1,078 results on '"Wayne Smith"'
Search Results
2. Obesity, hypertension, and tobacco use associated with left ventricular remodeling and hypertrophy in South African women: Birth to Twenty Plus Cohort
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Andrea Kolkenbeck-Ruh, Larske M. Soepnel, Simone H. Crouch, Sanushka Naidoo, Wayne Smith, Shane A. Norris, Justine Davies, and Lisa J. Ware
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Left ventricular hypertrophy ,Ventricular remodeling ,Sub-Saharan Africa ,South Africa ,Child health ,Women's health ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Left ventricular hypertrophy (LVH) is a marker of increased risk in developing future life-threatening cardiovascular disease (CVD), however, it is unclear how CVD risk factors, such as obesity, blood pressure (BP), and tobacco use, are associated with left ventricular (LV) remodeling and LVH in urban African populations. Therefore, we aimed to identify the prevalence of LVH as well as the health factors associated with LV remodeling and LVH, within black South African adult women and their pre-pubescent children. Methods Black female adults (n = 123; age: 29–68 years) and their children (n = 64; age: 4–10; 55% female) were recruited from the Birth to Twenty Plus Cohort in Soweto, South Africa. Tobacco and alcohol use, physical activity, presence of diabetes mellitus, heart disease, and medication were self-reported. Height, weight, and blood pressure were measured in triplicate to determine the prevalence of obesity and hypertension respectively. Echocardiography was used to assess LV mass at end-diastole, based on linear measurements, and indexed to body surface area to determine LVH. Results Hypertension and obesity prevalences were 35.8% and 59.3% for adults and 45.3% and 6.3% for children. Self-reported tobacco use in adults was 22.8%. LVH prevalence was 35.8% in adults (75% eccentric: 25% concentric), and 6.3% in children. Concentric remodeling was observed in 15.4% of adults, however, concentric remodeling was only found in one child. In adults, obesity [OR: 2.54 (1.07–6.02; p = 0.02)] and hypertension [3.39 (1.08–10.62; p = 0.04)] significantly increased the odds of LVH, specifically eccentric LVH, while concentric LVH was associated with self-reported tobacco use [OR: 4.58 (1.18–17.73; p = 0.03)]. Although no logistic regression was run within children, of the four children LVH, three had elevated blood pressure and the child with normal blood pressure was overweight. Conclusions The association between obesity, hypertension, tobacco use, and LVH in adults, and the 6% prevalence of LVH in children, calls for stronger public health efforts to control risk factors and monitor children who are at risk.
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- 2022
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3. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis
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Andi Orlowski, Rachel Ashton, Wayne Smith, Duncan McPherson, Nicola Clarke, Alison Martin, Andrea Bertuzzi, and Cassandra Springate
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Medicine - Abstract
Objectives Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.Design Systematic review and narrative synthesis.Data sources Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022.Eligibility criteria Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread.Data extraction and synthesis Data were extracted and synthesised narratively, according to the methods of Campbell et al.Results Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.Conclusions The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.PROSPERO registration number CRD42022311689.
