Background: Acute ischemic stroke is one of the leading causes of disability and mortality globally, with increasing incidence in Africa, as the continent is already burdened with infectious diseases. Rapid diagnosis and efficient treatment are crucial, as even a slight delay to reperfuse the brain significantly affects the recovery outcome. Neuroimaging is vital for optimal care and thrombolytic or endovascular therapy in specialised stroke care units. This review aims to discuss the burden of acute ischemic stroke in Africa and how healthcare systems have tried to reduce the incidence and improve outcomes for the disease. Methodology: Data was collected from online databases and medical journal published on PubMed, Ovid MEDLINE, ScienceDirect and Embase bibliographical data. All articles related to acute ischemic stroke in Africa were considered. Results: The medical care for acute ischemic stroke in Africa is far from optimal with little adherence to recommended protocols. There is a lack of public awareness of the disease, imaging infrastructure, personnel, stroke care units and recovery facilities, due to poor funding. Poor knowledge of stroke signs and symptoms results in delay in treatment and poor prognosis. Conclusion: We urge African leaders and private entities to invest in stroke care by building appropriate infrastructures, providing medical equipments, implementing guidelines, and sustainable follow-up systems. Telehealth is a suggested strategy to mitigate the scarcity of health personnel, and international and national efforts to increase treatment affordability should be doubled. Further extensive research on the impact of acute ischemic stroke on the African continent population is encouraged.
Background Paralympic swimmers with vision impairment (VI) currently compete in one of the three classes depending on their visual acuity (VA) and/or visual field. However, there is no evidence to suggest that a three-class system is the most legitimate approach for classification in swimming, or that the tests of VA and visual field are the most suitable. An evidence-based approach is required to establish the relationship between visual function and performance in the sport. Therefore, the aim of this study was to establish the relationship between visual function and performance in VI Para swimming. The swimming performance of 45 elite VI swimmers was evaluated during international competitions by measuring the total race time, start time, clean swim velocity, ability to swim in a straight line, turn time, and finish time. Visual function was measured using a test battery that included VA, contrast sensitivity, light sensitivity, depth perception, visual search, and motion perception. Results Results revealed that VA was the best predictor of total race time ( r = 0.40, p < 0.01), though the relationship was not linear. Decision tree analysis suggested that only two classes were necessary for legitimate competition in VI swimming, with a single cut-off between 2.6 and 3.5 logMAR. No further significant association remained between visual function and performance in either of the two resulting classes (all | r s|< 0.11 and p s > 0.54). Conclusions Results suggest that legitimate competition in VI swimming requires one class for partially sighted and another for functionally blind athletes.
Background Current pharmacologic prophylactic strategies for migraine have exhibited limited efficacy, with response rates as low as 40%–50%. In addition to the limited efficacy, the acceptability of those pharmacologic prophylactic strategies were unacceptable. Although noninvasive brain/nerve stimulation strategies may be effective, the evidence has been inconsistent. The aim of this network meta-analysis (NMA) was to compare strategies of noninvasive brain/nerve stimulation for migraine prophylaxis with respect to their effectiveness and acceptability. Methods The PubMed, Embase, ScienceDirect, ProQuest, ClinicalTrials.gov , ClinicalKey, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov databases were systematically searched to date of June 4th, 2021 for randomized controlled trials (RCTs). Patients with diagnosis of migraine, either episodic migraine or chronic migraine, were included. All NMA procedures were conducted under the frequentist model. Results Nineteen RCTs were included ( N = 1493; mean age = 38.2 years; 82.0% women). We determined that the high frequency repetitive transcranial magnetic stimulation (rTMS) over C3 yielded the most decreased monthly migraine days among all the interventions [mean difference = − 8.70 days, 95% confidence intervals (95%CIs): − 14.45 to − 2.95 compared to sham/control groups]. Only alternating frequency (2/100 Hz) transcutaneous occipital nerve stimulation (tONS) over the Oz (RR = 0.36, 95%CIs: 0.16 to 0.82) yielded a significantly lower drop-out rate than the sham/control groups did. Conclusions The current study provided a new direction for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on migraine prophylaxis in participants with migraine by different noninvasive brain/nerve stimulation, especially the application of rTMS and tONS. Trial registration CRD42021252638. The current study had been approval by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).
