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STRIKE-HBV: establishing an HBV screening programme in Kilifi, Kenya-challenges, successes and lessons learnt. Sex Transm Infect 2024:sextrans-2024-056163. [PMID: 38789267 DOI: 10.1136/sextrans-2024-056163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES Chronic hepatitis B infection affects 65 million people in the WHO African Region, but only 4.2% of these are diagnosed and 0.2% on treatment. Here, we present a short report describing establishment of a hepatitis B virus (HBV) programme in Kenya. We share experiences, successes and challenges to support development of future programmes. METHODS From March 2023, we began the 'STRIKE-HBV' Study to identify people living with HBV (PLWHB) in Kilifi, Kenya. We employed local staff and provided education and training. Individuals were identified through three routes: (1) we offered free-of-charge HBV testing for all non-pregnant adults attending Kilifi Country Hospital (KCH) outpatient department; (2) we invited PLWHB to reattend for review; and (3) we invited close contacts of PLWHB for screening and vaccination if HBV was negative. All those seropositive for HBV were offered a comprehensive liver health assessment. RESULTS We have established a framework for HBV screening, assessment and linkage to care in Kilifi. Between March 2023 and March 2024, we collected data for 80 PLWHB, comprising (1) screening of 1862 people of whom 30 were seropositive, (2) enrolment of 38 people known to be living with HBV and (3) testing of 97 close contacts of PLWHB, of whom 12 were positive. Among a limited subset with elastography data, we identified 9 of 59 as having significant fibrosis, and a further 6 people had laboratory aspartate transaminase (AST) to platelet ratio index (APRI) scores in keeping with fibrosis. We encountered challenges including procurement delays for hepatitis B surface antigen testing kits and HBV vaccinations, and issues accessing liver elastography. CONCLUSIONS HBV screening was well received by the Kilifi population, has identified people at risk of liver disease progression and is improving linkage to care and vaccination at KCH. Future HBV programmes in WHO Africa can build on this experience as we work to develop accessible, affordable and acceptable care pathways.
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Transdermal oestradiol and exercise in androgen deprivation therapy (ESTRACISE): protocol. BJU Int 2024. [PMID: 38587276 DOI: 10.1111/bju.16361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To report the protocol of a study evaluating the efficacy of transdermal oestradiol (E2) gel in reducing the adverse effects of androgen deprivation therapy (ADT), specifically on sexual function, and to assess the utility of E2 in combination with supervised exercise. STUDY DESIGN AND METHODS The primary endpoint of this open-label Phase IIA randomized controlled trial is the efficacy of transdermal E2 gel. Secondary endpoints include: (i) the occurrence of ADT-induced adverse effects; (ii) the safety and tolerability of E2; (iii) the impact of E2 with or without exercise on physical, physiological, muscle, and systemic biomarkers; and (iv) quality of life. The trial will recruit high-risk PCa patients (n = 310) undergoing external beam radiation therapy with adjuvant subcutaneous ADT. Participants will be stratified and randomized in a 1:1 ratio to either the E2 + ADT arm or the ADT-only control arm. Additionally, a subset of patients (n = 120) will be randomized into a supervised exercise programme. RESULTS The primary outcome is assessed according to the efficacy of E2 in mitigating the deterioration of Expanded Prostate Cancer Index Composite sexual function domain scores. Secondary outcomes are assessed according to the occurrence of ADT-induced adverse effects, safety and tolerability of E2, impact of E2 with or without exercise on physical performance, body composition, bone mineral density, muscle size, systematic biomarkers, and quality of life. CONCLUSION The ESTRACISE study's innovative design can offer novel insights about the benefits of E2 gel, and the substudy can reinforce the benefits resistance training and deliver valuable new novel insights into the synergistic benefits of E2 gel and exercise, which are currently unknown. TRIAL REGISTRATION The protocol has been registered in euclinicaltrials.eu (2023-504704-28-00) and in clinicaltrials.gov (NCT06271551).
