324139 research outputs found
Sort by
Unlocking the potential of community pharmacies to address hypertension in South Asia: the COPE-BP programme
Get PDFHypertension is a leading contributor to cardiovascular disease in South Asia, affecting over 40% of adults, of whom most remain undiagnosed or poorly managed. Despite urgent healthcare needs, the already overstretched public primary care systems in low- and middle-income countries, particularly in rapidly growing urban areas, are falling short. Community pharmacies, often the first point of contact for low-income urban residents, represent an opportunity for delivering frontline chronic disease care. The Community-Pharmacies managing hypertension: intervention development and Evaluation in Bangladesh and Pakistan (COPE-BP) programme aims to investigate whether these widely accessed yet under-evaluated community pharmacists are effective and cost-effective, and assess whether the COPE-BP intervention can be successfully integrated into hypertension care pathways in Bangladesh and Pakistan. Beyond evaluating clinical and economic outcomes, COPE-BP seeks to reframe the role of semi-formal providers, including community pharmacies, which are key actors in primary care delivery. Through a stepwise programme encompassing intervention development, a multicentre clinical trial, implementation research, and policy engagement, COPE-BP aims to provide a scalable model for integrating non-traditional providers into national health strategies. In doing so, COPE-BP will help strengthen inclusive, people-centred health systems in LMICs
Chikungunya clinical management guidance: insights from a health system stakeholder study in Indonesia
Get PDFChikungunya virus poses a significant public health challenge in Indonesia. Robust surveillance and diagnostics are lacking, and clinical management guidelines (CMGs) are absent.This practice article draws on insights from a qualitative health system stakeholder study conducted in Jakarta and Bali, Indonesia. The study examined barriers to the development and implementation of chikungunya CMGs.Findings reveal critical gaps in knowledge, diagnostic tools and prioritisation, exacerbated by systemic decentralisation and resource limitations. Robust, locally adapted CMGs could address these gaps, enhance clinical care and improve outbreak preparedness. This study underscores the importance of stakeholder engagement and capacity building in developing CMGs, offering lessons for low-resource settings managing emerging diseases
Monetary policy in open economies with production networks
No full textThis paper studies monetary policy design in small open economies with cross-border and input-output linkages. We derive the divine coincidence (DC) Phillips curve linking the output gap to a DC index that weights each sector’s inflation by sectoral contents in domestic consumption and exports, and of domestic labor. Output gap targeting can be implemented by stabilizing the DC index, which assigns larger weights to sectors that supply more inputs directly or indirectly to domestic output and face larger expenditureswitching effects. Disregarding openness or treating the economy as one sector overemphasizes inflation in sectors that export directly or indirectly, and underemphasizes inflation in sectors facing large expenditureswitching effects. We quantify our theoretical results using the World Input-Output Database, showing that the Phillips curves are steeper in open than closed economies, and that output gap targeting is near-optimal as in closed economies and outperforms alternative policies ignoring cross-border or input-output linkages
‘British children are not shrinking’, but child height is increasing for the wrong reasons: trends and inequalities in child measurement programme data for England, Scotland and Wales
Get PDFBackground: News media have reported that the average height of British children is falling, but these reports have been contested. Child Measurement Programmes (CMPs) operate in schools in England, Scotland and Wales, but their height data have been inaccessible, allowing conflicting claims about trends in child height to remain unresolved. Here, we aim to describe and explain trends and socioeconomic inequalities in child height using the best available evidence.
Methods: Freedom of information requests were submitted to relevant authorities in England, Scotland and Wales, requesting annual CMP height and obesity data, stratified by sex, ethnicity and deprivation to 2023/2024. Mean height and obesity prevalence were plotted against time by age group, sex and deprivation group.
Results: The COVID-19 pandemic prompted school closures in Britain, disrupting CMP data collection. This period was associated with sharp but transient increases in obesity prevalence and mean height. Before COVID-19, mean height increased, particularly among children in deprived areas. Children in deprived areas also showed the greatest increases in obesity and overweight prevalence. Narrowing socioeconomic inequalities in child height in Britain have been associated with widening inequalities in obesity.
Conclusions: This work complements research describing a causal link from child obesity to increased height during childhood and implies mean height may be an unreliable indicator of child health when obesity is prevalent and rising. In Britain, increases in overall mean child height and narrowing socioeconomic inequalities in child height during the 21st century may reflect widening inequalities in obesity and worsening health among deprived children
A theoretical model for solving wave scattering by multiple submerged horizontal plates and membranes
Get PDFThis paper presents a theoretical model for water wave scattering by arrays of submerged horizontal plates and membranes. Based on linear potential flow theory and the Fourier transform, the model overcomes limitations of eigenfunction matching by accommodating arbitrary plate arrangements. The potential jump across the plate is represented using Chebyshev polynomial expansions that inherently capture edge singularities, ensuring rapid convergence. A key theoretical finding proves that swapping the positions of two staggered porous flexible plates leaves the wave transmission coefficient unchanged across all frequencies. For coaxial dual plates, the reflection coefficient exhibits bimodal peaks. Staggered or side-by-side configurations shift these peaks lower and enhance short-wave attenuation. Larger plate spacing amplifies force oscillations on the seaward plate due to wave interference. The model is extended to analyse wave scattering by metastructures with square, circular, trapezoidal, and inverted trapezoidal profiles. The inverted trapezoidal design enhances low-frequency reflection through its extended shallow plates, while its deeper elements reduce short-wave interaction, enabling optimised performance for coastal protection applications
Longitudinal cardiorespiratory wearable sleep staging in the home
Get PDFIntroduction
There is a growing interest in performing automated, longitudinal tracking of sleep in the home using wearables and machine learning (ML). Wearables such as smart watches or chest patches can be comfortably worn for long periods, and cardiorespiratory waveforms measured by these wearables combined with ML models to estimate sleep state. However, the performance of these ML models is typically assessed using retrospective data from polysomnography, which is traditionally performed in a sleep lab. Importantly, polysomnography involves monitoring cardiorespiratory waveforms with bulky, specialized equipment, typically chest bands placed around the circumference of the upper toro and diaphragm, rather than with wearables. The performance of ML models evaluated on cardiorespiratory data from polysomnography may therefore not be representative of model performance when the cardiorespiratory input signals are acquired using modern wearable devices, where signal quality and available signal modalities may be more limited. Further work is needed to validate these ML models in their intended scenario of use: longitudinal, wearable sleep monitoring in the home.