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- 2023
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4. A single-institution review of image-guided brachytherapy for vaginal malignancies using customized molded applicators and interstitial needles
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Emily Flower, Salman Zanjani, Gemma Busuttil, Emma Sullivan, Wayne Smith, Kathy Tran, David Thwaites, Jennifer Chard, and Viet Do
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vagina ,endometrial recurrence ,brachytherapy. ,Medicine - Published
- 2021
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5. Outcomes of a Climate Change Workshop at the 2020 African Conference on Emergency Medicine
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Caitlin Rublee, Corey Bills, Elzarie Theron, Petra Brysiewicz, Swasthi Singh, Ivy Muya, Wayne Smith, On-Emore Akpevwe, Lawan Abdulrazaq Ali, Enoch Dauda, and Emilie Calvello Hynes
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Climate change ,Disasters ,Education ,Research ,Policy ,Climate-smart healthcare ,Medicine ,Medicine (General) ,R5-920 - Abstract
A changing climate will have demonstrable effects on health and healthcare systems, with specific and disproportionate effects on communities in Africa. Emergency care systems and providers have an opportunity to be at the forefront of efforts to combat the worst health effects from climate change. The 2020 African Conference on Emergency Medicine, under the auspices of the African Federation for Emergency Medicine, convened its first ever workshop on the topic of climate change and human health. Structured as a full day virtual course, the didactic sections were available for both live and asynchronous learning with more than 100 participants enrolled in the course. The workshop introduced the topic of the health effects of climate as they relate to emergency care in Africa and provided a forum to discuss ideas regarding the way forward. Lectures and focused discussions addressed three broad themes related to: health impacts, health care delivery, and advocacy. To our knowledge, this is the first workshop for health professionals to cover topics specific to emergency care, climate change, and health in Africa. The results of this workshop will help to guide future efforts aimed at advancing emergency care approaches in Africa with regard to medical education, research, and policy. African relevance: • Climate-related extreme weather events are adversely affecting health and health care delivery in African countries. • African organisations, cities, and nations have taken positive steps to adapt and build climate resilience. • There are opportunities for emergency care professionals and scholars to continue to expand, and lead, climate and health education, research, and policy initiatives on the continent.
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- 2021
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6. Are cardiovascular health measures heritable across three generations of families in Soweto, South Africa? A cross-sectional analysis using the random family method
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Juliana Kagura, Shane A Norris, Justine Davies, Innocent Maposa, Wayne Smith, Lisa J Ware, Andrea Kolkenbeck-Ruh, Larske Soepnel, Simone Crouch, and Sanushka Naidoo
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Medicine - Abstract
Objectives Cardiovascular disease is increasing in many low and middle-income countries, including those in Africa. To inform strategies for the prevention of cardiovascular disease in South Africa, we sought to determine the broad heritability of phenotypic markers of cardiovascular risk across three generations.Design A cross-sectional study conducted in a longitudinal family cohort.Setting Research unit within a tertiary hospital in a historically disadvantaged, large urban township of South Africa.Participants 195 individuals from 65 biological families with all three generations including third-generation children aged 4–10 years were recruited from the longest running intergenerational cohort study in Africa, the Birth to Twenty Plus cohort. All adults (grandparents and parents) were female while children were male or female.Primary and secondary outcome measures The primary outcome was heritability of blood pressure (BP; brachial and central pressures). Secondary outcomes were heritability of arterial stiffness (pulse wave velocity), carotid intima media thickness (cIMT) and left ventricular mass indexed to body surface area (LVMI).Results While no significant intergenerational relationships of BP or arterial stiffness were found, there were significant relationships in LVMI across all three generations (p
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- 2022
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7. A New Method to Calculate Cotton Fiber Length Uniformity Using the HVI Fibrogram
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Md Abu Sayeed, Christopher Turner, Brendan R. Kelly, John Wanjura, Wayne Smith, Mitchell Schumann, and Eric F. Hequet
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high volume instrument ,fiber length measurement ,fiber length uniformity ,fiber length distribution ,fibrogram ,Agriculture - Abstract
Knowledge of cotton fiber length uniformity is important for the cotton industry. The accurate and reliable measurement of fiber length uniformity would allow cotton breeders to release new cotton varieties with improved fiber length variation. This knowledge would also help spinning mills to optimize their machine setup, which would improve yarn processing performance. Currently, the high volume instrument (HVI) is most commonly used to characterize the cotton fiber length variation. The HVI length measurement is based on the fibrogram principle. The HVI length measurement characterizes 2 points, 1.8% as the upper half mean length (UHML) and 7.8% span length as the mean length (ML) from the fibrogram, and reports UHML and uniformity index (UI). The ratio of ML to the UHML is used to calculate the UI and is expressed as a percentage. UI measurement does not represent the shorter fibers as the above two span lengths only represent the longest fibers within a sample. We propose to calculate the uniformity of the cotton fiber length using the complete fibrogram as an alternative. First, the area of the measured fibrogram curve is calculated. Second, the area of a theoretical mono-length fibrogram with a length equal to the maximum length of the fibers for the same sample is calculated. Finally, we calculate a new length uniformity as the ratio of the measured fibrogram area to the mono-length fibrogram area expressed as a percentage. Based on the results obtained using a set of 991 commercial samples, the new length uniformity shows promise. We also applied this new length uniformity to a set of 60 commercial-like samples and developed partial least square regression (PLSR) prediction models to predict yarn quality. The results obtained demonstrate that the new length uniformity predicts yarn quality better than the current UI.
