Publications by authors named "John O"

135 Publications

Mouse experiments demonstrate differential pathogenicity and virulence of Trypanosoma brucei rhodesiense strains.

Exp Parasitol 2021 Jul 17:108135. Epub 2021 Jul 17.

Department of Biochemistry and Molecular Biology, Egerton University, P. O Box, 536-20115, Egerton, Kenya; International Centre of Insect Physiology and Ecology, P. O Box, 30772-000100, Nairobi, Kenya. Electronic address:

Trypanosoma brucei rhodesiense is the causative agent for Rhodesian human African trypanosomiasis. The disease is considered acute, but varying clinical outcomes including chronic infections have been observed. The basis for these different clinical manifestations is thought to be associated with a combination of parasite and host factors. In the current study, Trypanosoma brucei rhodesiense strains responsible for varying infection outcomes were sought using mouse model. Clinical rHAT parasite isolates were subjected to PCR tests to confirm presence of the serum resistance associated (SRA) gene. Thereafter, four T. b. rhodesiense isolates were subjected to a comparative pathogenicity study using female Swiss white mice; the parasite strains were compared on the basis of parasitaemia, host survival time, clinical and postmortem biomarkers of infection severity. Isolates identified to cause acute and chronic disease were compared for establishment in insect vector, tsetse fly. The mouse survival time was significantly different (Log-rankp = 0.0001). With mice infected with strain KETRI 3801 exhibiting the shortest survival time (20 days) as compared to those infected with KETRI 3928 that, as controls, survived past the 60 days study period. In addition, development of anaemia was rapid in KETRI 3801 and least in KETRI 3928 infections, and followed the magnitude of survival time. Notably, hepatosplenomegaly was pronounced with longer survival. Mouse weight and feed intake reduced (KETRI 3801 > KETRI 2636 > EATRO 1762) except in KETRI 3928 infections which remained similar to controls. Comparatively, acute to chronic infection outcomes is in the order of KETRI 3801 > KETRI 2636 > EATRO 1762 > KETRI 3928, indicative of predominant role of strain dependent factors. Further, KETRI 3928 strain established better in tsetse as compared to KETRI 3801, suggesting that transmission of strains causing chronic infections could be common. In sum, we have identified Trypanosoma brucei rhodesiense strains that cause acute and chronic infections in mice, that will be valuable in investigating pathogen - host interactions responsible for varying disease outcomes and transmission in African trypanosomiasis.
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http://dx.doi.org/10.1016/j.exppara.2021.108135DOI Listing
July 2021

Bioactive compounds, health benefits, and industrial applications of Tartary buckwheat ().

Crit Rev Food Sci Nutr 2021 Jul 19:1-17. Epub 2021 Jul 19.

Department of Analytical Chemistry and Food Science, Faculty of Food Science and Technology, University of Vigo - Ourense Campus, Ourense, Spain.

Tartary buckwheat belongs to the family Polygonaceae, which is a traditionally edible and medicinal plant. Due to its various bioactive compounds, the consumption of Tartary buckwheat is correlated to a wide range of health benefits, and increasing attention has been paid to its potential as a functional food. This review summarizes the main bioactive compounds and important bioactivities and health benefits of Tartary buckwheat, emphasizing its protective effects on metabolic diseases and relevant molecular mechanisms. Tartary buckwheat contains a wide range of bioactive compounds, such as flavonoids, phenolic acids, triterpenoids, phenylpropanoid glycosides, bioactive polysaccharides, and bioactive proteins and peptides, as well as D-chiro-inositol and its derivatives. Consumption of Tartary buckwheat and Tartary buckwheat-enriched products is linked to multiple health benefits, , antioxidant, anti-inflammatory, antihyperlipidemic, anticancer, antidiabetic, antiobesity, antihypertensive, and hepatoprotective activities. Especially, clinical studies indicate that Tartary buckwheat exhibits remarkable antidiabetic activities. Various tartary buckwheat -based foods presenting major health benefits as fat and blood glucose-lowering agents have been commercialized. Additionally, to address the safety concerns, , allergic reactions, heavy metal and mycotoxin contaminations, the quality control standards for Tartary buckwheat and its products should be drafted and completed in the future.
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http://dx.doi.org/10.1080/10408398.2021.1952161DOI Listing
July 2021

Challenges and prospects in india's digital health journey.

Indian J Public Health 2021 Apr-Jun;65(2):209-212

Senior Research Fellow, George Institute of Global Health, University of New South Wales, New Delhi, India, Prasanna School of Public Health, MAHE, Manipal, India.

India's journey in the digital health arena and its contribution to the landmark resolution on digital health by the World Health Organization has been recognized globally. India has demonstrated its commitment to leverage digital health as a health system strengthening intervention, as outlined in the National Digital Health Blueprint based on which, the National Digital Health Mission (NDHM) is currently being piloted by the National health authority. Further, the Sandbox environment of NDHM is actively encouraging all the ecosystem partners to familiarize with the evolving national digital health infrastructure. The strategy to enhance the India's progress in implementation and scale-up of digital health interventions are drawing attention to workforce capacity building, harnessing health data to facilitate research and development, evidence-informed development of policies, sustaining efficiency and quality of system through appropriate monitoring, and periodic evaluation informed by frameworks specific to digital health or those adapted to evaluate health informatics applications.
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http://dx.doi.org/10.4103/ijph.IJPH_1446_20DOI Listing
June 2021

Low-value medical care in the pandemic-is this what the doctor ordered?

Lancet Glob Health 2021 Jun 2. Epub 2021 Jun 2.

George Institute for Global Health, New Delhi 110025, India; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; School of Public Health, Imperial College, London, UK. Electronic address:

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http://dx.doi.org/10.1016/S2214-109X(21)00252-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172144PMC
June 2021

Genetic diversity and population structure of Plasmodium falciparum in Nigeria: insights from microsatellite loci analysis.

