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Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study
No full textDue to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40 440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55–78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5–19) days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6–23) days versus 8 (4–15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18 831) versus 39.0% (7532 out of 19 295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65–0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU
Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data
No full textBackground
Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia.
Methods
Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7.
Results
A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001).
Conclusions
In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery
Desain Kemasan Minuman Sari Buah Mengkudu (Morinda citrifolia) untuk Meningkatkan Pemasaran di UD Manjur Makmur
Full text linkOne of the variant of Morinda citrifolia fruit drink is called noni juice and known as Noni Super Power’s brand name at UD Manjur Makmur. This beverage is naturally fermented by spontaneous fermentation at 28-30°C during six months in a bottle that has been cleaned and tightly closed. During the marketing process to consumers, the design packaging of noni drink is needed to attract consumers buying. Meanwhile, the primary packaging of noni juice at UD Manjur Makmur is less attractive to consumers, there is also no secondary and tertiary packaging and it became the product's packaging weakness. So, label and packaging for noni juice products are needed to design to promote product identity and display product visuals to raise the consumers’ interest. This study was conducted to solve these problems. In this research, benchmarking of products, the Guide on Labeling of Processed Food Agency for National Drug and Food Control (2020), and the observation, imitation, modify methodology were applied. This research resulted in the design of primary, secondary, and tertiary packaging for noni fruit juice drinks. Following the benchmarking, the guide of processed food label requirements, and evaluating the packaging and labels (2020), the new design packaging and labels were better than before. As packaging of noni juice, plastic bottles with new design label are used for primary packaging, followed by rectangles (boxes) made from samson paper (size of 6,3 × 6,3 × 18 cm) for secondary packaging, and cardboard boxes made from corrugate (size of 30 × 20 × 40 cm) for tertiary packaging. Furthermore, the new design packaging (especially tertiary packaging) can accommodate a large amount of noni juice bottles during the marketing and distribution of its product.
Keywords: consumers’ interest, noni juice, label, packagin
Study dataset: The impact of traumatic childbirth on first-time mother’s social identity and psychological wellbeing: Study dataset: Traumatic childbirth, wellbeing and social identity of first-time mothers
No full textThe data were collected via an online survey using Qualtrics software between October 2020 and March 2021, and contributed to a research study for part fulfilment of a doctoral degree in Clinical Psychology. The data was analysed using SPSS software, version 27. The data are provided as SPSS and Excel files. In the Excel file, comments have been added to the column headings to indicate how the data are scored
New constraints on Titan's stratospheric n-butane abundance
No full textCuriously, n-butane has yet to be detected at Titan, though it is predicted to be present in a wide range of abundances that span over 2.5 orders of magnitude. We have searched infrared spectroscopic observations of Titan for signals from n-butane (n-C4H10) in Titan's stratosphere. Three sets of Cassini Composite Infrared Spectrometer Focal Plane 4 (1050–1500 cm−1) observations were selected for modeling, having been collected from different flybys and pointing latitudes. We modeled the observations with the Nonlinear Optimal Estimator for MultivariatE Spectral AnalySIS radiative transfer tool. Temperature profiles were retrieved for each of the data sets by modeling the ν4 emission from methane near 1305 cm−1. Then, incorporating the temperature profiles, we retrieved abundances of all of Titan's known trace gases that are active in this spectral region, reliably reproducing the observations. We then systematically tested a set of models with varying abundances of n-butane, investigating how the addition of this gas affected the fits. We did this for several different photochemically predicted abundance profiles from the literature, as well as for a constant-with-altitude profile. Ultimately, though we did not produce any firm detection of n-butane, we derived new upper limits on its abundance specific to the use of each profile and to multiple different ranges of stratospheric altitudes. These results will tightly constrain the C4 chemistry of future photochemical modeling of Titan's atmosphere and also motivate the continued search for n-butane and its isomer, isobutane
An anthropological toolkit: network analysis
No full textThis is a network analysis of the cross references between the 60 different sections of the book An Anthropological Toolkit, published by Bergahahn in 2022. As well as the visualisations the source data is include
Feasibility of delivering foot and ankle surgical courses in a partnership in Eastern, Central and Sothern Africa
No full textBackground
