinephrine] autoinjectors (AAIs) to school pupils on a named-patient basis to leave on school premises versus providing ‘spare’ AAIs to schools which can be used for any school pupil.
Design Retrospective cohort study.
Setting English primary electronic health data from the Clinical Practice Research Datalink (CPRD) and English prescriptions data from the NHS Business Services Authority.
Participants School-aged children in England.
Main outcome measures (1) Proportion of school children with food allergy prescribed AAI; (2) cost of providing more than two AAIs to individual pupils mapped to integrated care boards (ICBs) in England compared with the cost of providing four spare AAIs to every school for the academic year 2023/24.
Results 44% of school-aged children in the CPRD had at least one AAI prescription and only 34% had repeat AAIs prescribed. In pupils with previous anaphylaxis, rates were 59% and 44%, respectively. During the academic year 2023/24, 63% of pupils were dispensed more than two AAIs at an estimated cost of over £9 million. The estimated cost of providing spare AAIs to every school was £4.5 million. If spare AAIs were to replace the supply of named-patient AAIs exclusively to leave on school premises, this would represent a potential cost-saving of at least £4.6 million or 25% of the total national expenditure for AAIs.
Conclusions Under half of children at risk of anaphylaxis are prescribed AAIs. Providing spare AAIs to all schools (at no cost to the school) would be a cost-neutral strategy for the vast majority of ICBs and one that is likely to improve emergency access to AAIs and therefore safety
Performance assessment of structural joints against progressive collapse in precast concrete structures
No full textAdoption of precast concrete building systems is increasing, primarily due to reduced on-site construction times and enhanced quality control. However, inherent discontinuity at the joints of precast structures makes achievement of robustness challenging following sudden column loss. The paper uses a component-based NLFEA approach to investigate the effect of joint detailing on the robustness of a previously tested full scale precast concrete building. The analysis shows that flexure was the principal load resisting mechanism following various sudden column removal scenarios. Detailed parametric investigations show that the global structural response is significantly influenced by choices made in the modelling of the beam-column joints
Optimal contracts for delegated order execution
No full textWe determine the optimal affine contract for a client who delegates their order execution to a dealer. Existence and uniqueness are established for general linear price impact dynamics of the dealer's trades. Explicit solutions are available for the model of Obizhaeva and Wang, for example, and a simple gradient descent algorithm is applicable in general. The optimal contract allows the client to almost achieve the first-best performance without any agency conflicts for many reasonable parameter values. Common trading arrangements arise as limiting cases. In particular, optimal contracts for many reasonable model parameters resemble the “fixing contract” common in FX markets, in that they only incorporate market prices briefly before the conclusion of the trade. Price manipulation by the dealer is avoided by only putting a sufficiently small weight on these prices, and complementing this part of the contract with a sufficiently large fixed fee
Alterations in topology, cost and dynamics of gamma-band EEG functional networks in a preclinical model of traumatic brain injury
No full textTraumatic brain injury (TBI) is a major cause of disability leading to multiple sequelae in cognitive, sensory, and physical domains, including posttraumatic epilepsy. Despite extensive research, our understanding of its impact on macroscopic brain circuitry remains incomplete. We analyzed electrophysiological functional connectomes in the gamma band from an animal model of blast-induced TBI over multiple time points after injury. We revealed differences in small-world propensity and rich-club structure compared with age-matched controls, indicating functional reorganization following injury. We further investigated cost-efficiency trade-offs, propose a computationally efficient normalization procedure for quantifying the cost of spatially embedded networks that controls for connectivity strength differences, and observed dynamic changes across the injury timeline. To explore potential links between altered network topology and epileptic activity, we employed a brain-wide computational model of seizure dynamics and attribute brain reorganization to a homeostatic mechanism of activity regulation with the potential unintended consequence of driving generalized seizures. Finally, we demonstrated post-injury hyperexcitability that manifests as an increase in sound-evoked response amplitudes at the cortical level. Our work characterizes, for the first time, gamma-band functional network reorganization in a model of brain injury and proposes potential causes of these changes, thus identifying targets for future therapeutic interventions
Metabolome-wide association identifies ferredoxin-1 (FDX1) as a determinant of cholesterol metabolism and cardiovascular risk in Asian populations
No full textThe burden of cardiovascular disease is rising in the Asia-Pacific region, in contrast to falling cardiovascular disease mortality rates in Europe and North America. Here we perform quantification of 883 metabolites by untargeted mass spectroscopy in 8,124 Asian adults and investigate their relationships with carotid intima media thickness, a marker of atherosclerosis. Plasma concentrations of 3beta-hydroxy-5-cholestenoate (3BH5C), a cholesterol metabolite, were inversely associated with carotid intima media thickness, and Mendelian randomization studies supported a causal relationship between 3BH5C and coronary artery disease. The observed effect size was 5- to 6-fold higher in Asians than Europeans. Colocalization analyses indicated the presence of a shared causal variant between 3BH5C plasma levels and messenger RNA and protein expression of ferredoxin-1 (FDX1), a protein that is essential for sterol and bile acid synthesis. We validated FDX1 as a regulator of 3BH5C synthesis in hepatocytes and macrophages and demonstrated its role in cholesterol efflux in macrophages and aortic smooth muscle cells, using knockout and overexpression models