Malar J 2021 May 26;20(1):236. Epub 2021 May 26.

African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Nigeria.

Background: Malaria remains a public health burden especially in Nigeria. To develop new malaria control and elimination strategies or refine existing ones, understanding parasite population diversity and transmission patterns is crucial.

Methods: In this study, characterization of the parasite diversity and structure of Plasmodium falciparum isolates from 633 dried blood spot samples in Nigeria was carried out using 12 microsatellite loci of P. falciparum. These microsatellite loci were amplified via semi-nested polymerase chain reaction (PCR) and fragments were analysed using population genetic tools.

Results: Estimates of parasite genetic diversity, such as mean number of different alleles (13.52), effective alleles (7.13), allelic richness (11.15) and expected heterozygosity (0.804), were high. Overall linkage disequilibrium was weak (0.006, P < 0.001). Parasite population structure was low (Fst: 0.008-0.105, AMOVA: 0.039).

Conclusion: The high level of parasite genetic diversity and low population structuring in this study suggests that parasite populations circulating in Nigeria are homogenous. However, higher resolution methods, such as the 24 SNP barcode and whole genome sequencing, may capture more specific parasite genetic signatures circulating in the country. The results obtained can be used as a baseline for parasite genetic diversity and structure, aiding in the formulation of appropriate therapeutic and control strategies in Nigeria.
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http://dx.doi.org/10.1186/s12936-021-03734-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152046PMC
May 2021

The Big Five Inventory-2 in China: A Comprehensive Psychometric Evaluation in Four Diverse Samples.

Assessment 2021 Apr 22:10731911211008245. Epub 2021 Apr 22.

University of California, Berkeley, CA, USA.

The Big Five Inventory-2 (BFI-2) has received wide recognition since its publication because it strikes a good balance between content coverage and brevity. The current study translated the BFI-2 into Chinese, evaluated its psychometric properties in four diverse Chinese samples (college students, adult employees, adults treated for substance use, and adolescents), and compared its factor structure with those obtained from two U.S. samples. Across two studies, the Chinese BFI-2 demonstrated good reliability (Cronbach's α and test-retest reliability), structural validity, convergent/discriminant validity, and criterion-related validity at the domain level. At lower levels of analyses, some facets and negatively worded items functioned better among participants with higher than those with lower education levels. Implications, limitations, and future directions are discussed.
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http://dx.doi.org/10.1177/10731911211008245DOI Listing
April 2021

Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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http://dx.doi.org/10.1055/s-0041-1726484DOI Listing
April 2021

"I feel you": Greater linkage between friends' physiological responses and emotional experience is associated with greater empathic accuracy.

Biol Psychol 2021 04 13;161:108079. Epub 2021 Mar 13.

University of California, Berkeley, United States.

How do people come to know others' feelings? One idea is that affective processes (e.g., physiological responses) play an important role, leading to the prediction that linkage between one's physiological responses and others' emotions relates to one's ability to know how others feel (i.e., empathic accuracy). Participants (N = 96, 48 female friend pairs) completed a stressful speech task and then provided continuous ratings of their own (as "targets") and their friend's (as "perceivers") emotional experience for the video-taped speeches. We measured physiology-physiology linkage (linkage between perceivers' and targets' physiology), physiology-experience linkage (linkage between perceivers' physiology and targets' experience), and empathic accuracy (linkage between perceivers' ratings of targets' experience and targets' ratings of their experience). Physiology-experience (but not physiology-physiology) linkage was associated with greater empathic accuracy even when controlling for key potential confounds (random linkage, targets' and perceivers' emotional reactivity, and relationship closeness). Results suggest that physiological responses play a role in empathic accuracy.
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http://dx.doi.org/10.1016/j.biopsycho.2021.108079DOI Listing
April 2021

Continuum of care for non-communicable diseases during COVID-19 pandemic in rural India: A mixed methods study.

J Family Med Prim Care 2020 Dec 31;9(12):6012-6017. Epub 2020 Dec 31.

George Institute for Global Health, UNSW, New Delhi, India.

Background: COVID-19 pandemic has resulted in disruption to routine health services delivery as strict lockdowns were implemented in India and health workforce redeployed for COVID-19 focused responses. We assess the perceptions about COVID-19, the impact of the lockdown on access to health services and continuum of care for Non-communicable diseases (NCDs) among a cohort of adults in rural India.

Methodology: Since 2018, we have been following up a cohort of persons with non-communicable diseases in a high NCD burden region in Srikakulam District of Andhra Pradesh under the STOP CKDu study. We conducted this mixed methods study, administered through a structured telephonic questionnaire and interview to determine the awareness, perceptions and their compliance to ongoing treatment schedules.

Results: Overall, 68% of the participants exhibited adequate knowledge of symptoms of COVID-19, while 43% were not aware of the mode of transmission of the virus. In all, 822 (36.1%) participants reported at least one NCD condition. Among them, 115 (14%) missed their follow-up visit, 110 (13.4%) reported facing challenges in medication procurement and 11.6% either developed new complaints or experienced worsening of pre-existing symptoms. A total of 233 (28.5%) used a telemedicine facility and took telephonic advice from (private) physicians. As the access to medicines was restricted due to the lockdown, majority of the respondents were depending on rural medical practitioners (RMPs) for the procurement of medication.

Conclusion: Our finding implies the need for the future guidelines on adaptation of telehealth approaches within health systems to maintain the continuum of care, digital health tools to facilitate the patient's appointments including virtual follow-up visits for those with NCDs coupled with regular engagement by frontline healthcare workers at the local levels, evidence informed public health messaging taking into consideration the social and behavioural aspect and uninterrupted essential primary healthcare services.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1805_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928131PMC
December 2020

Higher vs lower doses of dexamethasone in patients with COVID-19 and severe hypoxia (COVID STEROID 2) trial: Protocol and statistical analysis plan.

