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A life-course approach to tackling noncommunicable diseases in women
No full textWomen’s health has been critically underserved by a failure to look beyond women’s sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women’s lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women’s health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole
Dietary patterns, dietary adequacy and nutrient intake in adults commencing peritoneal dialysis : outcomes from a longitudinal cohort study
No full text(1) Background: Optimal dietary intake is integral to good health in people receiving peritoneal dialysis (PD). We investigated how dietary patterns, dietary adequacy and nutrient intake may change over time in people commencing PD. (2) Methods: Participants were attending the PD training unit for the commencement of peritoneal dialysis, aged ≥18 years and willing to complete food records. Misreporters were excluded from the analysis. Dietary intake was compared at PD commencement and at 12 months. Intake was also compared to reference standards. Dietary patterns were derived using principal component analysis. (3) Results: There were no significant changes between baseline and 12 months for grains, fruit, vegetables and meat. Dairy and added sugar intake was significantly lower (p = 0.01). The intake of energy and protein was adequate and did not change. There was a significant reduction in dietary phosphorus and calcium, and increased vitamin C intake. Three dietary patterns were identified: the ‘Bread and Cereal’ pattern; ‘Milk and Potatoes’ pattern; and the ‘Semi Vegetarian’ pattern. (4) Conclusions: In this longitudinal cohort study, the diet quality was suboptimal and there were limited changes in intake after the commencement of PD. Further exploration of how dietary patterns may impact outcomes and quality of life is warranted
Gay gentrification
No full textGentrification is a contentious dimension of urban renewal. The term describes the process whereby rundown, industrial, marginal, low-income, or working-class neighborhoods are transformed into middle-class, wealthy residential neighborhoods or desirable entertainment or commercial precincts. Economic, demographic, and lifestyle shifts are bound up in the process. Gentrification entails transformations in the material aesthetic of the neighborhood, an increasing share of wealthier residents and commercial premises, rising rent and property prices, and the displacement of long-term residents and businesses unable to afford the increasing costs of local living. It is most commonly associated with changes, which started in the 1960s and are ongoing, in inner-city neighborhoods of large cities in the Global North
Observational sketching as a pedagogical tool and a research method
No full textThis chapter reports on a visual arts-based strategy used in performative language workshops whereby an artist worked alongside facilitators doing observational sketches as the workshops were in progress. The artist captured key moments and turning points in the workshops through gesture drawings which filled multiple purposes. As the workshops were in progress, the presence of the artist and the artworks being produced had pedagogical benefit during the workshops, as participants became engaged in the experience of being drawn and actively reflected on the artworks that were produced. The research team also found that the gesture drawings provided an additional lens through which the workshops could be analysed as they showed some key moments and turning points represented as a still image. This chapter outlines the rationale for the use of observational sketching in the performative language learning environment, and describes the process used by the artist and the research team. A semi-structured interview with the artist provided data that enabled the uses of observational sketching to be investigated
A Kalman-filtering derivation of input and state estimation for linear discrete-time systems with direct feedthrough
No full textThis paper is devoted to investigating the problem of simultaneous input and state estimation for linear discrete-time systems with direct feedthrough from the perspective of a limiting case of the Kalman filtering problem. First, when the unknown input of the underlying system is described as a white Gaussian noise with finite mean and finite variance, a Kalman filter is derived. Next, under the case that the variance of the unknown input tends to infinity, the Kalman filter and the existing simultaneous input and state estimator are unified. Finally, for linear discrete-time systems without direct feedthrough, the relationship between the Kalman filter and the simultaneous input and state estimator is established in a simple manner. The result of this study will pave the way for designing an unbiased estimator for linear systems with unknown inputs and packet drops
Impact of exacerbation history on dupilumab efficacy in children with uncontrolled moderate-to-severe asthma : Liberty Asthma Voyage study
No full textPurpose: Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukins-4/-13, key and central drivers of type 2 inflammation in multiple diseases. This post hoc analysis of the Phase 3 LIBERTY ASTHMA VOYAGE study (NCT02948959) evaluated the efficacy of dupilumab in children aged 6 to 11 years with moderate-to-severe asthma with a type 2 inflammatory phenotype (blood eosinophil count ≥150 cells/µL or fractional exhaled nitric oxide [FeNO] ≥20 ppb) and a history of 1, 2, or ≥3 prior exacerbations. The impact of baseline type 2 biomarker levels on the efficacy of dupilumab in this population was also investigated. Patients and Methods: Patients were stratified by the number of exacerbations in the prior year (1, 2, or ≥3) and level of FeNO or blood eosinophil count at baseline. Endpoints included rate of severe exacerbations, percentage of non-exacerbators, and change from baseline in both lung function parameters (pre-and post-bronchodilator [BD] percent predicted forced expiratory volume in 1 s (ppFEV1) and ppFEV1/forced vital capacity [FVC] ratio) and Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) score. Results: A total of 350 patients were included in this analysis. Across patients with 1, 2, or ≥3 prior exacerbations and different levels of type 2 biomarkers, dupilumab reduced the risk of severe asthma exacerbations vs placebo by 53.0–96.0% and improved both pre-BD ppFEV1 and pre-BD FEV1/FVC ratio at Week 52. Dupilumab led to significant reductions in ACQ-7-IA scores in all groups of patients by Week 52. Conclusion: In children with uncontrolled, moderate-to-severe asthma with a type 2 phenotype, dupilumab consistently reduced the risk of asthma exacerbations, improved lung function, and reduced ACQ-7-IA scores, regardless of exacerbation history
Urban river health assessment and management