Background In recent years there has been an increased focus on the role of large herbivores in ecosystem restoration and climate change mitigation. There are multiple processes by which large herbivores could potentially influence climate feedback and forcing effects, but the evidence has not yet been synthesised in a systematic and accessible format. Grazing, browsing, trampling, defecation, and seed dispersal by large herbivores can influence vegetation and soils in ways that may directly or indirectly contribute to climate change or mitigation. For example, changes in vegetation could impact wildfire regimes, carbon storage, and albedo, with ultimate impacts on climate. These processes may be influenced by herbivore species composition, density, and functional traits. The main aim of this systematic map is to synthesise the range of research on climate feedback and forcing effects from large herbivores (≥ 10 kg) in terrestrial ecosystems. We also aim to identify knowledge clusters and gaps in the research base, as well as assessing the potential for quantitative analyses. Methods A search of peer-reviewed and grey literature will be conducted using a range of bibliographic databases, search engines and websites. The search strategy will involve using a pre-defined search string with Boolean operators. All search results will be screened for relevance according to specific eligibility criteria. Screening will be conducted in two stages: all articles will initially be screened by title and abstract, then those that meet the eligibility criteria will be screened by full text. At both stages, articles will be excluded if they don’t meet all eligibility criteria or if they meet any exclusion criteria. All articles included as eligible after full text screening will be coded. At each stage (of screening and coding) a proportion of articles will be processed independently by two reviewers to assess inter-reviewer reliability and resolve differences. The evidence will be presented in a searchable database with accompanying visual outputs. A narrative synthesis will be provided outlining the range and distribution of evidence, knowledge gaps and clusters, potential bias, and areas for further research.
This study seeks to extend the variety of written methods used in sport and exercise research by outlining the use of a novel written technique for data collection: ‘a letter to my younger self’. The use of solicited letter writing has long been endorsed as a valuable technique as part of the therapeutic process, but has yet to be considered as a method of collecting qualitative data. In this study, 21 participants who had experienced chronic pain while playing sport were invited to write a letter back to their younger self. A dialogical narrative analysis was used to analyse the written letters and our results are presented in two forms. First, a ‘collective letter’, written using amalgamated participant quotations. Second, an accompanying commentary which illustrates the characterisations, structure, and narrative themes that were evident in the data collected. Our findings extend existing knowledge of chronic pain in sport, contrasting previous literature that has presented degenerative stories. Further, we also illuminate the danger of the performance narrative in privileging personal agency and the risks this poses to receiving support during chronic pain. We conclude by challenging researchers to consider the importance that should be attributed to hindsight and the value of re-describing experiences with wisdom and knowledge of the significance of the past.
Tumour necrosis factor receptor 2 or TNFR2 is considered an appealing target protein due to its limited frequency to TREGs, which are highly immunosuppressive and present on human malignancies. Numerous studies have revealed that TNFR2 is primarily found on MDSCs (myeloid-derived suppressor cells) and CD + Foxp3 + regulatory T cells (TREGs). Therefore, it has great importance in the proliferation and functional activity of TREGs and MDSCs. TNFR2 suppression must be downregulated or upregulated as required to treat malignancies and diseases like autoimmune disorders. Therefore, at the molecular level, advances in the comprehension of TNFR2's complex structure and its binding to TNF have opened the door to structure-guided drug development. Two critical obstacles to cancer treatment are the dearth of TREG-specific inhibitors and the lack of widely applicable ways to target tumours via frequently expressed surface oncogenes directly. Many researchers have discovered potential antagonists and agonists of TNFR2, which were successful in inhibiting TREGs proliferation, reducing soluble TNFR2 secretion from normal cells, and expanding T effector cells. The data represented in the following review article elucidates the clinically administrated TNFR2 antagonist and agonist in treating cancers.
Recently, nanotechnology is involved in various fields of science, of which medicine is one of the most obvious. The use of nanoparticles in the process of treating and diagnosing diseases has created a novel way of therapeutic strategies with effective mechanisms of action. Also, due to the remarkable progress of personalized medicine, the effort is to reduce the side effects of treatment paths as much as possible and to provide targeted treatments. Therefore, the targeted delivery of drugs is important in different diseases, especially in patients who receive combined drugs, because the delivery of different drug structures requires different systems so that there is no change in the drug and its effectiveness. Niosomes are polymeric nanoparticles that show favorable characteristics in drug delivery. In addition to biocompatibility and high absorption, these nanoparticles also provide the possibility of reducing the drug dosage and targeting the release of drugs, as well as the delivery of both hydrophilic and lipophilic drugs by Niosome vesicles. Since various factors such as components, preparation, and optimization methods are effective in the size and formation of niosomal structures, in this review, the characteristics related to niosome vesicles were first examined and then the in silico tools for designing, prediction, and optimization were explained. Finally, anticancer drugs delivered by niosomes were compared and discussed to be a suitable model for designing therapeutic strategies. In this research, it has been tried to examine all the aspects required for drug delivery engineering using niosomes and finally, by presenting clinical examples of the use of these nanocarriers in cancer, its clinical characteristics were also expressed.