Acta Anaesthesiol Scand 2021 Jul 9;65(6):834-845. Epub 2021 Mar 9.

Department of Anaesthesia and Critical Care Medicine, Odense University Hospital, Odense C, Denmark.

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of deaths and overburdened healthcare systems worldwide. Systemic low-dose corticosteroids have proven clinical benefit in patients with severe COVID-19. Higher doses of corticosteroids are used in other inflammatory lung diseases and may offer additional clinical benefits in COVID-19. At present, the balance between benefits and harms of higher vs. lower doses of corticosteroids for patients with COVID-19 is unclear.

Methods: The COVID STEROID 2 trial is an investigator-initiated, international, parallel-grouped, blinded, centrally randomised and stratified clinical trial assessing higher (12 mg) vs. lower (6 mg) doses of dexamethasone for adults with COVID-19 and severe hypoxia. We plan to enrol 1,000 patients in Denmark, Sweden, Switzerland and India. The primary outcome is days alive without life support (invasive mechanical ventilation, circulatory support or renal replacement therapy) at day 28. Secondary outcomes include serious adverse reactions at day 28; all-cause mortality at day 28, 90 and 180; days alive without life support at day 90; days alive and out of hospital at day 90; and health-related quality of life at day 180. The primary outcome will be analysed using the Kryger Jensen and Lange test adjusted for stratification variables and reported as adjusted mean differences and median differences. The full statistical analysis plan is outlined in this protocol.

Discussion: The COVID STEROID 2 trial will provide evidence on the optimal dosing of systemic corticosteroids for COVID-19 patients with severe hypoxia with important implications for patients, their relatives and society.
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http://dx.doi.org/10.1111/aas.13795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014264PMC
July 2021

Higher vs Lower Doses of Dexamethasone in Patients with COVID-19 and Severe Hypoxia (COVID STEROID 2) trial: Protocol for a secondary Bayesian analysis.

Acta Anaesthesiol Scand 2021 05 25;65(5):702-710. Epub 2021 Feb 25.

Department of Anaesthesia and Critical Care Medicine, Odense University Hospital, Odense C, Denmark.

Background: Coronavirus disease 2019 (COVID-19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID-19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs lower doses of dexamethasone (12 vs 6 mg intravenously daily for up to 10 days) in 1,000 adult patients with COVID-19 and severe hypoxia.

Methods: This protocol outlines the rationale and statistical methods for a secondary, pre-planned Bayesian analysis of the primary outcome (days alive without life support at day 28) and all secondary outcomes registered up to day 90. We will use hurdle-negative binomial models to estimate the mean number of days alive without life support in each group and present results as mean differences and incidence rate ratios with 95% credibility intervals (CrIs). Additional count outcomes will be analysed similarly and binary outcomes will be analysed using logistic regression models with results presented as probabilities, relative risks and risk differences with 95% CrIs. We will present probabilities of any benefit/harm, clinically important benefit/harm and probabilities of effects smaller than pre-defined clinically minimally important differences for all outcomes analysed. Analyses will be adjusted for stratification variables and conducted using weakly informative priors supplemented by sensitivity analyses using sceptic priors.

Discussion: This secondary, pre-planned Bayesian analysis will supplement the primary, conventional analysis and may help clinicians, researchers and policymakers interpret the results of the COVID STEROID 2 trial while avoiding arbitrarily dichotomised interpretations of the results.

Trial Registration: ClinicalTrials.gov: NCT04509973; EudraCT: 2020-003363-25.
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http://dx.doi.org/10.1111/aas.13793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014670PMC
May 2021

Ten-year experience with staged management of pectus carinatum: Results and lessons learned.

J Pediatr Surg 2021 Jan 27. Epub 2021 Jan 27.

Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Departments of Surgery and Pediatrics, Eastern Virginia Medical School.

Introduction: We report pectus carinatum management over a 10+year period.

Methods: Staged management, with initial bracing and operation for failure or special circumstances, was employed. A newer brace and a minimally invasive operation for PC (the Abramson procedure) were introduced during the study period.

Results: Of 695 consenting patients from 2008 to 2018, 265 (38%) were observed. Of 430 treated, 339 (79%) had bracing only; 65 (15%) underwent surgery without a trial of bracing, while 26(5%) underwent surgery after a failed attempt at bracing. Of 364 bracing patients, 144 (40%) were successful, 77 (21%) are ongoing, 25 (7%) failed, and 118 (32%) dropped out. Recurrence was noted in 17 (5%), an average 5.4 months later. Two (0.4%) overcorrected to pectus excavatum (PE). Successful patients experienced a 50% decrease in pressure of correction (POC) beginning one month after starting treatment. Brace failure patients did not. Reported compliance with brace utilization (hours/day) was similar. Surgery was required in 91 patients. Open operations were performed in 61 (67%), Abramson operations in 23 (25%), and Nuss procedure in 7 (8%) who developed excavatum over correction following bracing or who had mixed deformity, with excavatum one side of the sternum and carinatum on the other. Twenty-four (36%) of the surgeries for PC occurred after an attempt at bracing. All obtained good initial results by operation. No recurrence was noted after open operation and 3 (13%) after Abramson. Open complications included 1 (2%) infection. Abramson's operation required 11 (48%) revisions, 6 (26%) early bar removals, and had 3 (13%) infections.

Conclusion: Brace treatment for PC can be guided by pressure of correction, which fell by more than half in successfully treated patients. POC did not fall in patients who failed. If POC does not fall, surgery should be considered. Open repair of Pectus Carinatum is generally successful, while the Abramson operation has a significant rate of complications with the implants currently available in the U.S.

Levels Of Evidence: Level III - Retrospective comparative study.
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http://dx.doi.org/10.1016/j.jpedsurg.2021.01.027DOI Listing
January 2021

The 2020 "WHO Technical Specifications for Automated Non-Invasive Blood Pressure Measuring Devices With Cuff".

