Publications by authors named "John O"

159 Publications

Short-term implications of long-term thinking: Temporal distancing and emotional responses to daily stressors.

Emotion 2022 Aug 8. Epub 2022 Aug 8.

Department of Psychology.

Temporal distancing (TD) is a promising yet understudied emotion regulation strategy that involves reflecting on how one will feel much later in the future. Although limited, the available evidence suggests that TD is a beneficial way to appraise negative events. Experimental studies have demonstrated causality: Situational use of TD (e.g., when thinking about a negative event) confers short-term emotional benefits in the laboratory. In addition, correlational studies show that habitual use predicts better long-term well-being. However, several open questions remain. First, we do not fully understand associations between habitual TD and emotions in daily life. Second, we do not fully understand daily TD, either on average across days or fluctuating within person. We conducted an 8-day diary study to test associations between TD and emotional responses to daily stressful events for three distinct measures at two levels of analysis: habitual TD assessed with a survey, average daily TD across days, and within-person fluctuations in TD across days ( = 155 participants, 837 observations). TD was associated with lower negative emotion at the within-person level and with greater positive emotion at both levels. Overall, these findings suggest that TD-on average and fluctuating within person-is associated with a beneficial pattern of daily emotional experiences, which may support overall well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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http://dx.doi.org/10.1037/emo0001140DOI Listing
August 2022

Evaluation of Obstetricians' Opinion of Thrombocytopenia in Pregnancy: A Cross-Sectional Study.

West Afr J Med 2022 Jul;39(7):657-662

Department of Obstetrics and Gynaecology. University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.

Background: Thrombocytopenia occurs in about 8-10% of pregnancies. Thrombocytopenia may be incidental in pregnancy and could point to medical or gestational conditions that may pose a morbidity and mortality risk to both mother and foetus.

Aim: To determine Obstetricians' view/opinion about thrombocytopenia in pregnancy.

Methods: A pre-tested structured questionnaire was distributed amongst consultant and resident obstetricians during their antenatal clinics in 3 tertiary hospitals over a period of one month. Analysis was descriptive and results were expressed as frequencies in words, tables and charts.

Results: A total of 91 responders were studied of which 24 were consultants (26.4%), 57 (62.6%) senior registrars and 10 (11%) were registrars. There were 20 (22.7%) responders who were unaware of incidental thrombocytopenia in pregnancy. Most obstetricians (n=83, 91.2%) requested for only packed cell volume (PCV) at antenatal booking, only 2 (2.9%) routinely requested for full blood count (FBC). At booking; only 10 (11.1%) obstetricians asked for a history of thrombocytopenia. Majority (n=87, 98.9%) never requested for platelet counts. If they encountered thrombocytopenia, up to 89 (97.8%) would investigate further with a repeat FBC (n=77, 86.5%), coagulation screen (n=54, 61.4%) or bone marrow aspiration (n=20, 24.7%). Most of the obstetricians (n=82, 96.5%) would transfuse patients with thrombocytopenia and 34 (43.6%) of them would do so when the count is <50 X 109/L.

Conclusion: Obstetricians have the capacity to investigate symptomatic thrombocytopenia in pregnancy but do not routinely screen for asymptomatic thrombocytopenia. Routine FBC if done at booking may identify missed cases of asymptomatic thrombo-cytopenia for adequate management.
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July 2022

The metabolic and molecular mechanisms of α‑mangostin in cardiometabolic disorders (Review).

Int J Mol Med 2022 Sep 29;50(3). Epub 2022 Jul 29.

Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu, Sabah, Malaysia.