Malignant neoplasm is one of the most incurable diseases among inflammatory diseases. Researchers have been studying for decades to win over this lethal disease and provide the light of hope to humankind. The gastrointestinal bacteria of human hold a complex ecosystem and maintain homeostasis. One hundred trillion microbes are residing in the gastrointestinal tract of human. Disturbances in the microbiota of human’s gastrointestinal tract can create immune response against inflammation and also can develop diseases, including cancer. The bacteria of the gastrointestinal tract of human can secrete a variety of metabolites and bioproducts which aid in the preservation of homeostasis in the host and gut. During pathogenic dysbiosis, on the other hand, numerous microbiota subpopulations may increase and create excessive levels of toxins, which can cause inflammation and cancer. Furthermore, the immune system of host and the epithelium cell can be influenced by gut microbiota. Probiotics, which are bacteria that live in the gut, have been protected against tumor formation. Probiotics are now studied to see if they can help fight dysbiosis in cancer patients undergoing chemotherapy or radiotherapy because of their capacity to maintain gut homeostasis. Countless numbers of gut bacteria have demonstrated anti-cancer efficiency in cancer treatment, prevention, and boosting the efficiency of immunotherapy. The review article has briefly explained the anti-cancer immunity of gut microbes and their application in treating a variety of cancer. This review paper also highlights the pre-clinical studies of probiotics against cancer and the completed and ongoing clinical trials on cancers with the two most common and highly effective probiotics Lactobacillus and Bacillus spp.
Data collection in qualitative research is intended to capture the participant experience in relation to defined phenomena. Whilst attention is given to the different ways of gathering qualitative data, the presence of the researcher is a common feature. However, the researcher does not hold an inert position in the data collection process and may influence the type and level of data obtained. This paper highlights and explores the issue of researcher presence by suggesting a strategy to distance the researcher from the data collection frame via self-governing focus groups. Developed in a study examining vocational student experience in further education, a data collection method is proposed which aims to reduce the influencing factor of the researcher. A self-administered structured question schedule replaces the interviewer to promote authentic access to the participant voice in an environment which is familiar, comfortable and safe. Consideration is given to the construction of the question schedule and recording procedure which aims to stimulate inclusive and unhindered contributions, as well as maintaining the research focus. The analysis of contributions indicates that by standing back, the researcher can see authentic customary social processes which reveal a meaning of the phenomena for the participants.
In this reply to Thaler (2022), we take the opportunity to discuss two main aspects from his piece to continue the discussion: 1) the integration of social and natural sciences data, and 2) the importance of transdisciplinary research. We agree, and highlight that necessary learning, reflections and participation processes are time-intensive for researchers, practitioners and participants. We believe that these discussion pieces are important for informing, engaging, and debating challenges and practices, providing continued opportunities to learn from one another, enabling new forms of research and collaborations to flourish.
Counterfeiting has become a prevalent business worldwide, resulting in high losses for many businesses. Considerable attention has been paid to research an individual attitude toward purchasing luxury counterfeit products in the offline context. However, there is currently lesser-known literature on the given phenomenon in the context of social commerce. Moreover, researchers observed that counterfeiting consumption is associated with consumer ethical values or beliefs. Practitioners and researchers are keen to find those factors that affect consumers’ ethical consumption behavior to reduce pirated products’ demand. However, the role of religion in shaping ethical behavior is less documented in the counterfeiting context. Therefore, this study investigated the effect of religiosity on the counterfeiting of luxury products in Pakistan. A five-dimensional Islamic religiosity model was adopted to understand the consumption phenomena. For quantitative research, cross-sectional data were collected from the generation M of Pakistan through self-administrative questionnaires. A total of 394 valid responses from active online users were collected to empirically examine the conceptual model by employing the partial least square structural equation model (PLS-SEM). The results reveal that all five dimensions of religiosity negatively affect the attitude of generation M. Moreover, it is found that knowledge has the highest negative effect on attitude, followed by orthopraxis, experience, central duties, and basic duties. The study also explains the theoretical and practical implications of the research. Finally, limitations and future research were also discussed.