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Paediatric non-theatre emergency airway management. Anaesthesia 2024; 79:206-207. [PMID: 37946518 DOI: 10.1111/anae.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
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Genome-wide association study of esophageal squamous cell cancer identifies shared and distinct risk variants in African and Chinese populations. Am J Hum Genet 2023; 110:1690-1703. [PMID: 37673066 PMCID: PMC10577073 DOI: 10.1016/j.ajhg.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) has a high disease burden in sub-Saharan Africa and has a very poor prognosis. Genome-wide association studies (GWASs) of ESCC in predominantly East Asian populations indicate a substantial genetic contribution to its etiology, but no genome-wide studies have been done in populations of African ancestry. Here, we report a GWAS in 1,686 African individuals with ESCC and 3,217 population-matched control individuals to investigate its genetic etiology. We identified a genome-wide-significant risk locus on chromosome 9 upstream of FAM120A (rs12379660, p = 4.58 × 10-8, odds ratio = 1.28, 95% confidence interval = 1.22-1.34), as well as a potential African-specific risk locus on chromosome 2 (rs142741123, p = 5.49 × 10-8) within MYO1B. FAM120A is a component of oxidative stress-induced survival signals, and the associated variants at the FAM120A locus co-localized with highly significant cis-eQTLs in FAM120AOS in both esophageal mucosa and esophageal muscularis tissue. A trans-ethnic meta-analysis was then performed with the African ESCC study and a Chinese ESCC study in a combined total of 3,699 ESCC-affected individuals and 5,918 control individuals, which identified three genome-wide-significant loci on chromosome 9 at FAM120A (rs12379660, pmeta = 9.36 × 10-10), chromosome 10 at PLCE1 (rs7099485, pmeta = 1.48 × 10-8), and chromosome 22 at CHEK2 (rs1033667, pmeta = 1.47 × 10-9). This indicates the existence of both shared and distinct genetic risk loci for ESCC in African and Asian populations. Our GWAS of ESCC conducted in a population of African ancestry indicates a substantial genetic contribution to ESCC risk in Africa.
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WCN23-0503 Measurement of kidney function in Malawi, South Africa, and Uganda - a multi-centre population cohort study. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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The immediate effect of water treadmill walking exercise on overground in-hand walking locomotion in the horse. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Water treadmill (WT) exercise is frequently used for training/rehabilitation of horses but the effect of WT exercise on short-term movement patterns is yet to be investigated. The objective of this study was to determine the immediate effect of WT exercise on overground limb and back kinematics. Six horses (mean ± standard deviation., age 15±6.5 years, height 164±2 cm and weight 539±37 kg) walked twice in a straight line, led from both sides, before and after a standardised WT exercise session (19 min duration; speed 1.6 m/s; water depths: 0.0/7.5/21.0/32.0/47.0 cm) on a flat concrete surface. Horses wore five inertial-measurement-units to determine poll/wither/pelvic displacement, and 10 anatomical markers to determine fetlock/carpal/tarsal joint angles at specific stride points. Degree of mediolateral tarsal oscillation during stance was graded. Wilcoxon-signed-rank tests were used to investigate differences between pre- and post-WT exercise for each variable. Post-WT exercise, there was a significant decrease in hindlimb fetlock extension at mid-stance compared with pre-WT exercise. No significant changes in movement patterns of the poll/withers/pelvis were detected post-WT exercise. In all horses there was greater mediolateral tarsal oscillation during the stance phase of the stride post-WT exercise, which could relate to muscle fatigue. The results suggest that a 19-min WT session has an effect on immediately-following overground in-hand walking locomotion patterns. Further work is required to determine the duration of this effect, and how different WT speeds and water depths affect locomotion patterns.
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Effect of ground and raised poles on kinematics of the walk. J Equine Vet Sci 2022; 115:104005. [DOI: 10.1016/j.jevs.2022.104005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/02/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
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Photon quantum entanglement in the MeV regime and its application in PET imaging. Nat Commun 2021; 12:2646. [PMID: 33976168 PMCID: PMC8113573 DOI: 10.1038/s41467-021-22907-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Positron Emission Tomography (PET) is a widely-used imaging modality for medical research and clinical diagnosis. Imaging of the radiotracer is obtained from the detected hit positions of the two positron annihilation photons in a detector array. The image is degraded by backgrounds from random coincidences and in-patient scatter events which require correction. In addition to the geometric information, the two annihilation photons are predicted to be produced in a quantum-entangled state, resulting in enhanced correlations between their subsequent interaction processes. To explore this, the predicted entanglement in linear polarisation for the two photons was incorporated into a simulation and tested by comparison with experimental data from a cadmium zinc telluride (CZT) PET demonstrator apparatus. Adapted apparati also enabled correlation measurements where one of the photons had undergone a prior scatter process. We show that the entangled simulation describes the measured correlations and, through simulation of a larger preclinical PET scanner, illustrate a simple method to quantify and remove the unwanted backgrounds in PET using the quantum entanglement information alone.