α‑mangostin is a xanthone predominantly encountered in . Extensive research has been carried out concerning the effects of this compound on various diseases, including obesity, cancer and metabolic disorders. The present review suggests that α‑mangostin exerts promising anti‑obesity, hepatoprotective, antidiabetic, cardioprotective, antioxidant and anti‑inflammatory effects on various pathways in cardiometabolic diseases. The anti‑obesity effects of α‑mangostin include the reduction of body weight and adipose tissue size, the increase in fatty acid oxidation, the activation of hepatic AMP‑activated protein kinase and Sirtuin‑1, and the reduction of peroxisome proliferator‑activated receptor γ expression. Hepatoprotective effects have been revealed, due to reduced fibrosis through transforming growth factor‑β 1 pathways, reduced apoptosis and steatosis through reduced sterol regulatory‑element binding proteins expression. The antidiabetic effects include decreased fasting blood glucose levels, improved insulin sensitivity and the increased expression of GLUT transporters in various tissues. Cardioprotection is exhibited through the restoration of cardiac functions and structure, improved mitochondrial functions, the promotion of M2 macrophage populations, reduced endothelial and cardiomyocyte apoptosis and fibrosis, and reduced acid sphingomyelinase activity and ceramide depositions. The antioxidant effects of α‑mangostin are mainly related to the modulation of antioxidant enzymes, the reduction of oxidative stress markers, the reduction of oxidative damage through a reduction in Sirtuin 3 expression mediated by phosphoinositide 3‑kinase/protein kinase B/peroxisome proliferator‑activated receptor‑γ coactivator‑1α signaling pathways, and to the increase in Nuclear factor‑erythroid factor 2‑related factor 2 and heme oxygenase‑1 expression levels. The anti‑inflammatory effects of α‑mangostin include its modulation of nuclear factor‑κB related pathways, the suppression of mitogen‑activated protein kinase activation, increased macrophage polarization to M2, reduced inflammasome occurrence, increased Sirtuin 1 and 3 expression, the reduced expression of inducible nitric oxide synthase, the production of nitric oxide and prostaglandin E2, the reduced expression of Toll‑like receptors and reduced proinflammatory cytokine levels. These effects demonstrate that α‑mangostin may possess the properties required for a suitable candidate compound for the management of cardiometabolic diseases.
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http://dx.doi.org/10.3892/ijmm.2022.5176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354700PMC
September 2022

Telehealth as a Means of Enabling Health Equity.

Yearb Med Inform 2022 Jun 2. Epub 2022 Jun 2.

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

Objective: The goal of this paper is to provide a consensus review on telehealth delivery prior to and during the COVID-19 pandemic to develop a set of recommendations for designing telehealth services and tools that contribute to system resilience and equitable health.

Methods: The IMIA-Telehealth Working Group (WG) members conducted a two-step approach to understand the role of telehealth in enabling global health equity. We first conducted a consensus review on the topic followed by a modified Delphi process to respond to four questions related to the role telehealth can play in developing a resilient and equitable health system.

Results: Fifteen WG members from eight countries participated in the Delphi process to share their views. The experts agreed that while telehealth services before and during COVID-19 pandemic have enhanced the delivery of and access to healthcare services, they were also concerned that global telehealth delivery has not been equal for everyone. The group came to a consensus that health system concepts including technology, financing, access to medical supplies and equipment, and governance capacity can all impact the delivery of telehealth services.

Conclusion: Telehealth played a significant role in delivering healthcare services during the pandemic. However, telehealth delivery has also led to unintended consequences (UICs) including inequity issues and an increase in the digital divide. Telehealth practitioners, professionals and system designers therefore need to purposely design for equity as part of achieving broader health system goals.
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http://dx.doi.org/10.1055/s-0042-1742500DOI Listing
June 2022

Hydroxychloroquine plus personal protective equipment versus personal protective equipment alone for the prevention of laboratory-confirmed COVID-19 infections among healthcare workers: a multicentre, parallel-group randomised controlled trial from India.

BMJ Open 2022 06 1;12(6):e059540. Epub 2022 Jun 1.

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

Objectives: To determine whether hydroxychloroquine when used with personal protective equipment reduces the proportion of laboratory-confirmed COVID-19 among healthcare workers in comparison to the use of personal protective equipment alone.

Design: Multicentre, parallel-group, open-label randomised trial. Enrolment started on 29 June 2020 and stopped on 4 February 2021. Participants randomised in HydrOxychloroquine Prophylaxis Evaluation were followed for 6 months.

Setting: 9 hospitals across India.

Participants: Healthcare workers in an environment with exposure to COVID-19 were randomised in a 1:1 ratio to hydroxychloroquine plus use of personal protective equipment or personal protective equipment alone. 886 participants were screened and 416 randomised (213 hydroxychloroquine arm and 203 personal protective equipment).

Intervention: Participants in intervention arm received 800 mg of hydroxychloroquine on day of randomisation and then 400 mg once a week for 12 weeks in addition to the use of personal protective equipment. In the control arm, participants continued to use personal protective equipment alone.

Main Outcome: Proportion of laboratory-confirmed COVID-19 in the 6 months after randomisation.