Methods
This paper establishes and validates a pipeline for longitudinal cardiorespiratory sleep monitoring in the home using data from the RESTORE study. In RESTORE, 17 participants with a sleep-related condition (insomnia and depressive symptoms) underwent a sleep-related clinical intervention (sleep restriction therapy). Participants simultaneously wore a low-density home electroencephalogram device, allowing for expert, manual sleep staging using brain activity, as well as a wearable peel-and-stick chest patch, allowing for wearable monitoring of cardiorespiratory waveforms. Both devices were worn by participants for 10 nights while undergoing treatment at home. A state-of-the-art cardiorespiratory sleep staging model, combining transformer and convolutional neural networks, was then tuned and tested on the wearable data using leave-one-subject-out-cross-validation.
Results
After transfer learning, the cardiorespiratory sleep staging model had an accuracy of 77.1% and Cohen's Kappa of 0.679 for four-class sleep staging. Further, the model was able to accurately track sleep and sleep-derived metrics longitudinally while participants underwent sleep restriction therapy.
Discussion
These results represent one of the first direct demonstrations of the potential for wearable, cardiorespiratory sleep staging to track longitudinal, clinically relevant changes in sleep in individuals undergoing a sleep-related intervention in the home
Low Regularity of Self-Similar Solutions of Two-Dimensional Riemann Problems with Shocks for the Isentropic Euler System
Get PDFWe are concerned with the low regularity of self-similar solutions of two-dimensional Riemann problems for the isentropic Euler system. We establish a general framework for the analysis of the local regularity of such solutions for a class of two-dimensional Riemann problems for the isentropic Euler system, which includes the regular shock reflection problem, the Prandtl reflection problem, the Lighthill diffraction problem, and the four-shock Riemann problem. We prove that the velocity is not in in the subsonic domain for the self-similar solutions of these problems in general. This indicates that the self-similar solutions of the Riemann problems with shocks for the isentropic Euler system are of much more complicated structure than those for the Euler system for potential flow; in particular, the velocity is not necessarily continuous in the subsonic domain. The proof is based on a regularization of the isentropic Euler system to derive the transport equation for the vorticity, a renormalization argument extended to the case of domains with boundary, and DiPerna-Lions-type commutator estimates
Toward neuroanatomical and cognitive foundations of macaque social tolerance grades
Get PDFThe macaque genus includes 25 species with diverse social systems, ranging from low to high social tolerance grades. Such interspecific behavioral variability provides a unique model to tackle the evolutionary foundation of primate social brain. Yet, the neuroanatomical correlates of these social tolerance grades remain unknown. To address this question, we expressed social tolerance grades within a novel cognitive framework and analyzed post-mortem structural scans from 12 macaque species. Our results show that amygdala volume is a subcortical predictor of macaques’ social tolerance, with high tolerance species exhibiting larger amygdala than low tolerance ones. We further investigated the developmental trajectory of amygdala across social grades and found that intolerant species showed a gradual increase in relative amygdala volume across the lifespan. Unexpectedly, tolerant species exhibited a decrease in relative amygdala volume across the lifespan, contrasting with the age-related increase observed in intolerant species—a developmental pattern previously undescribed in primates. Taken together, these findings provide valuable insights into the cognitive, neuroanatomical, and evolutionary basis of primates’ social behaviors
Dosing practices of caffeine therapy for apnoea of prematurity: a retrospective single-centre observational study
Get PDFObjective: To evaluate caffeine prescribing practices in a tertiary neonatal unit, focusing on initiation, dose adjustment, discontinuation and recommencement, and to assess associations with gestational age and respiratory support. Design: Retrospective observational study. Setting: Neonatal unit, John Radcliffe Hospital, Oxford, United Kingdom. Patients: Preterm infants born ≤32 weeks gestation and admitted between 1 February 2022 and 31 October 2023. Data extracted from paper patient records included daily caffeine dosing, initiation, discontinuation, recommencement, coadministration with doxapram, demographics and duration of respiratory support. Associations between caffeine administration and clinical factors such as gestational age were assessed using regression. Results: 168 admissions were analysed from 163 infants. Caffeine was typically initiated with a loading dose of 20 mg/kg, and maintenance doses ranged from 5 mg/kg/day to 25 mg/kg/day. There were 1–8 dose adjustments per admission. Doxapram was administered to 19 infants. Caffeine was discontinued at a median (IQR) postmenstrual age of 34.0 (33.9–34.7) weeks and was recommenced in four infants. Gestational age at birth was negatively correlated with postmenstrual age at discontinuation (r(CI) –0.33 (–0.51 to –0.12), p=0.0029; R²=0.11) and infants born at lower gestational ages received higher doses. Conclusion: Caffeine therapy in this unit showed marked variability in dosing, discontinuation and recommencement, highlighting the individualised nature of bedside decision-making, which may reflect clinical response to therapy