No full textRiver systems in the world are under enormous pressure due to urbanization together with agricultural and industrial development and the effects of climate variability and change. Especially the urban segments of river systems are prone to additional pressures due to multiple points and nonpoint source discharges and impervious catchments that lead to rapid stormwater runoff of generally polluted water, all of which leads to degradation of river health. River health has been defined in many ways, often focusing on environmental aspects and ignoring social, cultural, and economic dimensions. This is mainly because natural river systems are distributed over a large geographical space with unique biotic and abiotic characteristics, where socio-economic and cultural perspectives of communities change vastly. In an urban context, however, for rivers to be sustainable, management strategies need to consider the broader meaning of river health to include socio-cultural aspects with the physio-chemical and biological nature of the river water. This chapter reviews a wide range of single and multimetric indicators and overarching frameworks used in different jurisdictions to assess the health of river systems and provide best practice recommendations for urban river health management. The chapter proposes systematic and integrated monitoring to understand the system’s health better. It promotes the understanding of urban river systems and recommends implementing a transdisciplinary approach for river management by harmonizing policy, involving active and passive users, with targeted monitoring and research efforts to reduce pressures and improve the condition of urban rivers
The effect of oral supplementation of paricalcitol on C-reactive protein levels in chronic kidney disease patients : GRADE-assessed systematic review and dose-response meta-analysis of data from randomized controlled trials
No full textBackground: Previous studies investigating the effect of oral supplementation of paricalcitol on reactive protein levels in chronic kidney disease (CKD) patients reported inconsistent findings. In this systematic review and meta-analysis, we have analyzed and interpreted the results obtained from previous randomized clinical trials on the effect of paricalcitol on C-reactive protein in CKD patients in the literature. Methods: MEDLINE, SciVerse Scopus, and Clarivate Analytics Web of Science databases were searched until January 2023 and related articles were obtained through a careful screening process allowing extraction of required data from selected articles. The effect size was calculated using a random effect model and weighted mean differences (WMD) and 95% confidence intervals (CI). Heterogeneity among studies was evaluated using Cochran’s Q test and I2. Results: Amongst the 182 articles obtained from the initial search, 4 studies (6 arms) were finally included in the meta-analysis. Pooled analysis shows that C-reactive protein levels significantly decrease after oral supplementation with paricalcitol (WMD: -2.55Â mg/L, 95% CI (-4.99 to -0.11; P = 0.04). The studies used in this meta-analysis showed significant heterogeneity (I2 = 66.3% and P = 0.01). Conclusion: Oral paricalcitol supplementation in CKD patients can significantly reduce C-reactive protein levels, which may prevent CKD progression
Neutrophil-based bionic delivery system breaks through the capillary barrier of liver sinusoidal endothelial cells and inhibits the activation of hepatic stellate cells
No full textThe capillarization of hepatic sinusoids resulting from the activation of hepatic stellate cells poses a significant challenge, impeding the effective delivery of therapeutic agents to the Disse space for liver fibrosis treatment. Therefore, overcoming these barriers and achieving efficient drug delivery to activated hepatic stellate cells (aHSCs) are pressing challenge. In this study, we developed a synergistic sequential drug delivery approach utilizing neutrophil membrane hybrid liposome@atorvastatin/amlisentan (NCM@AtAm) and vitamin A-neutrophil membrane hybrid liposome @albumin (VNCM@Bai) nanoparticles (NPs) to breach the capillary barrier for targeted HSC cell delivery. Initially, NCM@AtAm NPs were successfully directed to the site of hepatic fibrosis through neutrophil-mediated inflammatory targeting, resulting in the normalization of liver sinusoidal endothelial cells (LSECs) and restoration of fenestrations under the combined influence of At and Am. Elevated tissue levels of the p-Akt protein and endothelial nitric oxide synthase (eNOS) indicated the normalization of LSECs following treatment with At and Am. Subsequently, VNCM@Bai NPs traversed the restored LSEC fenestrations to access the Disse space, facilitating the delivery of Bai into aHSCs under vitamin A guidance. Lastly, both in vitro and in vivo results demonstrated the efficacy of Bai in inhibiting HSC cell activation by modulating the PPAR γ/TGF-β1 and STAT1/Smad7 signaling pathways, thereby effectively treating liver fibrosis. Overall, our designed synergistic sequential delivery system effectively overcomes the barrier imposed by LSECs, offering a promising therapeutic strategy for liver fibrosis treatment in clinical settings
Facilitators and barriers of wet nursing from antiquity to the present : a narrative review with implications for emergencies
Get PDFBackground: If maternal breastfeeding is not possible, wet nursing allows infants to receive the nutrition and protection against disease that breastfeeding provides. Such protection may be particularly valuable in emergencies. However, while wet nursing is recommended in the Operational Guidance on Infant and Young Child Feeding in Emergencies it is underutilized. This narrative review aimed to develop an understanding of wet nursing practice across time and location, and why wet nursing is currently so little supported to inform interventions to support wet nursing in emergencies. Method: Medline and Embase were searched for "wet nursing," "cross-nursing," "shared breastfeeding," and "non-maternal nursing". Included articles were inductively analyzed to identify positive and negative factors associated with previous wet nursing practice. Results: This review included 74 records. Our analysis of the wet nursing literature includes historical and contemporary themes with milk kinship and wet nursing as risky being shared themes across time periods. Our analysis revealed that it is how wet nursing is undertaken that influences whether it benefits women, children, and societies or not. Facilitators and barriers to wet nursing in emergencies related to infant mortality rates, cultural and individual support for wet nursing, availability of wet nurses, and resources to support wet nursing. Conclusion: Understanding the conditions under which wet nursing has positive outcomes and what can be done to facilitate beneficial wet nursing practices will assist in enabling wet nursing to be more commonly implemented in emergencies