Hypertension 2021 Mar 1;77(3):806-812. Epub 2021 Feb 1.

Biomedical Engineer, Independent Senior Consultant, Veracrus, México (L.P.L.M.).

High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884242PMC
March 2021

Rind from Purple Mangosteen () Attenuates Diet-Induced Physiological and Metabolic Changes in Obese Rats.

Nutrients 2021 Jan 22;13(2). Epub 2021 Jan 22.

Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia.

The pulp of the purple mangosteen, , is a popular tropical fruit but the rind containing xanthones such as α-mangostin together with procyanidins and anthocyanidins is usually discarded as waste. However, this rind has been used in South-East Asia for diarrhoea, dysentery, skin infections and wounds. As xanthones have reported anti-inflammatory and antioxidant responses, this study has determined the bioactive compounds and evaluated the effects of rind on physiological, metabolic, liver and cardiovascular parameters in rats with diet-induced metabolic syndrome. Rats fed a diet with increased simple sugars and saturated fats developed obesity, hypertension, increased left ventricular stiffness, dyslipidaemia and fatty liver. Administration of rind as 5% of the food to rats with diet-induced metabolic syndrome gave a dose of 168 mg/kg/day α-mangostin, 355 mg/kg/day procyanidins, 3.9 mg/kg/day anthocyanins and 11.8 mg/kg/day hydroxycitric acid for 8 weeks which reduced body weight and attenuated physiological and metabolic changes in rats including decreased abdominal fat deposition, decreased abdominal circumference and whole-body fat mass, improved liver structure and function and improved cardiovascular parameters such as systolic blood pressure, left ventricular stiffness and endothelial function. These responses were associated with decreased infiltration of inflammatory cells, decreased deposition of collagen in both heart and liver and decreased mean adipocyte size in retroperitoneal adipose tissues. We conclude that, in rats with diet-induced metabolic syndrome, chronic intake of rind decreased infiltration of inflammatory cells which decreased physiological, metabolic, liver and cardiovascular symptoms.
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http://dx.doi.org/10.3390/nu13020319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912346PMC
January 2021

Incremental theories of emotion across time: Temporal dynamics and correlates of change.

Emotion 2020 Dec 28. Epub 2020 Dec 28.

Department of Psychology, The Hebrew University of Jerusalem.

Accumulating research points to the importance of incremental theories of emotion. Yet, little is known about whether these beliefs change in adulthood across long time spans, and if so, whether such changes are prospectively linked to emotion regulation outcomes. In the present investigation, we tested how incremental theories of emotion change during college, and whether such changes are linked to emotion regulation practices. We followed 394 undergraduates as they entered and ultimately graduated from college. Focusing on the temporal dynamics of incremental theories of emotion, we found that they were somewhat stable, and their mean-level increased over time. Focusing on the correlates of such changes, we found that students who during college came to believe that emotions (but not intelligence) are more controllable, ended up using more cognitive reappraisal (but not expressive suppression) at the end of college. Similarly, students who during college came to use cognitive reappraisal (but not expressive suppression) more frequently, ended up believing that emotion (but not intelligence) is more controllable at the end of college. This pattern could not be explained by differences in initial levels or by differences in underlying affective experiences. We discuss potential implications of these findings for understanding the interplay between beliefs and emotion regulation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/emo0000945DOI Listing
December 2020

A Systematic Study of the Prevalence and Risk Factors of CKD in Uddanam, India.

Kidney Int Rep 2020 Dec 16;5(12):2246-2255. Epub 2020 Oct 16.

George Institute for Global Health, University of New South Wales, New Delhi, India.

Introduction: Despite reports of a high prevalence of chronic kidney disease (CKD) from the coastal Uddanam region of Andhra Pradesh, India, there are no accurate data on the distribution of kidney function abnormalities and CKD risk factors in this region.

Methods: A total of 2419 participants were recruited through multistage cluster random sampling from 67 villages. Serum creatinine and urine protein creatinine ratio were measured using validated methodologies. All abnormal estimated glomerular filtration rate (eGFR) and urine protein creatinine ratio values were reconfirmed after 3 months. A range of sociodemographic factors were evaluated for their association with CKD using Poisson regression.

Results: Of 2402 eligible subjects (mean ± SD age, 45.67 ± 13.29 years; 51% female), 506 (21.07%) had CKD (mean ± SD age, 51.79 ± 13.12 years; 41.3% female). A total of 246 (10.24%) had eGFR <60 ml/min/1.73 m, whereas 371 (15.45%) had an elevated urine protein creatinine ratio (>0.15 g/g). The poststratified estimates, adjusted for age and sex distribution of the region for CKD prevalence, are 18.7% (range, 16.4%-21.0%) overall and 21.3% (range, 18.2%-24.4% ) and 16.2% (range, 13.7%-18.8%) in men and women, respectively. Older age, male sex, tobacco use, hypertension, and family history of CKD were independently associated with CKD. Compared with those with higher eGFR, those with eGFR <60 ml/min/1.73m were older, were more likely to be uneducated, manual laborers/farmers, or tobacco users, and were more likely to have hypertension, a family history of CKD, a diagnosis of heart disease, and a lower body mass index. Among those with low eGFR, there was no difference between those with urine protein creatinine ratio <0.15 or >0.15, except a lower frequency of males in the former.

Conclusion: We confirmed the high prevalence of CKD in the adult population of Uddanam. The cause was not apparent in a majority. Subjects with a low eGFR with or without elevated proteinuria were phenotypically distinct from those with proteinuria and preserved eGFR. Our data suggest the need to apply a population-based approach to screening and prevention and studies to understand the causes of CKD in this region.
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http://dx.doi.org/10.1016/j.ekir.2020.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710882PMC
December 2020

People with disagreeable personalities (selfish, combative, and manipulative) do not have an advantage in pursuing power at work.

Proc Natl Acad Sci U S A 2020 09 31;117(37):22780-22786. Epub 2020 Aug 31.