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HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study. PUBLIC HEALTH IN PRACTICE 2021; 2:100128. [PMID: 36101575 PMCID: PMC9461590 DOI: 10.1016/j.puhip.2021.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda. Study design We conducted a matched case-control study between December 2016 and December 2018 at St Francis Hospital, Nsambya. Methods The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS. Results We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ± 14.8) for cases and 61.1 years (SD ± 14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] = 1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] = 4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR = 3.66, 95% CI 1.09-12.4 and aOR = 4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 mmHg) was associated with an increased risk of all stroke (aOR = 12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR = 6.48, 95% CI 1.15-36.7 and aOR = 5.63, 95% CI 1.74-18.2, respectively). Conclusions No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.
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The contribution of host genetics and environmental variation to immune response in gamma-herpesvirus infections. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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A ten-year study of Retinoblastoma in Uganda: An approach to improving outcome with limited resources. Cancer Epidemiol 2020; 71:101777. [PMID: 32660850 DOI: 10.1016/j.canep.2020.101777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Survival of children with cancer in resource-limited regions is very poor compared to better-resourced regions. Retinoblastoma (RB) is a childhood cancer that is commonly reported in many regions of Africa. RB may be safely and effectively treated by non-specialists, which could facilitate more widespread availability of treatment in under-resourced areas. METHODS A ten-year consecutive series of children with RB treated at Ruharo Eye Centre between December 2009 and November 2019 was prospectively followed up. Chemoreduction followed by surgery is the standard approach to therapy. Costs of therapy and also of travel and food are borne by the program which is unaffordable to most families and necessitates donors. Survival by stage of RB and number of eyes affected was described using Kaplan-Meier plots. Visual acuity was assessed for all children with bilateral disease and the retention of sight during follow-up assessed. RESULTS Among 665 children with RB, 18.2 % (121 children) presented with metastatic (Stage 4) RB with only two of these children surviving >24 months. Five-year survival was 60.2 % among all children with RB rising to 93.3 % and 87.2 % for children with unilateral and bilateral Stage 1 disease, respectively. Among 184 children with bilateral disease, 130 (70.7 %) retained some level of sight following primary treatment with 91 of those (49.5 % of all bilateral children) retaining vision up to their death or to the end of follow-up. CONCLUSION Many children in Uganda present with advanced RB and curative treatment is not possible in this setting. Children diagnosed and treated early have good prospects of survival. Retention of sight among many bilaterally affected children is achievable, facilitating access to normal education. Therefore, the strategic priorities for improving survival are changing community perceptions so that children with eye problems are brought without delay, and widening access to modern treatment by using genereal health workers with standard drugs, backed by financial, social and peer support.
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Abstract
Purpose To describe the epidemiology of Microbial Keratitis (MK) in Uganda. Methods We prospectively recruited patients presenting with MK at two main eye units in
Southern Uganda between December 2016 and March 2018. We collected information on
clinical history and presentation, microbiology and 3-month outcomes. Poor vision was
defined as vision < 6/60). Results 313 individuals were enrolled. Median age was 47 years (range 18–96) and 174 (56%) were
male. Median presentation time was 17 days from onset (IQR 8–32). Trauma was reported by
29% and use of Traditional Eye Medicine by 60%. Majority presented with severe
infections (median infiltrate size 5.2 mm); 47% were blind in the affected eye (vision
< 3/60). Microbiology was available from 270 cases: 62% were fungal, 7% mixed
(bacterial and fungal), 7% bacterial and 24% no organism detected. At 3 months, 30% of
the participants were blind in the affected eye, while 9% had lost their eye from the
infection. Delayed presentation (overall p = .007) and
prior use of Traditional Eye Medicine (aOR 1.58 [95% CI 1.04–2.42], p = .033) were responsible for poor presentation. Predictors of poor vision
at 3 months were: baseline vision (aOR 2.98 [95%CI 2.12–4.19], p < .0001), infiltrate size (aOR 1.19 [95%CI 1.03–1.36], p < .020) and perforation at presentation (aOR 9.93 [95% CI
3.70–26.6], p < .0001). Conclusion The most important outcome predictor was the state of the eye at presentation,
facilitated by prior use of Traditional Eye Medicine and delayed presentation. In order
to improve outcomes, we need effective early interventions.
