India has 18% of the global population and an increasing burden of chronic respiratory diseases. However, a systematic understanding of the distribution of chronic respiratory diseases and their ...trends over time is not readily available for all of the states of India. Our aim was to report the trends in the burden of chronic respiratory diseases and the heterogeneity in their distribution in all states of India between 1990 and 2016.
Using all accessible data from multiple sources, we estimated the prevalence of major chronic respiratory diseases and the deaths and disability-adjusted life-years (DALYs) caused by them for every state of India from 1990 to 2016 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016. We assessed heterogeneity in the burden of chronic obstructive pulmonary disease (COPD) and asthma across the states of India. The states were categorised into four groups based on their epidemiological transition level (ETL). ETL was defined as the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We also assessed the contribution of risk factors to DALYs due to COPD. We compared the burden of chronic respiratory diseases in India against the global average in GBD 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.
The contribution of chronic respiratory diseases to the total DALYs in India increased from 4·5% (95% UI 4·0–4·9) in 1990 to 6·4% (5·8–7·0) in 2016. Of the total global DALYs due to chronic respiratory diseases in 2016, 32·0% occurred in India. COPD and asthma were responsible for 75·6% and 20·0% of the chronic respiratory disease DALYs, respectively, in India in 2016. The number of cases of COPD in India increased from 28·1 million (27·0–29·2) in 1990 to 55·3 million (53·1–57·6) in 2016, an increase in prevalence from 3·3% (3·1–3·4) to 4·2% (4·0–4·4). The age-standardised COPD prevalence and DALY rates in 2016 were highest in the less developed low ETL state group. There were 37·9 million (35·7–40·2) cases of asthma in India in 2016, with similar prevalence in the four ETL state groups, but the highest DALY rate was in the low ETL state group. The highest DALY rates for both COPD and asthma in 2016 were in the low ETL states of Rajasthan and Uttar Pradesh. The DALYs per case of COPD and asthma were 1·7 and 2·4 times higher in India than the global average in 2016, respectively; most states had higher rates compared with other locations worldwide at similar levels of Socio-demographic Index. Of the DALYs due to COPD in India in 2016, 53·7% (43·1–65·0) were attributable to air pollution, 25·4% (19·5–31·7) to tobacco use, and 16·5% (14·1–19·2) to occupational risks, making these the leading risk factors for COPD.
India has a disproportionately high burden of chronic respiratory diseases. The increasing contribution of these diseases to the overall disease burden across India and the high rate of health loss from them, especially in the less developed low ETL states, highlights the need for focused policy interventions to address this significant cause of disease burden in India.
Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Abstract Background context Adjacent segment disease (ASD) after lumbar spinal fusion has been an important reason behind the development of nonfusion stabilization technology. However, the ...incidence, prevalence, and factors contributing to adjacent segment degeneration in the lumbar spine remain unclear. A range of prevalence rates for ASD have been reported in the lumbar spinal literature, but the annual incidence has not been widely studied in this region. Conflicting reports exist regarding risk factors, especially fusion length. Purpose To determine the annual incidence and prevalence of further surgery for adjacent segment disease (SxASD) after posterior lumbar arthrodesis and examine possible risk factors. Study design Retrospective cohort study. Patient sample Nine hundred twelve patients who underwent 1,000 consecutive posterior lumbar interbody fusion procedures, with mean follow-up duration of 63 months (range, 5 months–16 years). Outcome measures Further surgery for ASD or surgery-free survival. Methods A postal and telephone survey. Follow-up rate: 91% of patients. The annual incidence and prevalence of ASD requiring further surgery were determined using Kaplan–Meier survivorship analysis. Cox proportional-hazards (Cox) regression was used for multivariate analysis of possible risk factors. Significance was set at p<.05. Results Further surgery for ASD occurred following 130 of 1,000 or 13% of procedures at a mean time of 43 months (range, 2.3–162 months). The mean annual incidence of SxASD over the first 10 years, in all patients, was 2.5% (95% confidence interval 95% CI, 1.9–3.1) with prevalences of 13.6% and 22.2% at 5 and 10 years, respectively. Cox regression modeling found that the number of levels fused (p≤.0003), age of the patient, fusing to L5, and performing an additional laminectomy adjacent to a fusion all independently affect the risk of SxASD. The mean annual incidence figures in the first 10 years after a lumbar fusion were 1.7% (95% CI, 1.3–2.2) after fusion at single levels, 3.6% (2.1–5.2) after two levels, and 5.0% (3.3–6.7) after three and four levels. The 5- and 10-year prevalences were 9% and 16%, 17% and 31%, and 29% and 40% after single-, two-, and three-/four-level fusions, respectively. The risk of SxASD in patients younger than 45 years was one-quarter (95% CI, 10–64) the risk of patients older than 60 years (p=.003). A laminectomy adjacent to a fusion increases the relative risk by 2.4 times (95% CI, 1.1–5.2; p=.03). Stopping a fusion at L5 is associated with a 1.7-fold increased risk (95% CI, 1.2–2.4; p=.007) of SxASD compared with a fusion to S1, for fusions of the same length. Conclusion The overall annual incidence and predicted 10-year prevalence of further surgery for ASD after lumbar arthrodesis were 2.5% and 22.2%, respectively. These rates varied widely depending on the identified risk factors. Although young patients who underwent single-level fusions were at low risk, patients who underwent fusion of three or four levels had a threefold increased risk of further surgery, compared with single-level fusions (p<.0001), and a predicted 10-year prevalence of 40%.