Results: Participants were young (mean age 32.1 years, SD 9.1 years) with low-comorbid burden. 47.4% were female. In the 6 months after randomisation (primary analysis population=413), 11 participants assigned to the hydroxychloroquine group and 12 participants assigned to the standard practice group met the primary endpoint (5.2% vs 5.9%; OR 0.85, 95% CI 0.35 to 2.07, p=0.72). There was no heterogeneity of treatment effect in any prespecified subgroup. There were no significant differences in the secondary outcomes. The adverse event rates were 9.9% and 6.9% in the hydroxychloroquine and standard practice arms, respectively. There were no serious adverse events in either group.

Conclusions And Relevance: Hydroxychloroquine along with personal protective equipment was not superior to personal protective equipment alone on the proportion of laboratory-confirmed COVID-19. Definitive conclusions are precluded as the trial stopped early for futility, and hence was underpowered.

Trial Registration Number: CTRI/2020/05/025067.
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http://dx.doi.org/10.1136/bmjopen-2021-059540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160584PMC
June 2022

Simplified Cas13-based assays for the fast identification of SARS-CoV-2 and its variants.

Nat Biomed Eng 2022 May 30. Epub 2022 May 30.

Department of Molecular Biology, Princeton University, Princeton, NJ, USA.

The widespread transmission and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) call for rapid nucleic acid diagnostics that are easy to use outside of centralized clinical laboratories. Here we report the development and performance benchmarking of Cas13-based nucleic acid assays leveraging lyophilised reagents and fast sample inactivation at ambient temperature. The assays, which we named SHINEv.2 (for 'streamlined highlighting of infections to navigate epidemics, version 2'), simplify the previously reported RNA-extraction-free SHINEv.1 technology by eliminating heating steps and the need for cold storage of the reagents. SHINEv.2 detected SARS-CoV-2 in nasopharyngeal samples with 90.5% sensitivity and 100% specificity (benchmarked against the reverse transcription quantitative polymerase chain reaction) in less than 90 min, using lateral-flow technology and incubation in a heat block at 37 °C. SHINEv.2 also allows for the visual discrimination of the Alpha, Beta, Gamma, Delta and Omicron SARS-CoV-2 variants, and can be run without performance losses by using body heat. Accurate, easy-to-use and equipment-free nucleic acid assays could facilitate wider testing for SARS-CoV-2 and other pathogens in point-of-care and at-home settings.
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http://dx.doi.org/10.1038/s41551-022-00889-zDOI Listing
May 2022

Anthocyanins in Chronic Diseases: The Power of Purple.

Nutrients 2022 May 23;14(10). Epub 2022 May 23.

School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD 4222, Australia.

Anthocyanins are mainly purple-coloured phenolic compounds of plant origin that as secondary metabolites are important in plant survival. Understanding their health benefits in humans requires sourcing these unstable compounds in sufficient quantities at a reasonable cost, which has led to improved methods of extraction. Dark-coloured fruits, cereals and vegetables are current sources of these compounds. The range of potential sustainable sources is much larger and includes non-commercialised native plants from around the world and agri-waste containing anthocyanins. In the last 5 years, there have been significant advances in developing the therapeutic potential of anthocyanins in chronic human diseases. Anthocyanins exert their beneficial effects through improvements in gut microbiota, oxidative stress and inflammation, and modulation of neuropeptides such as insulin-like growth factor-1. Their health benefits in humans include reduced cognitive decline; protection of organs such as the liver, as well as the cardiovascular system, gastrointestinal tract and kidneys; improvements in bone health and obesity; and regulation of glucose and lipid metabolism. This review summarises some of the sources of anthocyanins and their mechanisms and benefits in the treatment of chronic human diseases.
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http://dx.doi.org/10.3390/nu14102161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142943PMC
May 2022

Regulatory Frameworks for Clinical Trial Data Sharing: Scoping Review.

J Med Internet Res 2022 05 4;24(5):e33591. Epub 2022 May 4.

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

Background: Although well recognized for its scientific value, data sharing from clinical trials remains limited. Steps toward harmonization and standardization are increasing in various pockets of the global scientific community. This issue has gained salience during the COVID-19 pandemic. Even for agencies willing to share data, data exclusivity practices complicate matters; strict regulations by funders affect this even further. Finally, many low- and middle-income countries (LMICs) have weaker institutional mechanisms. This complex of factors hampers research and rapid response during public health emergencies. This drew our attention to the need for a review of the regulatory landscape governing clinical trial data sharing.