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Abstract
Purpose: Microbial keratitis (MK), is a frequent cause of sight loss worldwide, particularly in low and middle-income countries. This study aimed to investigate the risk factors of MK in Uganda.Methods: Using a nested case control, we recruited healthy community controls for patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018. Controls were individually matched for age, gender and village of the cases on a 1:1 ratio. We collected information on demographics, occupation, HIV and Diabetes Mellitus status. In STATA version 14.1, multivariable conditional logistic regression was used to generate odds ratios for risk factors of MK and a likelihood ratio test used to assess statistical significance of associations.Results: Two hundred and fifteen case-control pairs were enrolled. The HIV positive patients among the cases was 9% versus 1% among the controls, p = .0003. Diabetes 7% among the cases versus 1.4% among the controls, p = .012. Eye trauma was 29% versus 0% among the cases and controls. In the multivariable model adjusted for age, sex and village, HIV (OR 83.5, 95%CI 2.01-3456, p = .020), Diabetes (OR 9.38, 95% CI 1.48-59.3, p = .017) and a farming occupation (OR 2.60, 95%CI 1.21-5.57, p = .014) were associated with MK. Compared to a low socio-economic status, a middle status was less likely to be associated with MK (OR 0.29, 95%CI 0.09-0.89, p < .0001).Conclusion: MK was associated with HIV, Diabetes, being poor and farming as the main occupation. More studies are needed to explore how these factors predispose to MK.
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Comprehensive genomic profiling and clinical outcomes in patients (pts) with fibroblast growth factor receptor rearrangement-positive (FGFR2+) cholangiocarcinoma (CCA) treated with pemigatinib in the fight-202 trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross-sectional study. Sex Transm Infect 2019; 95:405-411. [PMID: 31266818 PMCID: PMC6824617 DOI: 10.1136/sextrans-2018-053854] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/27/2019] [Accepted: 04/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We assessed the prevalence and risk factors associated with virological failure among female sex workers living with HIV on antiretroviral therapy (ART) in Kampala, Uganda. METHODS We conducted a cross-sectional study between January 2015 and December 2016 using routinely collected data at a research clinic providing services to women at high risk of STIs including HIV. Plasma samples were tested for viral load from HIV-seropositive women aged ≥18 years who had been on ART for at least 6 months and had received adherence counselling. Samples from women with virological failure (≥1000 copies/mL) were tested for HIV drug resistance by population-based sequencing. We used logistic regression to identify factors associated with virological failure. RESULTS Of 584 women, 432 (74%) with a mean age of 32 (SD 6.5) were assessed, and 38 (9%) were found to have virological failure. HIV resistance testing was available for 78% (28/38), of whom 82.1% (23/28) had at least one major drug resistance mutation (DRM), most frequently M184V (70%, 16/23) and K103N (65%, 15/23). In multivariable analysis, virological failure was associated with participant age 18-24 (adjusted OR (aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART non-adherence (aOR=2.6, 95% CI 1.2 to 5.8) and baseline CD4+ T-cell count ≤350 cells/mm3 (aOR=3.1, 95% CI 1.4 to 7.0). CONCLUSIONS A relatively low prevalence of virological failure but high rate of DRM was found in this population at high risk of transmission. Younger age, self-reported ART non-adherence and low CD4+ T-cell count on ART initiation were associated with increased risk of virological failure.
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Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda - a descriptive retrospective study. BMC Health Serv Res 2019; 19:598. [PMID: 31443649 PMCID: PMC6708238 DOI: 10.1186/s12913-019-4415-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. Methods We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients’ LTFU rates in hazard ratios (HRs). Results Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2–36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. Conclusion We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients.
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Abstract
Purpose To describe the care seeking journey and causes of delay among patients with Microbial Keratitis in Uganda. Methods A prospective cohort of patients presenting with microbial keratitis at the two main eye units in Southern Uganda (2016–2018). We collected information on demographics, home address, clinical history, and presentation pathway including, order of facilities where patients went to seek care, treatment advice, cost of care, and use of Traditional Eye Medicine. Presentation time was noted. We compared “direct” presenters versus “indirect” presenters and analysed predictors of delay. Results About 313 patients were enrolled. All were self-referred. Only 19% of the patients presented directly to the eye hospital. Majority (52%) visited one facility before presenting, 19% visited two facilities, 9% visited three facilities, and 2% visited four facilities. The cost of care increased with increase in the number of facilities visited. People in a large household, further distance from the eye hospital and those who used Traditional Eye Medicine were less likely to come directly to the eye hospital. Visiting another facility prior to the eye hospital and use of Traditional Eye Medicine aOR 1.58 (95%CI 1.03–2.43), p = .038 were associated with delayed presentation to the eye hospital. Conclusion This study provided information on patient journeys to seek care. Delay was largely attributable to having visited another health facility: a referral mechanism for microbial keratitis was non-existent. There is need to explore how these health system gaps can be strengthened.