Department of Psychology, University of California, Berkeley, CA 94720-1650.

Does being disagreeable-that is, behaving in aggressive, selfish, and manipulative ways-help people attain power? This question has long captivated philosophers, scholars, and laypeople alike, and yet prior empirical findings have been inconclusive. In the current research, we conducted two preregistered prospective longitudinal studies in which we measured participants' disagreeableness prior to entering the labor market and then assessed the power they attained in the context of their work organization ∼14 y later when their professional careers had unfolded. Both studies found disagreeable individuals did not attain higher power as opposed to extraverted individuals who did gain higher power in their organizations. Furthermore, the null relationship between disagreeableness and power was not moderated by individual differences, such as gender or ethnicity, or by contextual variables, such as organizational culture. What can account for this null relationship? A close examination of behavior patterns in the workplace found that disagreeable individuals engaged in two distinct patterns of behavior that offset each other's effects on power attainment: They engaged in more dominant-aggressive behavior, which positively predicted attaining higher power, but also engaged in less communal and generous behavior, which predicted attaining less power. These two effects, when combined, appeared to cancel each other out and led to a null correlation between disagreeableness and power.
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http://dx.doi.org/10.1073/pnas.2005088117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502814PMC
September 2020

Hydroxychloroquine plus personal protective equipment versus standard personal protective equipment alone for the prevention of COVID-19 infections among frontline healthcare workers: the HydrOxychloroquine Prophylaxis Evaluation(HOPE) trial: A structured summary of a study protocol for a randomized controlled trial.

Trials 2020 Aug 31;21(1):754. Epub 2020 Aug 31.

The George Institute for Global Health, Sydney, New South Wales, Australia.

Objectives: To evaluate the effect of the combination of hydroxychloroquine (HCQ) and standard personal protective equipment (PPE) compared to the use of standard personal protective equipment alone on the proportion of laboratory confirmed COVID-19 infections among frontline healthcare workers(HCWs) in India TRIAL DESIGN: HOPE is an investigator initiated multi-centre open-label parallel group randomized controlled trial.

Participants: All HCWs currently working in an environment with direct exposure to patients with confirmed COVID-19 infection are eligible to participate in the trial. The trial aims to be conducted across 20-30 centres (public and private hospitals) in India. HCWs who decline consent, who have a confirmed COVID-19 infection, those who are already on chloroquine/HCQ for any indication, or if pregnant or breast-feeding, or have known QT prolongation or are on medications that when taken with HCQ can prolong the QTc will be excluded.

Intervention And Comparator: The interventions to be compared in this trial are standard practice (use of recommended PPE) and HCQ plus standard practice. In the standard practice arm, HCWs will use recommended PPE as per institutional guidelines and based on their roles. They will be discouraged from taking HCQ to prevent contamination and contacted every week for the duration of the study to ascertain if they have taken any HCQ. Any such use will be reported as a protocol violation. In the intervention arm, HCWs will be administered 800mg of HCQ as a loading dose on the day of randomization (as two 400mg doses 12hrs apart) and subsequently continued on 400mg once a week for 12 weeks. This will be in addition to the use of recommended PPE as per institutional guidelines and based on their roles. HCWs will collect the drug once every week from designated research and pharmacy staff at site. A weekly phone reminder will be provided to participants in this arm to ensure compliance. An ECG will be performed between 4-6 weeks in this arm and if the QTc is prolonged (greater than 450milliseconds), the drug will be stopped. Follow-up will however continue. Participants in both arms will receive a weekly phone call for evaluation of the primary outcome, to monitor protocol compliance and development of any adverse events (in the HCQ group).

Main Outcomes: Participants will be followed on a weekly basis. The primary outcome is the proportion of HCWs developing laboratory confirmed COVID-19 infection within 6 months of randomization. We will also evaluate a number of secondary outcomes, including hospitalization related to suspected/confirmed COVID-19 infection, intensive care unit or high-dependency unit admission due to suspected/confirmed COVID-19 infection, all-cause mortality, need for organ support ( non-invasive or invasive ventilation, vasopressors and renal replacement therapy), ICU and hospital length of stay, readmission, days off work and treatment-related adverse events.

Randomisation: Randomisation will be conducted through a password-protected, secure website using a central, computer-based randomisation program. Randomisation will be stratified by participating institutions and by the role of HCW - nursing, medical and other. Participants will be randomised 1:1 to either standard practice only or HCQ plus standard practice. Allocation concealment is maintained by central web-based randomisation BLINDING (MASKING): This is an unblinded study: study assigned treatment will be known to the research team and participant. Bias will be mitigated through an objective end point (laboratory confirmed COVID-19 infection).

Numbers To Be Randomised (sample Size): A total of 6,950 HCWs will be enrolled (3475 to the intervention) and (3475 to the standard practice group) to detect a 25% relative reduction, or 2.5% absolute reduction, in the infection rate from an estimated baseline infection rate of 10%, with 80% statistical power using a two-sided test at 5% level of significance. Available data from China and Italy indicate that the rate of infection among frontline healthcare workers varies between 4% to 12%. We therefore assumed a baseline infection rate of 10% among HCWs. This sample size allows for a potential loss to follow-up rate of 10% and a potential non-compliance rate of 10% in both the treatment and control arms.

Trial Status: HOPE protocol version 3.0 dated June 3 2020. Recruitment started on 29 June 2020 and currently 56 participants have been enrolled. Planned completion of enrolment is January 31 2021.

Trial Registration: Clinical Trials Registry of India: CTRI/2020/05/025067 (prospectively registered) Date of registration: 6 May 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expedited dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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http://dx.doi.org/10.1186/s13063-020-04679-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456761PMC
August 2020

Tropical foods as functional foods for metabolic syndrome.

Food Funct 2020 Aug;11(8):6946-6960

Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia. and School of Health and Wellbeing, University of Southern Queensland, Ipswich, QLD 4305, Australia.