Objective: This review seeks to identify regulatory frameworks and policies that govern clinical trial data sharing and explore key elements of data-sharing mechanisms as outlined in existing regulatory documents. Following from, and based on, this empirical analysis of gaps in existing policy frameworks, we aimed to suggest focal areas for policy interventions on a systematic basis to facilitate clinical trial data sharing.

Methods: We followed the JBI scoping review approach. Our review covered electronic databases and relevant gray literature through a targeted web search. We included records (all publication types, except for conference abstracts) available in English that describe clinical trial data-sharing policies, guidelines, or standard operating procedures. Data extraction was performed independently by 2 authors, and findings were summarized using a narrative synthesis approach.

Results: We identified 4 articles and 13 policy documents; none originated from LMICs. Most (11/17, 65%) of the clinical trial agencies mandated a data-sharing agreement; 47% (8/17) of these policies required informed consent by trial participants; and 71% (12/17) outlined requirements for a data-sharing proposal review committee. Data-sharing policies have, a priori, milestone-based timelines when clinical trial data can be shared. We classify clinical trial agencies as following either controlled- or open-access data-sharing models. Incentives to promote data sharing and distinctions between mandated requirements and supportive requirements for informed consent during the data-sharing process remain gray areas, needing explication. To augment participant privacy and confidentiality, a neutral institutional mechanism to oversee dissemination of information from the appropriate data sets and more policy interventions led by LMICs to facilitate data sharing are strongly recommended.

Conclusions: Our review outlines the immediate need for developing a pragmatic data-sharing mechanism that aims to improve research and innovations as well as facilitate cross-border collaborations. Although a one-policy-fits-all approach would not account for regional and subnational legislation, we suggest that a focus on key elements of data-sharing mechanisms can be used to inform the development of flexible yet comprehensive data-sharing policies so that institutional mechanisms rather than disparate efforts guide data generation, which is the foundation of all scientific endeavor.
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http://dx.doi.org/10.2196/33591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118011PMC
May 2022

Who has different-race friends, and does it depend on context? Openness (to other), but not agreeableness, predicts lower racial homophily in friendship networks.

J Pers Soc Psychol 2022 May;122(5):894-919

Department of Psychology.

People form relationships with people from their own racial groups, a phenomenon called , which reduces interracial contact and exacerbates inequality and prejudice. Although viewed as arising from environmental factors, we argue that racial homophily also involves individual choice and, thus, personality factors. We address three major issues. First, are interpersonal concerns (Agreeableness) and intergroup concerns (Openness) differentially relevant to cross-race friendships? Second, are current conceptions of Openness sufficient, or do we need lower-level facets more attuned to intergroup concerns? Third, can we specify the interplay between personality and contextual factors in different settings? Across four studies (total N = 1,820), failed to predict more cross-race friendships, in both self- and peer reports, suggesting that interpersonal kindness was not sufficient to overcome racial homophily. In contrast, Openness and (O2, a new social facet of Openness) consistently predicted cross-race friendship. However, the O2 facet had the stronger and only unique effect, suggesting it is the "active ingredient." High-O2 individuals had an almost equal 1:1 ratio of same-to-different-race network members, whereas low-O2 individuals had 4:1 same-race. These results held for both college students and middle-aged adults, both friends and new acquaintances in the network, and both networks established before and at a diverse university. Finally, when moving to a more diverse environment, high-O2 individuals seemed to take advantage of the new environmental affordances, adding more different-race members to their networks. Overall, these studies advance understanding of person-environment transactions, showing how personality traits matter to the structure of people's social networks. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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http://dx.doi.org/10.1037/pspp0000413DOI Listing
May 2022

Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia.

Intensive Care Med 2022 05 31;48(5):580-589. Epub 2022 Mar 31.

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

Purpose: We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia.

Methods: We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the international, stratified, blinded COVID STEROID 2 trial, which randomised 1000 adults with confirmed COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 26 hospitals in Europe and India. In the HRQoL analyses, higher values indicated better outcomes, and deceased patients were given a score of zero.