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Feasibility of conducting HIV combination prevention interventions in fishing communities in Uganda: A pilot cluster randomised trial. PLoS One 2019; 14:e0210719. [PMID: 30917121 PMCID: PMC6436767 DOI: 10.1371/journal.pone.0210719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We assessed feasibility of an HIV-combination-prevention trial among fishing communities in Uganda. DESIGN Cluster randomised trial in four fishing communities on Lake Victoria, Uganda. Two intervention communities received a combination-prevention-package (behaviour change communication, condom promotion, HIV testing, voluntary male medical circumcision and referral for anti-retroviral therapy if HIV-positive). All four communities received routine government HIV care services. METHODS Using household census data we randomly selected a cohort of consenting residents aged ≥18 years. A baseline sero-survey in July 2014 was followed by two repeat surveys in March and December 2015. We measured uptake of HIV prevention methods, loss-to-follow-up and HIV incidence, accounting for multistage survey design. RESULTS A total of 862 participants were enrolled and followed for 15 months. Participation was 62% and 74% in the control and intervention arms respectively; Overall loss to follow up (LTFU) was 21.6% and was similar by arm. Self-reported abstinence/faithfulness increased between baseline and endline in both arms from 53% to 73% in the control arm, and 55% to 67% in the intervention arm. Reported condom use throughout the study period was 36% in the intervention arm vs 28% in the control arm; number of male participants reporting circumsicion in both arms from 58% to 79% in the intervention arm, and 39% to 46% in the control arm. Independent baseline predictors of loss-to-follow-up were: being HIV positive, residence in the community for <1 year, younger age, living in an urban area, and being away from the area for >1 month/year. CONCLUSIONS Recruitment and retention of participants in longitudinal trials in highly mobile HIV fishing communities is challenging. Future research should investigate modes for locating and retaining participants, and delivery of HIV-combination prevention.
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New clinical data from the DeCidE1 trial: Results on DPX-Survivac, low dose cyclophosphamide (CPA), and epacadostat (INCB024360) in subjects with advanced recurrent epithelial ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pragmatic implementation of exercise oncology in the Australian health system. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Respiratory disease and sero-epidemiology of respiratory pathogens in the working horses of Ethiopia. Equine Vet J 2018; 50:793-799. [PMID: 29574904 PMCID: PMC6175379 DOI: 10.1111/evj.12834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 03/02/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND Pathogens are frequently implicated in equine respiratory disease. In Ethiopia, respiratory disease is a frequent cause for presentation at veterinary clinics and a priority concern for users of working horses. However, there is little existing literature on possible aetiologies. OBJECTIVES Determine prevalence of respiratory signs and exposure to major respiratory pathogens through a serological survey. STUDY DESIGN Cross-sectional. METHODS Systematically selected horses from 19 sites in central Ethiopia were examined clinically and sampled once (August-December 2013). A face-to-face interview collected data on horses' management and history. Serological testing targeted equine influenza virus (EIV), equine herpesviruses-1 (EHV-1) and -4 (EHV-4), equine rhinitis viruses A (ERAV) and B (ERBV), equine arteritis virus (EAV) and Streptococcus equi subspecies equi (S. equi). RESULTS Owners reported a recent history of coughing in 38% of horses and nasal discharge in 7%. No animals were observed coughing during examination but 6% had a nasal discharge. Antibodies towards S. equi, were most prevalent (8%, 33/350). Antibodies to EAV were confirmed in one animal (0.3%). Low antibody titres to EHV-1/4 and ERA/BV suggested prior exposure but antibodies to EIV were not detected. Multivariable, multilevel logistic regression analysis for risk factors associated with S. equi serostatus showed higher odds of seropositivity in younger animals and those working less frequently. MAIN LIMITATIONS A single serological sample cannot describe dynamic changes in antibodies. Sampling horses at the place of work may result in healthy-worker bias. CONCLUSIONS S. equi may be endemic in this population and contributing, in part, to the occurrence of respiratory disease. Low prevalence of antibodies to viruses, with the exception of EIV, indicates these pathogens are present, but unlikely a predominant cause of respiratory signs and noninfectious causes of disease should also be investigated. Working horses in this region would be vulnerable to incursion of equine influenza.