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- 2023
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8. Vascular function and cardiovascular risk in a HIV infected and HIV free cohort of African ancestry: baseline profile, rationale and methods of the longitudinal EndoAfrica-NWU study
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Carla M. T. Fourie, Shani Botha-Le Roux, Wayne Smith, Aletta E. Schutte, Yolandi Breet, Carina M. C. Mels, Lebo F. Gafane-Matemane, Leandi Lammertyn, Lisa Uys, Adele Burger, Jitcy S. Joseph, Nandu Goswami, Patrick De Boever, and Hans Strijdom
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HIV ,Antiretroviral therapy ,Cardiovascular risk markers ,Endothelial function ,Vascular function ,African ancestry ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background People living with the Human Immunodeficiency Virus (PLHIV) have an increased susceptibility to develop non-communicable diseases such as cardiovascular disease (CVD). Infection with HIV contributes to the development of CVD independent of traditional risk factors, with endothelial dysfunction being the central physiological mechanism. While HIV-related mortality is declining due to antiretroviral treatment (ART), the number of deaths due to CVD is rising in South Africa - the country with the highest number of PLHIV and the world’s largest ART programme. The EndoAfrica study was developed to determine whether HIV infection and ART are associated with cardiovascular risk markers and changes in vascular structure and function over 18 months in adults from different provinces of South Africa. This paper describes the rationale, methodology and baseline cohort profile of the EndoAfrica study conducted in the North West Province, South Africa. Methods In this case-control study, conducted between August 2017 and June 2018, 382 volunteers of African descent (276 women; 106 men), comprising of 278 HIV infected and 104 HIV free individuals were included. We measured health behaviours, a detailed cardiovascular profile, and performed biomarker analyses. We compared baseline characteristics, blood pressure, vascular function and biochemical markers between those infected and HIV free. Results At baseline, the HIV infected participants were older (43 vs 39 years), less were employed (21% vs 40%), less had a tertiary education (7% vs 16%) and their body mass index was lower (26 vs 29 kg/m2) than that of the HIV free participants. While the cardiovascular profile, flow-mediated dilation and pulse wave velocity did not differ, glycated haemoglobin was lower (p = 0.017) and total cholesterol, high density lipoprotein cholesterol, triglycerides, gamma-glutamyltransferase and tobacco use were higher (all p
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- 2020
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9. How an electronic health record became a real-world research resource: comparison between London’s Whole Systems Integrated Care database and the Clinical Practice Research Datalink
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Alex Bottle, Carole Cohen, Amanda Lucas, Kavitha Saravanakumar, Zia Ul-Haq, Wayne Smith, Azeem Majeed, and Paul Aylin
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Data warehousing ,Electronic medical records ,Integrated care ,Real world evidence ,Clinical practice research Datalink ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background In the UK, several initiatives have resulted in the creation of local data warehouses of electronic patient records. Originally developed for commissioning and direct patient care, they are potentially useful for research, but little is known about them outside their home area. We describe one such local warehouse, the Whole Systems Integrated Care (WSIC) database in NW London, and its potential for research as the “Discover” platform. We compare Discover with the Clinical Practice Research Datalink (CPRD), a popular UK research database also based on linked primary care records. Methods We describe the key features of the Discover database, including scope, architecture and governance; descriptive analyses compare the population demographics and chronic disease prevalences with those in CPRD. Results As of June 2019, Discover held records for a total of 2.3 million currently registered patients, or 95% of the NW London population; CPRD held records for over 11 million. The Discover population matches the overall age-sex distribution of the UK and CPRD but is more ethnically diverse. Most Discover chronic disease prevalences were comparable to the national rates. Unlike CPRD, Discover has identifiable care organisations and postcodes, allowing mapping and linkage to healthcare provider variables such as staffing, and includes contacts with social, community and mental health care. Discover also includes a consent-to-contact register of over 3000 volunteers to date for prospective studies. Conclusions Like CPRD, Discover has been a number of years in the making, is a valuable research tool, and can serve as a model for other areas developing similar data warehouses.