The utilisation, application, and quality of videos of clinical interventions in peer-reviewed literature: a scoping review
No full textBackground: Videos of clinical interventions (VoCIs) demonstrating surgical and interventional procedures have become a mainstay in clinical practice and peer-reviewed academic literature. Despite the widespread availability of VoCI in the literature, there remain no established guidelines regarding the reporting of VoCI. We undertook a scoping review to investigate the current utilisation, application, and quality in VoCI reporting. Summary: A comprehensive literature search of Medline, Embase, Emcare, and CINAHL databases was performed to retrieve articles presenting VoCI, from January 2020 to December 2023. A customised data extraction tool assessed video characteristics (e.g., case presentation, outcomes), utility (e.g., target audience, reproducibility of procedure), and quality (subjective and objective). A total of 624 VoCIs were included (mean length 06:06), with over 62 h of VoCI reviewed. The most common VoCI perspectives were endoscopic (n = 153; 25%) and laparoscopic (n = 140; 22%). The clinical background and outcomes were described in 480 (76.9%) and 403 cases (64.6%), respectively, with disclosures (n = 23; 3.8%) rarely presented. VoCI primarily targeted trainees (n = 547; 87.7%) with most videos providing technical guidance (n = 394; 63.1%). In total, 248 videos (40%) were rated as medium or low quality on subjective assessment. Key Messages: There are significant heterogeneity and notably poor-quality control in VoCI reporting in peer-reviewed literature resulting in the omission of critical procedural steps and suboptimal visual quality. VoCI reporting guidelines are therefore urgently required to provide a set of minimum items that should be reported by clinicians when uploading VoCI
Hydrogen escaping from a pair of exoplanets smaller than Neptune
No full textExoplanet surveys have shown a class of abundant exoplanets smaller than Neptune on close, <100-day orbits1,2,3,4. These planets form two populations separated by a natural division at about 1.8 R⊕ termed the radius valley. It is uncertain whether these populations arose from separate dry versus water-rich formation channels, evolved apart because of long-term atmospheric loss or a combination of both5,6,7,8,9,10,11,12,13,14. Here we report observations of ongoing hydrogen loss from two sibling planets, TOI-776 b (1.85 ± 0.13 R⊕) and TOI-776 c (2.02 ± 0.14 R⊕), the sizes of which near the radius valley and mature (1–4 Gyr) age make them valuable for investigating the origins of the divided population of which they are a part. During the transits of these planets, absorption appeared against the Lyman-α emission of the host star, compatible with hydrogen escape at rates equivalent to 0.03–0.6% and 0.1–0.9% of the total mass per billion years of each planet, respectively. Observations of the outer planet, TOI-776 c, are incompatible with an outflow of dissociated steam, suggesting both it and its inner sibling formed in a dry environment. These observations support the strong role of hydrogen loss in the evolution of close-orbiting sub-Neptunes5,6,7,8,15,16
Tuning structure and magnetic order through Cr substitution in Co3O2BO3 Ludwigite
No full textIn the Co3O2BO3 Ludwigite, there are four crystallographic sites for the metal ion Co. Three sites are occupied by Co2+ in a high-spin state, and one
site by Co3+ in low-spin state, resulting in a compound where the number of Co2+ ions is twice that of Co3+ ions. Given the particular distribution of magnetic and non-magnetic ions, the compound can be visualized as consisting of magnetic planes containing Co2+ ions, separated by non-magnetic planesformed by Co3+ ions. In this work, were studied the structural changes, especially magnetic ones, caused by the gradual substitution of low-spin Co3+ (S=0) by Cr3+ ions (S = 3/2). We synthesized the Co3−xCrxO2BO3 series, and X-ray experiments showed a gradual increase in unit cell volume with increasing Cr concentration. Magnetization measurements show that this type of substitution drastically increases the magnetic transition temperature, from 42 K for the un-doped compound to 115 K for the compound with the highest Cr concentration. The latter is the highest long-range magnetic ordering temperature recorded so far for cobalt Ludwigites. The results from specific heat and magnetization measurements show that this substitution changes the ground-state magnetic structure of the compound, transitioning from a ferrimagnetic state (at low Cr concentrations) to an antiferromagnetic state (at high Cr concentrations), in agreement with the results of exchange integral calculations
Heating and cooling at a coronal magnetic null
No full textConductive cooling of the solar corona at a magnetic null is examined. An initial equilibrium is set up, balancing thermal conduction and a constant spatially uniform coronal heating. The heating is then turned off and the subsequent conductive cooling calculated. An equation for the cooling is obtained using the method of separation of variables and it is shown that the equations for the equilibrium between conduction and heating, and the time-dependent cooling are mathematically identical with a simple change of variables. Thus, the properties of the cooling phase are automatically determined by the equilibrium state. For a two-dimensional null, the characteristic cooling time-scale increases over that in a straight field by a factor of between 2 and 5, with a scaling determined by the ratio of the average and base areas of a flux element. There is no explicit dependence on the very large areas that can arise near the null