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ISQUA18-2101Formative Evaluation to Enhance Physician Training and Engagement in Patient Safety. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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ISQUA18-2596A National Learning Collaborative to Prepare New Physicians to Engage in Patient Safety. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Reliance of ultrasound imaging in the management groin hernias: Are we imaging too often? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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EP-1703: Exercise medicine is the new radiotherapy adjunct - when co-located and timetabled with treatment. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Genetic diversity of equine herpesvirus 1 isolated from neurological, abortigenic and respiratory disease outbreaks. Transbound Emerg Dis 2018; 65:817-832. [PMID: 29423949 PMCID: PMC5947664 DOI: 10.1111/tbed.12809] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 12/14/2022]
Abstract
Equine herpesvirus 1 (EHV‐1) causes respiratory disease, abortion, neonatal death and neurological disease in equines and is endemic in most countries. The viral factors that influence EHV‐1 disease severity are poorly understood, and this has hampered vaccine development. However, the N752D substitution in the viral DNA polymerase catalytic subunit has been shown statistically to be associated with neurological disease. This has given rise to the term “neuropathic strain,” even though strains lacking the polymorphism have been recovered from cases of neurological disease. To broaden understanding of EHV‐1 diversity in the field, 78 EHV‐1 strains isolated over a period of 35 years were sequenced. The great majority of isolates originated from the United Kingdom and included in the collection were low passage isolates from respiratory, abortigenic and neurological outbreaks. Phylogenetic analysis of regions spanning 80% of the genome showed that up to 13 viral clades have been circulating in the United Kingdom and that most of these are continuing to circulate. Abortion isolates grouped into nine clades, and neurological isolates grouped into five. Most neurological isolates had the N752D substitution, whereas most abortion isolates did not, although three of the neurological isolates from linked outbreaks had a different polymorphism. Finally, bioinformatic analysis suggested that recombination has occurred between EHV‐1 clades, between EHV‐1 and equine herpesvirus 4, and between EHV‐1 and equine herpesvirus 8.
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What works to boost social relations and community wellbeing? A scoping review of the evidence. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Effect of 12 weeks combined aerobic and resistance training on fitness, arterial stiffness and body composition in Indigenous Australian men and women. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Assessment of the Combined Effect of Epstein-Barr Virus and Plasmodium falciparum Infections on Endemic Burkitt Lymphoma Using a Multiplex Serological Approach. Front Immunol 2017; 8:1284. [PMID: 29123514 PMCID: PMC5662586 DOI: 10.3389/fimmu.2017.01284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022] Open
Abstract
Epstein-Barr virus (EBV) is a necessary cause of endemic Burkitt lymphoma (eBL), while the role of Plasmodium falciparum in eBL remains uncertain. This study aimed to generate new hypotheses on the interplay between both infections in the development of eBL by investigating the IgG and IgM profiles against several EBV and P. falciparum antigens. Serum samples collected in a childhood study in Malawi (2005-2006) from 442 HIV-seronegative children (271 eBL cases and 171 controls) between 1.4 and 15 years old were tested by quantitative suspension array technology against a newly developed multiplex panel combining 4 EBV antigens [Z Epstein-Barr replication activator protein (ZEBRA), early antigen-diffuse component (EA-D), EBV nuclear antigen 1, and viral capsid antigen p18 subunit (VCA-p18)] and 15 P. falciparum antigens selected for their immunogenicity, role in malaria pathogenesis, and presence in different parasite stages. Principal component analyses, multivariate logistic models, and elastic-net regressions were used. As expected, elevated levels of EBV IgG (especially against the lytic antigens ZEBRA, EA-D, and VCA-p18) were strongly associated with eBL [high vs low tertile odds ratio (OR) = 8.67, 95% confidence interval (CI) = 4.81-15.64]. Higher IgG responses to the merozoite surface protein 3 were observed in children with eBL compared with controls (OR = 1.29, 95% CI = 1.02-1.64), showing an additive interaction with EBV IgGs (OR = 10.6, 95% CI = 5.1-22.2, P = 0.05). Using elastic-net regression models, eBL serological profile was further characterized by lower IgM levels against P. falciparum preerythrocytic-stage antigen CelTOS and EBV lytic antigen VCA-p18 compared with controls. In a secondary analysis, abdominal Burkitt lymphoma had lower IgM to EBV and higher IgG to EA-D levels than cases with head involvement. Overall, this exploratory study confirmed the strong role of EBV in eBL and identified differential IgG and IgM patterns to erythrocytic vs preerythrocytic P. falciparum antigens that suggest a more persistent/chronic malaria exposure and a weaker IgM immune response in children with eBL compared with controls. Future studies should continue exploring how the malaria infection status and the immune response to P. falciparum interact with EBV infection in the development of eBL.