Tropical foods are an integral part of the traditional diet and form part of traditional medicine in many countries. This review examines the potential of tropical foods to treat signs of metabolic syndrome, defined as a chronic low-grade inflammation leading to obesity, hypertension, impaired glucose tolerance, insulin resistance, dyslipidaemia and fatty liver. It is a major risk factor for cardiovascular and metabolic disease as well as osteoarthritis and some cancers. Tropical foods such as seaweeds and tropical fruits including indigenous fruits such as Davidson's plums are effective in reducing these signs of metabolic syndrome in rats, as well as reducing degeneration of bone cartilage and altering gut microbiome. Further, waste products from tropical fruits including mangosteen rind, coffee pulp and spent coffee grounds provide further options to reduce metabolic syndrome. Production of local tropical foods and local recovery of food waste from these foods could allow the development of commercial, sustainable and cost-effective functional foods in tropical countries. The aim is to develop these functional foods to reduce the incidence of metabolic syndrome and decrease the risk of costly chronic cardiovascular and metabolic disorders locally and globally.
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http://dx.doi.org/10.1039/d0fo01133aDOI Listing
August 2020

Does parental education influence child educational outcomes? A developmental analysis in a full-population sample and adoptee design.

J Pers Soc Psychol 2021 Apr 15;120(4):1074-1090. Epub 2020 Jun 15.

Department of Political Science.

Children's educational outcomes are strongly correlated with their parents' educational attainment. This finding is often attributed to the family environment-assuming, for instance, that parents' behavior and resources affect their children's educational outcomes. However, such inferences of a causal role of the family environment depend on the largely untested assumption that such relationships do not simply reflect genes shared between parent and child. We examine this assumption with an adoptee design in full-population cohorts from Danish administrative data. We test whether parental education predicts children's educational outcomes in both biological and adopted children, looking at four components of the child's educational development: (I) the child's conscientiousness during compulsory schooling, (II) academic performance in those same years, (III) enrollment in academically challenging high schools, and (IV) graduation success. Parental education was a substantial predictor of each of these child outcomes in the full population. However, little intergenerational correlation in education was observed in the absence of genetic similarity between parent and child-that is, among adoptees. Further analysis showed that what links adoptive parents' education did have with later-occurring components such as educational attainment (IV) and enrollment (III) appeared to be largely attributable to effects identifiable earlier in development, namely early academic performance (II). The primary nongenetic mechanisms by which education is transmitted across generations may thus have their effects on children early in their educational development, even as the consequences of those early effects persist throughout the child's educational development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pspp0000314DOI Listing
April 2021

An overview of mobile applications (apps) to support the coronavirus disease 2019 response in India.

Indian J Med Res 2020 May;151(5):468-473

The George Institute for Global Health, New Delhi, India.

Background & Objectives: The potential benefits of mobile health (mHealth) initiatives to manage the coronavirus disease 2019 (COVID-19) pandemic have been explored. The Government of India, State governments, and healthcare organizations have developed various mobile apps for the containment of COVID-19. This study was aimed to systematically review COVID-19 related mobile apps and highlight gaps to inform the development of future mHealth initiatives.

Methods: Google Play and the Apple app stores were searched using the terms 'COVID-19', 'coronavirus', 'pandemic', and 'epidemic' in the first week of April 2020. A list of COVID-19-specific functions was compiled based on the review of the selected apps, the literature on epidemic surveillance, and national and international media reports. The World Health Organization guideline on Digital Health Interventions was used to classify the app functions under the categories of the general public, health workers, health system managers, and data services.

Results: The search yielded 346 potential COVID-19 apps, of which 50 met the inclusion criteria. Dissemination of untargeted COVID-19-related information on preventative strategies and monitoring the movements of quarantined individuals was the function of 27 (54%) and 19 (32%) apps, respectively. Eight (16%) apps had a contact tracing and hotspot identification function.

Interpretation & Conclusions: Our study highlights the current emphasis on the development of self-testing, quarantine monitoring, and contact tracing apps. India's response to COVID-19 can be strengthened by developing comprehensive mHealth solutions for frontline healthcare workers, rapid response teams and public health authorities. Among this unprecedented global health emergency, the Governments must ensure the necessary but least intrusive measures for disease surveillance.
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http://dx.doi.org/10.4103/ijmr.IJMR_1200_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530460PMC
May 2020

[Validation of the French version of the 10-item Big Five Inventory].

Encephale 2020 Dec 21;46(6):455-462. Epub 2020 Apr 21.

Department of psychology et institute of personality and social research, university of California Berkeley, Berkeley, California, États-Unis; Paris, France.

Objective: Our primary objective was to validate the French version of the BFI-10, an ultra-short ten-item version of the Big Five Inventory (BFI; John et al., 1991), which allows for a reasonably accurate assessment of personality in circumstances in which more in-depth assessment is not possible. In order to reach a thorough evaluation of the external validity, we also aimed to examine the bandwidth of the BFI-10 scales with reference to the study by De Young, Quilty and Peterson (2007) who distinguished between two aspects in each of the Big Five: Assertiveness and Enthusiasm for Extraversion; Compassion and Politeness for Agreeability; Orderliness and Productiveness for Conscientiousness; Withdrawal and Volatility for Negative Emotionality, and finally Openness to Aesthetics and Openness to Ideas for Open-Mindedness. Our concern with regard to bandwidth was to examine whether the BFI-10 scales have strong enough correlations with both aspects of each domain.

Methods: Participants. Data from four samples were analysed: Sample 1 comprised 2499 undergraduate students (1654 women) who completed the full BFI in university classes; Sample 2 comprised 13,306 participants (8471 women) who filled out the BFI-10 ten items online via Internet; Sample 3 comprised 143 undergraduate students (115 women) who completed the full BFI twice with a two-week interval; Sample 4 comprised 360 undergraduate students (183 women) who filled out the BFI and NEO PI-R.