Results: We obtained vital status at 180 days for 963 of 982 patients (98.1%) in the intention-to-treat population, EQ-5D-5L index value data for 922 (93.9%) and EQ VAS data for 924 (94.1%). At 180 days, 164 of 486 patients (33.7%) had died in the 12 mg group versus 184 of 477 (38.6%) in the 6 mg group [adjusted risk difference - 4.3%; 99% confidence interval (CI) - 11.7-3.0; relative risk 0.89; 0.72-1.09; P = 0.13]. The adjusted mean differences between the 12 mg and the 6 mg groups in EQ-5D-5L index values were 0.06 (99% CI - 0.01 to 0.12; P = 0.10) and in EQ VAS scores 4 (- 3 to 10; P = 0.22).

Conclusion: Among patients with COVID-19 and severe hypoxaemia, dexamethasone 12 mg compared with 6 mg did not result in statistically significant improvements in mortality or HRQoL at 180 days, but the results were most compatible with benefit from the higher dose.
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http://dx.doi.org/10.1007/s00134-022-06677-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8970069PMC
May 2022

Wrist pressure and angulation during keyboarding: Comparison between two common wrist supports.

Work 2022 ;71(4):1121-1128

OTDS, Huntington University, Fort Wayne, IN, USA.

Background: Wrist pressure and angulation while working at a computer workstation have been associated with cumulative trauma disorders (CTDs) like carpal tunnel syndrome (CTS).

Objective: This quantitative, comparative study analyzed wrist pressure and angulation between two common wrist supports while typing at a standardized computer workstation.

Methods: A convenience sample of healthy young adults completed a five-minute typing task at a standardized workstation with no wrist support, with the ErgoBeads™ wrist support, and with an Elzo™ (memory foam) wrist support. Pressure mapping (Tekscan™)) and goniometry were used as quantitative measures to examine wrist pressure and wrist angulation during the typing task; descriptive and inferential statistics were performed to compare wrist angulation and wrist pressure between two supports.

Results: For the sample (n = 54), both wrist supports demonstrated a significant (p < 0.001) reduction in wrist extension as well as pressure compared to typing at the workstation with no support. There was no statistically significant difference in peak or mean pressure between the ErgoBeads™ and Elzo™ wrist supports (p = 0.99). Significant difference was identified ((p < 0.001) for wrist angle as participants exhibited less wrist extension using the ErgoBeads™ (x¯=12.56∘; SD = 3.32°) support as compared to the Elzo™ (x¯=19.25∘; SD = 3.77°) support.

Conclusions: The results suggest that the ErgoBeads™ and Elzo™ memory foam wrist supports are effective for reducing pressure between the wrist and work surface while the ErgoBeads™ support may promote a more neutral angle of the wrist while typing.
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http://dx.doi.org/10.3233/WOR-205154DOI Listing
May 2022

Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union.

Interact J Med Res 2022 Feb 8;11(1):e30755. Epub 2022 Feb 8.

Ujala Cygnus Healthcare Services, New Delhi, India.

This viewpoint summarizes the discussion that occurred during the "Translating Policy to Practice in Telehealth-Lessons from Global Implementation Experiences" panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth.
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http://dx.doi.org/10.2196/30755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864525PMC
February 2022

SENNA Inventory for the Assessment of Social and Emotional Skills in Public School Students in Brazil: Measuring Both Identity and Self-Efficacy.

Front Psychol 2021 25;12:716639. Epub 2021 Nov 25.

EduLab21, Ayrton Senna Institute, São Paulo, Brazil.

Responding to the need for school-based, broadly applicable, low-cost, and brief assessments of socio-emotional skills, we describe the conceptual background and empirical development of the SENNA inventory and provide new psychometric information on its internal structure. Data were obtained through a computerized survey from 50,000 Brazilian students enrolled in public school grades 6 to 12, spread across the entire State of São Paulo. The SENNA inventory was designed to assess 18 particular skills (e.g., empathy, responsibility, tolerance of frustration, and social initiative), each operationalized by nine items that represent three types of items: three positively keyed trait-identity items, three negatively keyed identity items, and three (always positively keyed) self-efficacy items, totaling a set of 162 items. Results show that the 18 skill constructs empirically defined a higher-order structure that we interpret as the social-emotional Big Five, labeled as Engaging with Others, Amity, Self-Management, Emotional Regulation, and Open-Mindedness. The same five factors emerged whether we assessed the 18 skills with items representing (a) a trait-identity approach that emphasizes lived skills (what do I do?) or (b) a self-efficacy approach that emphasizes capability (). Given that its target youth group is as young as 11 years old (grade 6), a population particularly prone to the response bias of acquiescence, SENNA is also equipped to correct for individual differences in acquiescence, which are shown to systematically bias results when not corrected.
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http://dx.doi.org/10.3389/fpsyg.2021.716639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657760PMC
November 2021

Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go.