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Tree height strongly affects estimates of water-use efficiency responses to climate and CO 2 using isotopes. Nat Commun 2017; 8:288. [PMID: 28819277 PMCID: PMC5561090 DOI: 10.1038/s41467-017-00225-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/09/2017] [Indexed: 11/29/2022] Open
Abstract
Various studies report substantial increases in intrinsic water-use efficiency (W i ), estimated using carbon isotopes in tree rings, suggesting trees are gaining increasingly more carbon per unit water lost due to increases in atmospheric CO2. Usually, reconstructions do not, however, correct for the effect of intrinsic developmental changes in W i as trees grow larger. Here we show, by comparing W i across varying tree sizes at one CO2 level, that ignoring such developmental effects can severely affect inferences of trees' W i . W i doubled or even tripled over a trees' lifespan in three broadleaf species due to changes in tree height and light availability alone, and there are also weak trends for Pine trees. Developmental trends in broadleaf species are as large as the trends previously assigned to CO2 and climate. Credible future tree ring isotope studies require explicit accounting for species-specific developmental effects before CO2 and climate effects are inferred.Intrinsic water-use efficiency (W i ) reconstructions using tree rings often disregard developmental changes in W i as trees age. Here, the authors compare W i across varying tree sizes at a fixed CO2 level and show that ignoring developmental changes impacts conclusions on trees' W i responses to CO2 or climate.
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ASPECTS OF THE COMPETITION BETWEEN INFORMAL AND FORMAL VOLUNTEERING AMONG OLDER PEOPLE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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OLDER PEOPLE’S UNDERSTANDING OF AND RECEPTIVENESS TO ACTIVITIES TO PREVENT COGNITIVE DECLINE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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MOVING BEYOND WALKING: ENCOURAGING SENIORS TO DO MORE VARIED PHYSICAL ACTIVITY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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HOUSING ADAPTATIONS IN THE UK: SCOPING THE EVIDENCE TO SUPPORT POLICY AND PRACTICE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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The need for an integrated approach for chronic disease research and care in Africa. Glob Health Epidemiol Genom 2016; 1:e19. [PMID: 29868211 PMCID: PMC5870416 DOI: 10.1017/gheg.2016.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/09/2016] [Accepted: 09/11/2016] [Indexed: 02/06/2023] Open
Abstract
With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.
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Promoting physical activity in older adults. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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More than walking: Encouraging seniors to vary their exercise habits. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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M17 The effect of multidisciplinary therapy on objective and subjective sleep quality in premanifest huntington’s disease. Journal of Neurology, Neurosurgery and Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Book Review: The Telemedicine Tool Kit. Scott Med J 2016. [DOI: 10.1177/003693300104600632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Unraveling the causes of respiratory disease in the working equids of Ethiopia: A cross sectional survey. J Equine Vet Sci 2016. [DOI: 10.1016/j.jevs.2016.02.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Heterogeneity of HIV incidence: a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control. Sex Transm Infect 2016; 92:447-54. [PMID: 26933046 PMCID: PMC5013105 DOI: 10.1136/sextrans-2015-052179] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 02/06/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe HIV heterogeneity in rural Uganda using incidence data collected between January 2012 and December 2014 among fishing cohort (FC) and in an adjacent rural general population cohort (GPC). METHODS In the FC, eligible HIV high-risk adults aged 18+ years were enrolled, followed and HIV tested every 3 months. Demographic and sexual behaviour data were also collected. The GPC, approximately 47 km away from the FC, was followed through annual surveys, and sociodemographic and behavioural data collected. A subset of GPC with comparable risk profiles to the FC was selected. We presented sociodemographic and risk profiles and also computed stratified HIV incidence. Cox regression was used to assess factors associated with HIV incidence. RESULTS Overall HIV incidence was higher in the FC than in the 'high-risk' GPC, 6.04 and 0.56 per 100 person years at risk, respectively, with a rate ratio (RR) of 10.83 (95% CI 6.11 to 19.76). This was higher among those aged 18-24 years, unmarried and those with more than two sex partners in the past year, RR of 15.44, 22.99 and 19.29, respectively. In the FC, factors associated with high incidence in multivariate analysis were duration in the community and unprotected sex. The factors in the GPC were ethnicity, marital status and duration in the community. CONCLUSIONS We have observed a substantial heterogeneity in HIV incidence. The high incidence in fishing communities is contributing greatly to the overall HIV burden in Uganda, and thus urgent combination prevention efforts are needed towards national goal to reduce HIV epidemic.
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Adverse pregnancy outcomes in rural Uganda (1996-2013): trends and associated factors from serial cross sectional surveys. BMC Pregnancy Childbirth 2015; 15:279. [PMID: 26515763 PMCID: PMC4627380 DOI: 10.1186/s12884-015-0708-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/16/2015] [Indexed: 11/22/2022] Open
Abstract
Objective Community based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods. Methods Within a general population cohort, between 1996 and 2013, women aged 15–49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012–13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome. Results One third of women reported an adverse pregnancy outcome; 10.8 % (abortion = 8.4 %, stillbirth = 2.4 %) by method 1 and 8.5 % (abortion = 7.2 %, stillbirth = 1.3 %) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity. Discussion Both methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates. Conclusion Strategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0708-8) contains supplementary material, which is available to authorized users.