In low-income countries tetanus is a major public health concern owing to a low immunization coverage and unclean birth practices. Although it is a vaccine-preventable disease, tetanus can be contracted across the life course. The disease is prevalent and harmful in newborn babies and their mothers when the mothers` are unvaccinated against tetanus. We report on a case of a 12-year-old girl who presented with general malaise, anorexia, dysphagia, trismus and dehydration, which rapidly developed into severe generalized tetanus and was successfully managed in a low-resource setting without the availability of human anti-tetanus immunoglobulins.
Lack of laboratory staff was an important obstacle in scaling up covid-19 testing. Jordan Skittrall and colleagues consider how we can be better prepared in future.
Purpose Little is known about the impact of osteoarthritis on the long-term work participation of working-age adults. Therefore, the goal of this study was to investigate the prevalence of and the factors associated with long-term sick leave in people newly diagnosed with osteoarthritis from Germany. Methods This retrospective cohort study included patients aged 18–65 years diagnosed with osteoarthritis for the first time (index date) in 1 of 1198 general practices in Germany between 2016 and 2019 (Disease Analyzer database, IQVIA). Patients were considered to be on long-term sick leave if they were absent from work for medical reasons for more than 42 days in the year following the index date. Independent variables included sociodemographic characteristics, type of osteoarthritis, and frequent comorbidities. The association between these variables and long-term sick leave (dependent variable) was studied using an adjusted logistic regression model. Results This study included 51,034 patients with osteoarthritis [mean (standard deviation) age 50.8 (9.2) years; 50.9% women]. The prevalence of long-term sick leave was 36.2%. Younger age and male sex were positively and significantly associated with long-term sick leave compared with older age and female sex, respectively. There was also a strong relationship between several comorbidities (e.g., reaction to severe stress, and adjustment disorders, gastritis and duodenitis, and depression) with long-term sick leave. Conclusions The prevalence of long-term sick leave was high in this sample of patients newly diagnosed with osteoarthritis from Germany. In this context, interventions should be implemented to increase the long-term working participation of people with osteoarthritis.
Pregnancy is a time of great physical and psychological change. As well as prominent changes in the external appearance of the body, such as the baby bump, there are also substantial changes taking place within the body. Our awareness of, and attention towards, internal bodily signals (interoception) is thought to have a direct impact on how we feel about our bodies. Therefore, understanding how our experience of these interoceptive signals might change during pregnancy may have important implications for maternal wellbeing. This study examined body satisfaction and interoceptive sensibility (subjective experience of interoception) in pregnant and non-pregnant women with and without children. Feelings towards pregnancy-specific changes in body satisfaction and interoceptive sensibility were also examined in women in their first pregnancy (primigravida) and subsequent pregnancies (multigravida). It was found that pregnancy did not directly impact levels of body satisfaction, instead pregnant and non-pregnant women with children reported less satisfaction with their bodies compared to those without children. Primigravida women were more satisfied with the appearance of pregnancy specific bodily changes compared to multigravida women. Interestingly, these differences in body satisfaction in those with children (pregnant and non-pregnant) were mediated by the extent to which women trusted their bodies (measure of interoceptive sensibility). All other pregnancy related changes in interoceptive sensibility and body satisfaction were either non-significant or had small effect sizes. These results may suggest body trust as an important factor to support during the transition to parenthood in order to improve body satisfaction in mothers.
Background: A James Lind Alliance Priority Setting Partnership (JLAPSP) was established by FifthSense to identify the top 10 research questions in the field of smell and taste disorders in the United Kingdom. Methods: After steering group was established, an electronic survey was disseminated to all stakeholders (patients, healthcare professionals, family, carers, researchers) to determine the list of questions. After removing out-of-scope responses, the remainder were consolidated to create summary questions. A literature search was conducted to remove already answered questions. A second survey was used to determine the top questions that formed the subject of final debate at a workshop attended by clinicians and patients to determine the top 10 priorities. Results: The 665 respondents to the initial survey provided 1698 research questions. Thirteen were out-of-scope and removed; remaining 1685 were then consolidated to form 147 summary questions. Following literature search and discussion with the steering group, 37 questions remained for the second survey, which 235 people responded. The top ten priorities agreed upon in the workshop covered themes of improved understanding of pathophysiologlogy, improving health services, and managing long-term effects of smell/taste disorders. The most important research question agreed was "How can we further our understanding of the mechanism of disease in the nerve pathways that affect smell and taste disorders, including where parosmia and phantosmia exist." Conclusions: We report the top 10 research priorities in smell and taste disorders. These priorities will now empower researchers to secure research funding and provide the basis of the Fifth Sense research hub.
