Serum lipid and lipoprotein levels in Ghanaians with diabetes mellitus and hypertension.

Both diabetes mellitus and hypertension alter lipid and lipoprotein metabolism and increase the risk of coronary artery disease. We have reported previously on lipid and lipoprotein levels in healthy Ghanaians, and this study deals with the levels of these biochemical parameters in Ghanaians with diabetes mellitus and hypertension. Fasting serum lipoproteins were determined on blood samples drawn from healthy male and female Ghanaians as well as age-matched individuals with either diabetes or hypertension. Cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, and fasting blood glucose were measured. Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were derived. Total serum cholesterol levels were 4.43 +/- 0.22 mmol/L and 4.67 +/- 0.26 mmol/L for diabetic males and females, respectively. High-density lipoprotein was 1.55 +/- 0.09 mmol/L and 1.50 +/- 0.09 mmol/L for male and female diabetics, respectively. Lipid and lipoprotein levels in the hypertensive patients did not differ from the above values. The levels of cholesterol and lipoprotein obtained in Ghanaians with hypertension and diabetes mellitus were similar to those of their age-matched healthy controls. These results suggest a reduced risk of coronary artery disease from the atherogenic effects of cholesterol in Ghanaians with diabetes mellitus and hypertension.     

Loops and Building Blocks: a Knowledge co-Production Framework for Equitable Urban Health

This paper sets out a structured process for the co-production of knowledge between researchers and societal partners and illustrates its application in an urban health equity project in Accra, Ghana. The main insight of this approach is that research and knowledge co-production is always partial, both in the sense of being incomplete, as well as being circumscribed by the interests of participating researchers and societal partners. A second insight is that project-bound societal engagement takes place in a broader context of public and policy debate. The approach to co-production described here is formed of three recursive processes: co-designing, co-analysing, and co-creating knowledge. These ‘co-production loops’ are themselves iterative, each representing a stage of knowledge production. Each loop is operationalized through a series of research and engagement practices, which we call building blocks. Building blocks are activities and interaction-based methods aimed at bringing together a range of participants involved in joint knowledge production. In practice, recursive iterations within loops may be limited due of constraints on time, resources, or attention. We suggest that co-production loops and building blocks are deployed flexibly.     

Evaluating the swelling,erosion, and compaction properties of cellulose ethers

Swelling, erosion, deformation, and consolidation properties can affect the performance of cellulose ethers, the most commonly used matrix former in hydrophilic sustained tablet formulations. The present study was designed to comparatively evaluate the swelling, erosion, compression, compaction, and relaxation properties of the cellulose ethers in a comprehensive study using standardised conditions. The interrelationship between various compressional models and the inherent deformation and consolidation properties of the polymers on the derived swelling and erosion parameters are consolidated. The impact of swelling (K_w) on erosion rates (K_E) and the inter-relationship between Heckel and Kawakita plasticity constants was also investigated. It is evident from the findings that the increases in both substitution and polymer chain length led to higher K_w, but a lower K_E; this was also true for all particle size fractions regardless of polymer grade. Smaller particle size and high substitution levels tend to increase the relative density of the matrix but reduce porosity, yield pressure (P_y), Kawakita plasticity parameter (b^?1) and elastic relaxation. Both K_W versus K_E (R²?=?0.949–0.980) and P_y versus. b^?1 correlations (R²?=?0.820–0.934) were reasonably linear with regards to increasing hydroxypropyl substitution and molecular size. Hence, it can be concluded that the combined knowledge of swelling and erosion kinetics in tandem with the in- and out-of-die compression findings can be used to select a specific polymer grade and further to develop and optimize formulations for oral controlled drug delivery applications.     

Managing HIV-positive sero-status in Ghana’s most HIV concentrated district: self-perceived explanations and theoretical discourse

As of December 2015 there were 37 million persons living with HIV/AIDS (PLWHAs), 70% of whom are in sub-Saharan Africa. Ghana, which contributes a relatively small number to Africa’s HIV burden, has a generalised HIV epidemic. The current national prevalence is 1.47%. Agormanya, one of the HIV sentinel sites in the county and where this study was conducted, has current prevalence of 11.6%. This makes it critical to explore how persons infected with HIV manage their lives, especially in the midst of entrenched stigma and discrimination. However, available information on how PLWHAs in sub-Saharan Africa handle their day-to-day lives mostly dwell on food and nutrition. Thus, there is dearth of information on how PLWHAs in Ghana particularly handle the circumstances of their daily lives which are mostly coloured by their HIV-positive statuses, given their stigmatised identity. We explore how PLWHAs respond to the experiences and challenges of living with HIV/AIDS in Lower Manya Krobo, consistently most HIV-infected district in Ghana. Data were collected from 38 combined purposive and randomly selected HIV-positive persons in two leading hospitals (St Martins Depores Agormanya and Atua Government hospitals which provide specialised HIV care in the district. Using in-depth interviews, we studied how PLWHAs managed their routine livelihoods in the midst of extreme stigma. We combined the social capital and resilience theoretical frameworks to show that our respondents were mostly resilient and strategically mostly drew upon extended family social support to cope with their livelihood challenges. We recommend that community opinion leaders and other stakeholders sensitise community members in Lower Manya Krobo to better understand the mode of HIV infection and encourage/strengthen family and community cohesion and social support.     