Kidney Int Rep 2021 Nov 9;6(11):2743-2751. Epub 2021 Aug 9.

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

Chronic kidney disease (CKD) not associated with known risk factors has been reported from parts of India and is presumed to be similar to CKD of unknown etiology (CKDu) that has been described from Central America. The reports from India have been fragmented without clear description of the disease phenotype or its determinants. This paper summarizes the current state of knowledge around CKDu in India based on a review of literature, multi-stakeholder consultation, and a survey of Indian nephrologists. We also contacted individual research groups to solicit data. Our findings suggest that that CKDu is reported from most regions in India; however, it is interpreted differently from the phenotype described from Central America and Sri Lanka. The differences include lack of a clear demographic or occupation group, older age of affected participants, and presence of mild hypertension and low-grade proteinuria. Well-designed prospective field studies with appropriate diagnostic workup are needed to establish the disease burden and identify etiologies, along with socioeconomic and health consequences, the intersection with the environment, and the public health response. Community-based research should phenotype the entire CKD population rather than be restricted to cases with presumed CKDu based on predefined criteria. Guidelines are needed for clinical evaluation, referral, management, and harmonization of clinical documentation and health records. More data are needed to support the existence of a unique CKDu phenotype in India.
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http://dx.doi.org/10.1016/j.ekir.2021.07.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589686PMC
November 2021

The Pandemic, Infodemic, and People's Resilience in India: Viewpoint.

JMIR Public Health Surveill 2021 12 8;7(12):e31645. Epub 2021 Dec 8.

Manav Rachna University, Faridabad, India.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused widespread fear and stress. The pandemic has affected everyone, everywhere, and created systemic inequities, leaving no one behind. In India alone, more than 34,094,373 confirmed COVID-19 cases and 452,454 related deaths have been reported as of October 19, 2021. Around May 2021, the daily number of new COVID-19 cases crossed the 400,000 mark, seriously hampering the health care system. Despite the devastating situation, the public response was seen through their efforts to come forward with innovative ideas for potential ways to combat the pandemic, for instance, dealing with the shortage of oxygen cylinders and hospital bed availability. With increasing COVID-19 vaccination rates since September 2021, along with the diminishing number of daily new cases, the country is conducting preventive and preparatory measures for the third wave. In this article, we propose the pivotal role of public participation and digital solutions to re-establish our society and describe how Sustainable Development Goals (SDGs) can support eHealth initiatives and mitigate infodemics to tackle a postpandemic situation. This viewpoint reflects that the COVID-19 pandemic has featured a need to bring together research findings across disciplines, build greater coherence within the field, and be a driving force for multi-sectoral, cross-disciplinary collaboration. The article also highlights the various needs to develop digital solutions that can be applied to pandemic situations and be reprocessed to focus on other SDGs. Promoting the use of digital health care solutions to implement preventive measures can be enhanced by public empowerment and engagement. Wearable technologies can be efficiently used for remote monitoring or home-based care for patients with chronic conditions. Furthermore, the development and implementation of informational tools can aid the improvement of well-being and dissolve panic-ridden behaviors contributing toward infodemics. Thus, a call to action for an observatory of digital health initiatives on COVID-19 is required to share the main conclusions and lessons learned in terms of resilience, crisis mitigation, and preparedness.
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http://dx.doi.org/10.2196/31645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658220PMC
December 2021

Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial.

Intensive Care Med 2022 01 10;48(1):45-55. Epub 2021 Nov 10.

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

Purpose: We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bayesian analysis to facilitate probabilistic interpretation.

Methods: We analysed outcome data within 90 days in the intention-to-treat population (data available in 967 to 982 patients) using Bayesian models with various sensitivity analyses. Results are presented as median posterior probabilities with 95% credible intervals (CrIs) and probabilities of different effect sizes with 12 mg dexamethasone.