Foot and ankle pathology if not treated appropriately and in a timely manner can adversely affect both disability and quality adjusted life years. More so in the low- and middle-income countries where ambulation is the predominant means of getting around for the majority of the population in order to earn a livelihood. This has necessitated the equipping of the new generation of orthopaedic surgeons with the expertise and skills set to manage these conditions. To address this need, surgeons from the British Orthopaedic Foot & Ankle Society (BOFAS) and College of Surgeons of Eastern, Central and Southern Africa (COSECSA) transferred the “Principles of Foot and Ankle Surgery” course to an African regional setting. The course was offered to surgical trainees from 14-member countries of the COSECSA region and previously in the UK. The faculty was drawn from practicing surgeons experienced in both surgical education and foot and ankle surgery. The course comprises didactic lectures, case-based discussions in small groups, patient evaluations and guided surgical dissections on human cadavers. It was offered free to all participants. The feasibility of the course was evaluated using the model defined by Bowen considering the eight facets of acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. At the end of the course participants were expected to give verbal subjective feedback and objective feedback using a cloud based digital feedback questionnaire. The course content was evaluated by the participants as “Poor”, “Below average”, “Average”, “Good” and “Excellent”, which was converted into a value from 1–5 for analysis. The non-parametric categorical data was analysed using the Two-sample Wilcoxon rank-sum (Mann–Whitney) test, and significance was considered to be p
Results
Six courses in total were held between 2018 and 2020. Three in the UK and three in the COSECSA region. There were 78 participants in the three UK courses and 96 in the three courses run in the COSECSA region. Hundred percent of the UK participants and 97% of the COSECSA participants completed the feedback. Male to female ratio was 4:1 for the UK courses and 10:1 for the COSECSA Courses. In both regions all the participants responded that they would recommend the course to their colleagues. Among the COSECSA participants 91% reported that the course was pitched at the right level, which is similar to the 89% of the UK participants (p = 0.28).
Conclusion
The BOFAS Principles of Foot and Ankle Surgery course design provides core knowledge, with an emphasis on clinical examination techniques of the foot and ankle, while at the same time, caters for the anticipated difference in the local clinical case mix and resources. This study establishes that by attending the course surgical trainees can achieve their learning goals in foot and ankle surgery with the same high quality qualitative and quantitative feedback in both regions. This would improve their clinical practice and confidence. The multifaceted approach adopted in this course blending didactic teaching, small group discussions, interactive sessions, case-based discussions, cadaveric surgical skills training printed educational materials and feedback helped fulfil these educational objectives. Working in partnership with local expert orthopaedic surgeons from a number of Sub-Saharan countries, was key to adapting the course to local pathology and the COSECSA setting
WISDOM Project - X. The morphology of the molecular ISM in galaxy centres and its dependence on galaxy structure
No full textWe use high-resolution maps of the molecular interstellar medium (ISM) in the centres of eighty-six nearby galaxies from the millimetre-Wave Interferometric Survey of Dark Object Masses (WISDOM) and Physics at High Angular Resolution in Nearby GalaxieS (PHANGS) surveys to investigate the physical mechanisms setting the morphology of the ISM at molecular cloud scales. We show that early-type galaxies tend to have smooth, regular molecular gas morphologies, while the ISM in spiral galaxy bulges is much more asymmetric and clumpy when observed at the same spatial scales. We quantify these differences using non-parametric morphology measures (Asymmetry, Smoothness and Gini), and compare these measurements with those extracted from idealised galaxy simulations. We show that the morphology of the molecular ISM changes systematically as a function of various large scale galaxy parameters, including galaxy morphological type, stellar mass, stellar velocity dispersion, effective stellar mass surface density, molecular gas surface density, star formation efficiency and the presence of a bar. We perform a statistical analysis to determine which of these correlated parameters best predicts the morphology of the ISM. We find the effective stellar mass surface (or volume) density to be the strongest predictor of the morphology of the molecular gas, while star formation and bars maybe be important secondary drivers. We find that gas self-gravity is not the dominant process shaping the morphology of the molecular gas in galaxy centres. Instead effects caused by the depth of the potential well such as shear, suppression of stellar spiral density waves and/or inflow affect the ability of the gas to fragment
Listening to young lives at work in Vietnam: fifth call
No full textThis brief report provides headline findings from the fifth call in Young Lives at Work's COVID-19 Phone Survey in Vietnam.
The young people in our study were contacted by phone between October and December 2021 to find out if and how the pandemic is continuing to affect their education, employment, household income, access to food, health and well-being. The report also draws data from a brief 'getting in touch' Call 4, conducted in August 2021 which explored vaccine access and uptake