Impact of COVID-19 Pandemic on Training: Global Perceptions of Gastroenterology and Hepatology Fellows in the USA

Background

The COVID-19 pandemic has impacted numerous facets of healthcare workers’ lives. There have also been significant changes in Gastroenterology (GI) fellowship training as a result of the challenges presented by the pandemic.

Aims

We conducted a national survey of Gastroenterology fellows to evaluate fellows’ perceptions, changes in clinical duties, and education during the pandemic.

Methods

A survey was sent to Gastroenterology (GI) fellows in the USA. Information regarding redeployment, fellow restriction in endoscopy, outpatient clinics and inpatient consults, impact on educational activities, and available wellness resources was obtained. Fellows’ level of agreement with adjustments to clinical duties was also assessed.

Results

One hundred and seventy-seven Gastroenterology fellows responded, and 29.4% were redeployed to non-GI services during the pandemic. COVID-19 impacted all aspects of GI fellowship training in the USA (endoscopy, outpatient clinics, inpatient consults, educational activities). Fellows’ level of agreement in changes to various aspects of fellowship varied. 72.5% of respondents reported that their programs provided them with increased wellness resources to cope with the additional stress during the pandemic. For respondents with children, 17.6% reported no support with childcare.

Conclusions

Our results show that the COVID-19 pandemic has impacted GI fellowship training in the USA in multiple domains, including gastrointestinal endoscopy, inpatient consults, outpatient clinics, and educational conferences. Our study highlights the importance of considering and incorporating fellows’ viewpoints, as changes are made in response to the ongoing pandemic.

     

Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis

ObjectiveTo assess the association between the employment status of human immunodeficiency virus (HIV)-infected individuals and adherence to antiretroviral therapy (ART).MethodsWe searched the Medline, Embase and Cochrane Central Register of Controlled Trials databases for studies reporting ART adherence and employment status published between January 1980 and September 2014. Information from a wide range of other sources, including the grey literature, was also analysed. Two independent reviewers extracted data on treatment adherence and study characteristics. Study data on the association between being employed and adhering to ART were pooled using a random-effects model. Between-study heterogeneity and sources of bias were evaluated.FindingsThe meta-analysis included 28 studies published between 1996 and 2014 that together involved 8743 HIV-infected individuals from 14 countries. The overall pooled odds ratio (OR) for the association between being employed and adhering to ART was 1.27 (95% confidence interval, CI: 1.04–1.55). The association was significant for studies from low-income countries (OR: 1.85, 95% CI: 1.58–2.18) and high-income countries (OR: 1.33, 95% CI: 1.02–1.74) but not middle-income countries (OR: 0.94, 95% CI: 0.62–1.42). In addition, studies published after 2011 and larger studies showed less association between employment and adherence than earlier and small studies, respectively.ConclusionEmployed HIV-infected individuals, particularly those in low- and high-income countries, were more likely to adhere to ART than unemployed individuals. Further research is needed on the mechanisms by which employment and ART adherence affect each other and on whether employment-creation interventions can positively influence ART adherence, HIV disease progression and quality of life.     

Population data and genetic characteristics of 12 X-STR loci using the Investigator® Argus X-12 Quality Sensor kit for the Kedayan population of Borneo in Malaysia

International Journal of Legal Medicine - DNA profiling of X-chromosomal short tandem repeats (X-STR) has exceptional value in criminal investigations, especially for complex kinship and incest...     

Can Near-infrared Spectroscopy Detect and Differentiate Implant-associated Biofilms?

Background

Established bacterial diagnostic techniques for orthopaedic-related infections rely on a combination of imperfect tests that often can lead to negative culture results. Spectroscopy is a tool that potentially could aid in rapid detection and differentiation of bacteria in implant-associated infections.

Questions/purposes

We asked: (1) Can principal component analysis explain variation in spectral curves for biofilm obtained from Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa? (2) What is the accuracy of Fourier transformed-near infrared (FT-NIR)/multivariate data analysis in identifying the specific species associated with biofilm?

Methods

Three clinical isolates, S aureus, S epidermidis, and P aeruginosa were cultured to create biofilm on surgical grade stainless steel. At least 52 samples were analyzed per group using a FT-NIR spectrometer. Multivariate and principal component analyses were performed on the spectral data to allow for modeling and identification of the bacterial species.

Results

Spectral analysis was able to correctly identify 86% (37/43) of S aureus, 89% (16/18) of S epidermidis, and 70% (28/40) of P aeruginosa samples with minimal error. Overall, models developed using spectral data preprocessed using a combination of standard normal variant and first-derivative transformations performed much better than models developed with the raw spectral data in discriminating between the three classes of bacteria because of its low Type 1 error and large intermodel distinction.

Conclusions

The use of spectroscopic methods to identify and classify bacterial biofilms on orthopaedic implant material is possible and improves with advanced modeling that can be obtained rapidly with little error. The sensitivity for identification was 97% for S aureus (95% CI, 88-99%), 100% for S epidermidis (95% CI, 95–100%), and 77% for P aeruginosa (95% CI, 65–86%). The specificity of the S aureus was 86% (95% CI, 3–93%), S epidermidis was 89% (95% CI, 67–97%), and P aeruginosa was 70% (95% CI, 55–82%).

Clinical Relevance

This technique of spectral data acquisition and advanced modeling should continue to be explored as a method for bacterial biofilm identification. A spectral databank of bacterial and potentially contaminating tissues should be acquired initially through an in vivo animal model and quickly transition to explanted devices and the clinical arena.