Results: The adjusted mean difference on days alive without life support at day 28 (primary outcome) was 1.3 days (95% CrI -0.3 to 2.9; 94.2% probability of benefit). Adjusted relative risks and probabilities of benefit on serious adverse reactions was 0.85 (0.63 to 1.16; 84.1%) and on mortality 0.87 (0.73 to 1.03; 94.8%) at day 28 and 0.88 (0.75 to 1.02; 95.1%) at day 90. Probabilities of benefit on days alive without life support and days alive out of hospital at day 90 were 85 and 95.7%, respectively. Results were largely consistent across sensitivity analyses, with relatively low probabilities of clinically important harm with 12 mg on all outcomes in all analyses.

Conclusion: We found high probabilities of benefit and low probabilities of clinically important harm with dexamethasone 12 mg versus 6 mg daily in patients with COVID-19 and severe hypoxaemia on all outcomes up to 90 days.
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http://dx.doi.org/10.1007/s00134-021-06573-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579417PMC
January 2022

Equipment-free detection of SARS-CoV-2 and Variants of Concern using Cas13.

medRxiv 2021 Nov 2. Epub 2021 Nov 2.

The COVID-19 pandemic, and the recent rise and widespread transmission of SARS-CoV-2 Variants of Concern (VOCs), have demonstrated the need for ubiquitous nucleic acid testing outside of centralized clinical laboratories. Here, we develop SHINEv2, a Cas13-based nucleic acid diagnostic that combines quick and ambient temperature sample processing and lyophilized reagents to greatly simplify the test procedure and assay distribution. We benchmarked a SHINEv2 assay for SARS-CoV-2 detection against state-of-the-art antigen-capture tests using 96 patient samples, demonstrating 50-fold greater sensitivity and 100% specificity. We designed SHINEv2 assays for discriminating the Alpha, Beta, Gamma and Delta VOCs, which can be read out visually using lateral flow technology. We further demonstrate that our assays can be performed without any equipment in less than 90 minutes. SHINEv2 represents an important advance towards rapid nucleic acid tests that can be performed in any location.
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http://dx.doi.org/10.1101/2021.11.01.21265764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575147PMC
November 2021

Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia: The COVID STEROID 2 Randomized Trial.

JAMA 2021 11;326(18):1807-1817

Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

Importance: A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease.

Objective: To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia.

Design, Setting, And Participants: A multicenter, randomized clinical trial was conducted between August 2020 and May 2021 at 26 hospitals in Europe and India and included 1000 adults with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation. End of 90-day follow-up was on August 19, 2021.

Interventions: Patients were randomized 1:1 to 12 mg/d of intravenous dexamethasone (n = 503) or 6 mg/d of intravenous dexamethasone (n = 497) for up to 10 days.

Main Outcomes And Measures: The primary outcome was the number of days alive without life support (invasive mechanical ventilation, circulatory support, or kidney replacement therapy) at 28 days and was adjusted for stratification variables. Of the 8 prespecified secondary outcomes, 5 are included in this analysis (the number of days alive without life support at 90 days, the number of days alive out of the hospital at 90 days, mortality at 28 days and at 90 days, and ≥1 serious adverse reactions at 28 days).

Results: Of the 1000 randomized patients, 982 were included (median age, 65 [IQR, 55-73] years; 305 [31%] women) and primary outcome data were available for 971 (491 in the 12 mg of dexamethasone group and 480 in the 6 mg of dexamethasone group). The median number of days alive without life support was 22.0 days (IQR, 6.0-28.0 days) in the 12 mg of dexamethasone group and 20.5 days (IQR, 4.0-28.0 days) in the 6 mg of dexamethasone group (adjusted mean difference, 1.3 days [95% CI, 0-2.6 days]; P = .07). Mortality at 28 days was 27.1% in the 12 mg of dexamethasone group vs 32.3% in the 6 mg of dexamethasone group (adjusted relative risk, 0.86 [99% CI, 0.68-1.08]). Mortality at 90 days was 32.0% in the 12 mg of dexamethasone group vs 37.7% in the 6 mg of dexamethasone group (adjusted relative risk, 0.87 [99% CI, 0.70-1.07]). Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% in the 12 mg of dexamethasone group vs 13.4% in the 6 mg of dexamethasone group (adjusted relative risk, 0.83 [99% CI, 0.54-1.29]).