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Is ice-rafted sediment in a North Pole marine record evidence for perennial sea-ice cover? PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2015; 373:rsta.2014.0168. [PMID: 26347534 DOI: 10.1098/rsta.2014.0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 06/05/2023]
Abstract
Ice-rafted sediments of Eurasian and North American origin are found consistently in the upper part (13 Ma BP to present) of the Arctic Coring Expedition (ACEX) ocean core from the Lomonosov Ridge, near the North Pole (≈88° N). Based on modern sea-ice drift trajectories and speeds, this has been taken as evidence of the presence of a perennial sea-ice cover in the Arctic Ocean from the middle Miocene onwards (Krylov et al. 2008 Paleoceanography 23, PA1S06. (doi:10.1029/2007PA001497); Darby 2008 Paleoceanography 23, PA1S07. (doi:10.1029/2007PA001479)). However, other high latitude land and marine records indicate a long-term trend towards cooling broken by periods of extensive warming suggestive of a seasonally ice-free Arctic between the Miocene and the present (Polyak et al. 2010 Quaternary Science Reviews 29, 1757-1778. (doi:10.1016/j.quascirev.2010.02.010)). We use a coupled sea-ice slab-ocean model including sediment transport tracers to map the spatial distribution of ice-rafted deposits in the Arctic Ocean. We use 6 hourly wind forcing and surface heat fluxes for two different climates: one with a perennial sea-ice cover similar to that of the present day and one with seasonally ice-free conditions, similar to that simulated in future projections. Model results confirm that in the present-day climate, sea ice takes more than 1 year to transport sediment from all its peripheral seas to the North Pole. However, in a warmer climate, sea-ice speeds are significantly faster (for the same wind forcing) and can deposit sediments of Laptev, East Siberian and perhaps also Beaufort Sea origin at the North Pole. This is primarily because of the fact that sea-ice interactions are much weaker with a thinner ice cover and there is less resistance to drift. We conclude that the presence of ice-rafted sediment of Eurasian and North American origin at the North Pole does not imply a perennial sea-ice cover in the Arctic Ocean, reconciling the ACEX ocean core data with other land and marine records.
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Seroprevalence and factors associated with seropositivity to equine arteritis virus in Spanish Purebred horses in Spain. Equine Vet J 2015; 48:573-7. [PMID: 26278700 DOI: 10.1111/evj.12500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/24/2015] [Indexed: 12/01/2022]
Abstract
REASONS FOR PERFORMING STUDY Equine viral arteritis (EVA), a disease caused by infection with the equine arteritis virus (EAV), is present in many European countries. In Spain, the last confirmed outbreak was reported in 1992 and there is a paucity of seroprevalence studies. The disease has a major impact on the equine breeding industry, which is mainly represented by Spanish Purebred (SP) horses in Spain. OBJECTIVES To estimate the seroprevalence of EAV in the breeding SP horse population in central Spain and identify potential horse and studfarm level factors associated with seropositivity to EAV. STUDY DESIGN Cross-sectional study. METHODS Individual serum samples from 555 SP horses, collected between September 2011 and November 2013 at 35 studfarms, were tested using a commercially available EAV antibody ELISA and seroneutralisation as the World Organisation for Animal Health reference confirmation test for samples with positive and equivocal results. Data on factors putatively associated with seropositivity to EAV were collected via a questionnaire and examined using random effects logistic regression for analysis of clustered data. RESULTS Equine arteritis virus seroprevalence in the SP breeding population in central Spain standardised for the sex distribution of the reference horse population, was estimated to be 16.8% (95% confidence interval 5.2-28.5%). Increasing numbers of breeding mares on the studfarm and increasing percentage of mares with reproductive problems during the last 12 months were identified as being positively associated with EAV seropositivity. Mares vaccinated against Equine herpesvirus-1 (EHV-1) and/or -4 (EHV-4) were also positively associated with EAV seropositivity. CONCLUSIONS These findings are of importance to ensure appropriate biosecurity measures for studfarms are carried out and may help facilitate the development of an EVA surveillance programme in the SP breeding horse population.
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What Effect Does Medium and Extended Trot Have on the Kinematics of the Forelimb in Dressage Horses? Equine Vet J 2015. [DOI: 10.1111/evj.12486_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fear of falling in Hispanic and African-American older adults. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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