Objective The United Nations' Sustainable Development Goals (SDGs) require population-based data on children with disabilities to inform global policies and intervention programs. We set out to compare the prevalence estimates of disabilities among children and adolescents younger than 20 years as reported by the world's leading organizations for global health statistics. Methods We purposively searched the disability reports and databases of the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), the World Bank and the Global Burden of Diseases (GBD) Study. We analyzed the latest disability data reported by these organizations since 2015. We examined the methodologies adopted in generating the reported prevalence estimates and evaluated the degree of agreement among the data sources using Welch's test of statistical difference, and the two one-sided t- test (TOST) for statistical equivalence. Results Only UNICEF and GBD provided the most comprehensive prevalence estimates of disabilities in children and adolescents. Globally, UNICEF estimated that 28.9 million (4.3%) children aged 0–4 years, 207.4 million (12.5%) children aged 5–17 years and 236.4 million (10.1%) children aged 0–17 years have moderate-to-severe disabilities based on household surveys of child functional status. Using the UNICEF estimated prevalence of 10.1%, approximately 266 million children aged 0–19 years are expected to have moderate-to-severe disabilities. In contrast, GBD 2019 estimated that 49.8 million (7.5%) children aged under-5 years, 241.5 million (12.6%) children aged 5–19 years and 291.3 million (11.3%) children younger than 20 years have mild-to-severe disabilities. In both databases, Sub-Saharan Africa and South Asia accounted for more than half of children with disabilities. A comparison of the UNICEF and GBD estimates showed that the overall mean prevalence estimates for children under-5 years were statistically different and not statistically equivalent based on ±3 percentage-point margin. However, the prevalence estimates for children 5–19 years and < 20 years were not statistically different and were statistically equivalent. Conclusion Prevalence estimates of disabilities among children and adolescents generated using either functional approach or statistical modeling appear to be comparable and complementary. Improved alignment of the age-groups, thresholds of disability and the estimation process across databases, particularly among children under-5 years should be considered. Children and adolescents with disabilities will be well-served by a variety of complementary data sources to optimize their health and well-being as envisioned in the SDGs.
Aim The aim of the present study is to determine target hemoglobin (Hgb) values in older females and males with chronic kidney disease (CKD) according to best performance in mood, gait and balance, muscle strength and activities of daily living, which are important parameters of geriatric assessment. Method Patients’ age, gender, education level, and comorbidities were recorded. All the participants underwent comprehensive geriatric assessment (CGA) including Basic and Instrumental Activities of Daily Living for functional evaluation, Tinetti Performance-Oriented Assessment of Mobility and Timed Up and Go Test for fall risk, and hand grip strength for muscle strength. Hgb levels and kidney functions were analyzed on the same day as CGA measurements. Receiver Operating Characteristic (ROC) analysis was used to detect the optimum level of Hgb according to the best performance of CGA parameters. Results 622 elderly CKD patients (69.3% female, 55.7% with anemia) were included. After adjustment for confounders, those with anemia had dynapenia (OR 1.60), high risk of falls (OR 1.60), and decreased functional capacity (OR 1.83) among females and those with anemia had dynapenia (OR 4.31), a high risk of falling (OR 2.42) and decreased functional capacity (OR 2.94) among males. The optimum value of Hgb level is 11.8–12.1 in females and 12.6–12.8 in males according to ROC analysis. Conclusion Anemia is associated with dynapenia, high risk of falls, and decreased functional capacity in older CKD patients regardless of genericity. To prevent these negative outcomes, Hgb should be kept in the range of 11.8–12.1 in older females with CKD and 12.6–12.8 in older males with CKD.
This book examines representations of the nation found within contemporary British cinema against a backdrop of rising political tensions and deepening social divisions following the ‘Brexit’ referendum of 23 June 2016. It offers an exploration of the ways in which the contest of ideologies always at work within media representation have played out post-2016. The focus is on historical and contemporary drama films. Contemporary British Cinema and a Divided Nation analyses a nation’s contested understandings of its past, present and future, probing the various ways recent mainstream films have approached the concept of nationhood. Consideration is given to whether there might be seen to be a new, or renewed, emphasis on the competing ideological perspectives that confront each other around the issue of nationalism. Is what we see, the negotiation of a new relationship with the world for a new age, or simply a re-iteration of a long-standing British, or English, understanding of national identity? A crucial aspect of this approach is necessarily an assessment of the relative importance of this issue in relation to other socio-economic concerns found in the films under discussion. Each of the central focus films considered completed production after the referendum of 2016. Earlier British films act as points of comparison but, generally, will not be analysed in depth.
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