Instruments: The French version of the Big Five Inventory is a 45-item inventory, which measures the five broader domains of personality. The ultrashort Ten-item Big Five Inventory (BFI-10) was developed simultaneously in German and English by Rammstedt and John (2007); it comprises five two-item scales measuring the big five domains. The Neuroticism-Extraversion-Openness Personality Inventory Revised (NEO PI-R; Costa et McCrae, 1992) is a 240-item questionnaire which assesses the big five domains and 30 lower-order facets, i.e. six facets per domain.

Statistical Analyses: Factor structure and reliability of the five two-item scales were first investigated on samples 1 and 3. Confirmatory factor analyses (CFAs) were conducted on samples 1 and 2, and discriminant validity was assessed via comparison with the NEO PI-R (sample 4). In order to examine the bandwidth of the BFI-10 two-item scales, we studied their correlation not only with the NEO PI-R domains but also with the 30 facets.

Results: The CFAs showed the good fit of the five-factor structure, with RMSEA=.077 (.072), CFI=.974 (.956), and SRMR=.029 (.027) in samples 1 and 2 respectively. Multigroup CFA conducted in groups 1 and 2 showed invariance across gender of factor loadings and item intercepts. Test-retest reliability was satisfactory with rs ranging from .68 (Open-Mindedness) to .86 (Extraversion and Negative Emotionality). The comparison of the two-item scales with the NEO PI-R scales showed high correlations not only with the NEO domain scales, but also with several facets: Four BFI-10 two-item scales (Extraversion, Conscientiousness, Negative Emotionality, and Open-Mindedness) were highly correlated with at least three of the six NEO facet scales in each domain. For Agreeableness, the magnitude of correlations was smaller, but the pattern of correlations was the same. All BFI-10 scales had at least moderate correlations with both aspects of each domain, with the exception of Negative Emotionality, which measured the NEO Withdrawal aspect better than Volatility.

Conclusion: The French version of the BFI-10 demonstrated the expected five-factor structure, satisfactory reliability, and broad bandwidth. It could be a valuable tool for the assessment of personality in circumstances in which it is not possible to use a longer and more in-depth instrument, especially when personality is not the main focus of research but one of the variables to be controlled.
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http://dx.doi.org/10.1016/j.encep.2020.02.006DOI Listing
December 2020

Video consultations for triage of patients with covid-19.

Authors:
Oommen John

BMJ 2020 04 23;369:m1583. Epub 2020 Apr 23.

George Institute for Global Health India, New Delhi 110025, India.

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http://dx.doi.org/10.1136/bmj.m1583DOI Listing
April 2020

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems.

Yearb Med Inform 2020 Aug 17;29(1):44-50. Epub 2020 Apr 17.

School of Health Sciences, University of Canterbury, New Zealand.

Objectives: To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives.

Methods: We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth.

Results: Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts.

Conclusions: Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.
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http://dx.doi.org/10.1055/s-0040-1701976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442533PMC
August 2020

Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators.

BMC Nephrol 2020 01 29;21(1):26. Epub 2020 Jan 29.

The George Institute for Global Health, University of New South Wales, New Delhi, India.

Background: Despite the high and rising burden of chronic kidney disease (CKD) in South Asia, factors that influence access to CKD care at the community level have not been studied previously, especially in the rural areas. We conducted a mixed methods study and interviewed key stakeholders to explore the views and experiences of key stakeholders, and identify barriers and potential facilitators that influence access to CKD care at the primary care level in rural India.

Methods: A total of 21 stakeholders participated in the study. We conducted 15 in-depth interviews on a purposive sample of stakeholders (CKD patients, healthcare providers and health planners) and one focus group discussion with 6 community health workers. The interviews were audio-recorded and transcribed verbatim. We employed the Lévesque's framework for access to care to base interview guides and structure the initial codes. By inductive and deductive approaches, thematic analysis was undertaken using QSR NVivo version 11.

Results: The major patient-level barriers to CKD care as reported by the most patients and healthcare providers was poor knowledge and awareness of CKD. Health system-level barriers included shortages of skilled healthcare professionals and medicines, fragmented referrals pathways to the specialists at the hospitals with inadequate follow up care. Many patients and healthcare providers, when asked about areas for improving access to CKD care, reported educational initiatives to increase awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a systems-level approach to care coordination including task shifting by engaging community health workers in CKD care, as potential facilitators.

Conclusions: We identified several barriers to access CKD care at the primary care level in rural India that need urgent attention. Targeted CKD screening programs and CKD specific educational initiatives may improve awareness of CKD. Additionally, primary care infrastructure needs to be strengthened for CKD care, ensuring trained staff, availability of essential diagnostics and medications, and creating efficient referral pathways for quality CKD care.
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http://dx.doi.org/10.1186/s12882-020-1702-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988353PMC
January 2020

Physiological and Metabolic Effects of Yellow Mangosteen () Rind in Rats with Diet-Induced Metabolic Syndrome.

Int J Mol Sci 2019 Dec 31;21(1). Epub 2019 Dec 31.

Functional Foods Research Group, University of Southern Queensland, Toowoomba, QLD 4350, Australia.

Metabolic syndrome is a cluster of disorders that increase the risk of cardiovascular disease and diabetes. This study has investigated the responses to rind of yellow mangosteen (), usually discarded as waste, in a rat model of human metabolic syndrome. The rind contains higher concentrations of phytochemicals (such as garcinol, morelloflavone and citric acid) than the pulp. Male Wistar rats aged 8-9 weeks were fed either corn starch diet or high-carbohydrate, high-fat diet for 16 weeks, which were supplemented with 5% freeze-dried fruit rind powder during the last 8 weeks. We characterised metabolic, cardiovascular, liver and gut microbiota parameters. High-carbohydrate, high-fat diet-fed rats developed abdominal obesity, hypertension, increased left ventricular diastolic stiffness, decreased glucose tolerance, fatty liver and reduced with increased in the colonic microbiota. fruit rind powder attenuated these changes, improved cardiovascular and liver structure and function, and attenuated changes in colonic microbiota. fruit rind powder may be effective in metabolic syndrome by appetite suppression, inhibition of inflammatory processes and increased fat metabolism, possibly related to changes in the colonic microbiota. Hence, we propose the use of fruit rind as a functional food to ameliorate symptoms of metabolic syndrome.
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http://dx.doi.org/10.3390/ijms21010272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981489PMC
December 2019

A stable relationship between personality and academic performance from childhood through adolescence. An original study and replication in hundred-thousand-person samples.