Conclusions And Relevance: Among patients with COVID-19 and severe hypoxemia, 12 mg/d of dexamethasone compared with 6 mg/d of dexamethasone did not result in statistically significantly more days alive without life support at 28 days. However, the trial may have been underpowered to identify a significant difference.

Trial Registration: ClinicalTrials.gov Identifier: NCT04509973 and ctri.nic.in Identifier: CTRI/2020/10/028731.
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http://dx.doi.org/10.1001/jama.2021.18295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532039PMC
November 2021

Remote mental health services: a mixed-methods survey and interview study on the use, value, benefits and challenges of a national video consulting service in NHS Wales, UK.

BMJ Open 2021 09 30;11(9):e053014. Epub 2021 Sep 30.

Department of Informatics, TEC Cymru, Aneurin Bevan University Health Board, Gwent, UK.

Social distancing laws during the first year of the pandemic, and its unprecedented changes to the National Health Service (NHS) forced a large majority of services, especially mental health teams to deliver patient care remotely. For many, this approach was adopted out of necessity, rather than choice, thus presenting a true 'testing ground' for remote healthcare and a robust evaluation on a national and representative level.

Objective: To extract and analyse mental health specific data from a national dataset for 1 year (March 2020-March 2021).

Design: A mixed-methods study using surveys and interviews.

Setting: In NHS mental health services in Wales, UK.

Participants: With NHS patients and clinicians across child and adolescent, adult and older adult mental health services.

Outcome Measures: Mixed methods data captured measures on use, value, benefits and challenges of video consulting (VC).

Results: A total of 3561 participants provided mental health specific data. These data and its findings demonstrate that remote mental health service delivery, via the method of VC is highly satisfactory, well-accepted and clinically suitable for many patients, and provides a range of benefits to NHS patients and clinicians. Interestingly, clinicians working from 'home' rated VC more positively compared with those at their 'clinical base'.

Conclusions: Post 1-year adoption, remote mental health services in Wales UK have demonstrated that VC is possible from both a technical and behavioural standpoint. Moving forward, we suggest clinical leaders and government support to sustain this approach 'by default' as an option for NHS appointments.
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http://dx.doi.org/10.1136/bmjopen-2021-053014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487209PMC
September 2021

"Assessing Today for a Better Tomorrow": An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea.

PLoS One 2021 30;16(8):e0254938. Epub 2021 Aug 30.

Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Background: Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed.

Objective: To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality.

Methods: Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models.

Results: Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42-11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10-3.65, p = 0.023).

Conclusion: Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254938PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405010PMC
November 2021

How secured and safe is the sanitation and hygiene services in a maximum-security correctional facility in Southwest Nigeria: a descriptive cross-sectional study.

Int J Environ Health Res 2021 Jul 27:1-18. Epub 2021 Jul 27.

Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.

Poorly maintained living conditions and infrastructure are the banes of Nigerian prisons. The study investigated its environmental conditions and the prevalent diseases among inmates.The descriptive, cross-sectional study enrolled 420-inmates through a multistage sampling technique. Pre-tested instruments were administered and results presented with descriptive and logistic regression to identify predictors of toilet-cleaning and handwashing practices at P0.05.The mean(±SD) age and modal inmates/cell were 30±7.2 years and 36. Most inmates were males (97%), await-trial (79%) and lives in overcrowded cells (58%). Sixty-nine percent of free-cells has pour-flush toilets and 36% waits for 2-5 minutes before accessing toilets.Fifty-three percent of inmates clean latrines with water and soap, 71% burn solid waste while handwashing period-prevalence was 36%. Religion, toilet-cleaning, and education were predictors of handwashing while types of toilets and access predict toilet-cleaning behaviour. Malaria (81.1%) and scabies (7.3%) were endemic. The prison rehabilitation shall satisfy basic life needs and promote prisoners' health.
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http://dx.doi.org/10.1080/09603123.2021.1949438DOI Listing
July 2021

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework.

BMJ Glob Health 2021 07;6(Suppl 5)

Ministry of Health and Family Welfare, New Delhi, India.

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.
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http://dx.doi.org/10.1136/bmjgh-2021-005242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728378PMC
July 2021

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

Exp Parasitol 2021 Sep 17;228:108135. 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
September 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
October 2021

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

Lancet Glob Health 2021 09 2;9(9):e1203-e1204. 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
September 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 2022 09 22;29(6):1262-1284. 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
September 2022
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