IntroductionFeeding practices developed in early life can impact a child’s nutrition, growth, dental health, cognitive development and lifetime risk of chronic diseases. Substantial evidence suggests ...ethnic health inequalities, and non-recommended complementary infant feeding practices among UK’s South Asian (SA) population. Nurture Early for Optimal Nutrition aims to use women’s group participatory learning and action (PLA) cycles to optimise infant feeding, care and dental hygiene practices in SA infants <2 years in East London.Methods and analysisA three-arm pilot feasibility cluster randomised controlled trial will assess feasibility, acceptability, costs and explore preliminary effectiveness for proposed primary outcome (ie, reporting on body mass index (BMI) z-score). Multilingual SA community facilitators will deliver the intervention, group PLA Cycle, to mothers/carers in respective ethnic/language groups. 12 wards are randomised to face-to-face PLA, online PLA and usual care arms in 1:1:1 ratio. Primary outcomes are feasibility and process measures (ie, BMI z-score, study records, feedback questionnaires, direct observation of intervention and sustainability) for assessment against Go/Stop criteria. Secondary outcomes are cluster-level and economic outcomes (ie, eating behaviour, parental feeding practices, network diffusion, children development performance, level of dental caries, general practitioner utilisation, costs, staff time). Outcomes are measured at baseline, every 2 weeks during intervention, 14 weeks and at 6 months by blinded outcome assessors where possible. This study will use concurrent mixed-methods evaluation. Quantitative analyses include descriptive summary with 95% CI and sample size calculation for the definitive trial. The intervention effect with CI will be estimated for child BMI z-score. Implementation will be evaluated qualitatively using thematic framework analysis.Ethics and disseminationEthics approval was obtained from University College London (UCL), National Health Service (Health Research Authority (HRA) and Health and Care Research Wales (HRCW)). Results will be published in peer-reviewed journals, presented at scientific conferences/workshops with commissioners, partners and participating communities. Plain language summaries will be disseminated through community groups, websites and social media.Trial registration numberIRAS-ID-296259 (ISRCTN10234623).
Method Evaluation—A Practical Guide Smith, Mari; Sheehan, Chris; He, Jianwen
The Immunoassay Handbook: Theory and applications of ligand binding, ELISA and related techniques,
2013
Reference
Platelet-derived growth factor-A (PDGF-A) is essential for processes involving cell motility throughout embryonic development. Here we examined the underlying basis of its role as a guidance cue for ...the directed migration of anterior mesendoderm cells during a period of cell reorganizations called gastrulation. In Xenopus laevis embryos, these cells migrate across a fibronectinrich extracellular matrix (ECM) that lines the blastocoel roof (BCR). We tested the hypothesis that PDGF-A mRNA is in a graded pattern across the BCR that is modulated by mesendoderm cells as they move across it. Quantitative reverse transcriptase polymerase chain reactions were performed on BCR tissue sections. Throughout gastrulation, the overall levels of PDGF-A mRNA increased, and at all developmental stages examined, the same pattern of PDGF-A mRNA was identified. PDGF-A mRNA levels were lowest at the blastopore lip and although higher levels were detected across the rest of the BCR, they were equivalent between tissue sections. Tissues were also dissected from altered embryos in which the position of the mesendoderm remained like that of earlier gastrula staged embryos (stages 10 and 10.5). In these cases, the low levels and distribution of PDGF-A mRNA was similar to that of earlier staged embryos across all developmental stages examined. These data supported our hypothesis and suggested that during gastrulation the mesendoderm moves from a lower to a higher level of PDGF-A expression. They further indicated that the mesendoderm itself plays a role in modulating PDGF-A mRNA during gastrulation. To understand how PDGF-A might be established as a guidance cue for migrating mesendoderm cells, the interaction of PDGF-A with the ECM was investigated. We found a direct interaction between PDGF-A and fibronectin. This interaction is enhanced by heparin, which revealed PDGF-A binding sites by modulating fibronectin structure. We further demonstrated that endogenous heparan sulfate proteoglycans (HSPG's) are required for PDGF-A-guided mesendoderm movement, indicating an in vivo role for HSPGs in mediating the interaction between PDGF-A and fibronectin. Our data further suggested that the expression pattern of PDGF-A in the BCR could lead to a graded distribution of PDGF-A in the ECM by binding to fibronectin at its site of secretion.
Application of the filter diagonalization method (FDM) to the spectral estimation of purely phase-modulated 2D-J NMR data is described. It is shown that obtaining an entire 2D line list of spectral ...parameters is not a prerequisite for constructing a spectral estimate of the data. Common problems with 2D FT analysis, such as phase-twist lineshapes, spectral broadening from the time-frequency uncertainty principle, and vanishing phase-sensitive 45° projections, can be ameliorated using 2D FDM. Averaging over several different FDM calculations improves the spectral presentation. Examples are shown with complex spectra obtained using only a handful of time increments.
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