J Pers 2020 10 17;88(5):925-939. Epub 2020 Jan 17.

Department of Psychology, University of California, Berkeley, Berkeley, CA, USA.

Objective: Many studies have demonstrated that personality traits predict academic performance for students in high school and college. Much less evidence exists on whether the relationship between personality traits and academic performance changes from childhood to adolescence, and existing studies show very mixed findings. This study tests one hypothesis-that the importance of Agreeableness, Emotional Stability, and Conscientiousness for academic performance changes fundamentally during school-against an alternative hypothesis suggesting that the changing relationships found in previous research are largely measurement artifacts.

Method: We used a nationwide sample of 135,389 primary and lower secondary students from Grade 4 to Grade 8. We replicated all results in a separate sample of another 127,375 students.

Results: We found that academic performance was equally strongly related to our measure of Conscientiousness at all these grade levels, and the significance of Agreeableness and Emotional Stability predominantly reflected their connections with Conscientiousness. However, age also appeared to shape the relationship between Emotional Stability and performance.

Conclusion: Amidst the replication crisis in psychology these findings demonstrate a very stable and predictable relationship between personality traits and academic performance, which may have important implications for the education of children already in primary school.
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http://dx.doi.org/10.1111/jopy.12538DOI Listing
October 2020

Beta-cell dysfunction and abnormal glucose metabolism among non-diabetic women with recurrent miscarriages.

Arch Gynecol Obstet 2020 02 10;301(2):559-564. Epub 2019 Dec 10.

Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Bingham University, Jos Campus, PMB 2238, Jos, Nigeria.

Background: Subclinical beta-cell (β-cell) dysfunction is an endocrine abnormality and its association with recurrent miscarriages (RM) has not been extensively studied.

Objective: This study aimed to determine the prevalence of β-cell dysfunction and abnormal glucose metabolism [fasting blood glucose (FBG) ≥ 5.1 mmol/L] among non-diabetic women with recurrent miscarriages and to establish if there was an association between RM and β-cell dysfunction and FBG ≥ 5.1 mmol/L.

Methodology: This was a cross-sectional study involving 80 women with miscarriages at ≤ 13 weeks gestation and 80 women with normal pregnancies at ≤ 13 weeks of gestation with at least one successful live-birth and no history of miscarriage (comparison group). Interviewer-administered questionnaire was used to obtain relevant information. From each participant, FBG and fasting insulin were assayed. β-Cell function was computed. The data obtained was analysed using IBM-SPSS version 22.0.

Results: A significantly higher prevalence of β-cell dysfunction and abnormal glucose metabolism were observed among non-diabetic women with RM compared to age-matched controls (38.8% vs 10.0%, P < 0.001) and (27.5% vs 6.3%, P = 0.005) respectively. The mean β-cell function of the cases was 59.0% of the controls (264.41 ± 105.13 vs 447.82 ± 181.24, P < 0.001). Mean FBG was significantly higher in the case-group compared to the controls (4.77 ± 1.14 mmol/L vs 3.58 ± 0.78 mmol/L, P < 0.001). There was a significant association between RM and FBG ≥ 5.1 mmol/L and low β-cell function (P < 0.001).

Conclusion: This study suggests that women with recurrent miscarriages are more likely to have impaired β-cell function and abnormal glucose metabolism (FBG ≥ 5.1 mmol/L).
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http://dx.doi.org/10.1007/s00404-019-05407-2DOI Listing
February 2020

Study to Test and Operationalize Preventive Approaches for CKD of Undetermined Etiology in Andhra Pradesh, India.

Kidney Int Rep 2019 Oct 21;4(10):1412-1419. Epub 2019 Jun 21.

George Institute for Global Health, University of New South Wales, New Delhi, India.

Introduction: High prevalence of chronic kidney disease (CKD) not associated with known risk factors has been reported from coastal districts of Andhra Pradesh. The Study to Test and Operationalize Preventive Approaches for Chronic Kidney Disease of Undetermined Etiology in Andhra Pradesh (STOP CKDu AP) aims to ascertain the burden (prevalence and incidence) of CKD, the risk factor profile, and the community perceptions about the disease in the Uddanam area of Andhra Pradesh.

Methods: Study participants will be sampled from the Uddanam area using multistage cluster random sampling. Information will be collected on the demographic profile, occupational history, and presence of conventional as well as nonconventional risk factors. Glomerular filtration rate (GFR) will be estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and proteinuria will be measured. All abnormal values will be confirmed by repeat testing after 3 months. Cases of CKD not associated with identified etiologies will be identified. Biospecimens will be stored to explore future hypotheses. The entire cohort will be followed up every 6 months to determine the incidence of CKD and to identify risk factors for decline in kidney function. Qualitative studies will be performed to understand the community perceptions and expectations with respect to the interventions.

Implications: CKD is an important public health challenge in low- and middle-income countries. This study will establish the prevalence and determine the incidence of CKD not associated with known risk factors in a reported high-burden region, and will provide insights to help design targeted health systems responses. The findings will contribute to the policy development to tackle CKD in the region and will permit international comparisons with other regions with similar high prevalence.
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http://dx.doi.org/10.1016/j.ekir.2019.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829197PMC
October 2019