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- 2020
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10. Cross-Talk Between Large Artery Stiffness and Retinal Microvasculature in Children: The ExAMIN Youth SA Study
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Yolandi Breet, Ashleigh Craig, Wayne Smith, Shani Botha-Le Roux, Lebo F. Gafane-Matemane, Sanette Brits, Johannes M. van Rooyen, Henner Hanssen, and Ruan Kruger
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arterial stiffness ,central retinal artery equivalent ,central retinal vein equivalent ,arterio-venous ratio ,ethnicity ,pediatric ,Pediatrics ,RJ1-570 - Abstract
Background: Cross-talk between the macro-and microvasculature is considered an important contributor to target organ damage. Previous findings were predominantly in adult populations and investigation into this mechanism in children may provide insight into the development of early adverse vascular changes. Whether any ethnic differences in cross-talk is evident, also remains to be determined.Objective: To determine whether retinal microvascular diameters are associated with large artery stiffness in young children and whether ethnic differences are evident.Materials and Methods: In this cross-sectional study, 730 black (n = 437) and white (n = 293) school children aged 5-9 years were included. Pulse wave velocity (PWV) was measured and the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) diameters were calculated from fundus images. The arterio-venous ratio (AVR) was subsequently calculated.Results: Pulse wave velocity was lower (p ≤ 0.001) in the black group when compared to the white group. The black group had a narrower CRAE, wider CRVE and lower AVR (all p < 0.001). Pulse wave velocity associated negatively with CRAE (r = –0.141, p = 0.003) and AVR (r = –0.185, p ≤ 0.001) in the black group only. A positive association between PWV and CRVE was seen in the black (r = 0.174, p ≤ 0.001) and white (r = 0.119, p = 0.043) group.Conclusion: Large artery stiffness is associated with retinal arterial narrowing and venular widening in children, suggesting cross-talk between the macro-and microvasculature. Ethnic differences in these associations are also evident. Our findings warrant further investigation into environmental and sociocultural risk factors contributing to premature cardiovascular disease development.
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- 2021
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11. Teaching for Student and Societal Wellbeing in HPE: Nine Pedagogies for Social Justice
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Göran Gerdin, Rod Philpot, Wayne Smith, Katarina Schenker, Kjersti Mordal Moen, Lena Larsson, Susanne Linnér, and Knut Westlie
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wellbeing ,health ,physical education ,social justice ,pedagogy ,Sports ,GV557-1198.995 - Abstract
We currently find ourselves living in precarious times, with old and new social inequities on the rise due to the challenges associated with an unprecedented rise of global migration and neoliberalism, amplified in our post COVID-19 world. Research has demonstrated that there is a high correlation between inequality at the societal level and the overall health and wellbeing of individuals within those societies. We believe that school health and physical education (HPE) has a significant role to play in addressing and acting on social inequities that impact on the wellbeing of both students and society as a whole. Based on the findings of an international research project called EDUHEALTH which explored pedagogies for social justice in school health and physical education (HPE) across Sweden, Norway and New Zealand, this paper aims to highlight the addressing of (in)equality and student wellbeing through HPE practice. In particular, the paper presents nine different but complementary pedagogies for social justice that we believe can improve individual, collective, and societal wellbeing. We conclude by proposing that, if adopted across a whole school curriculum, these nine pedagogies for social justice could form the basis of a holistic school-wide community approach aimed at improving both student and societal wellbeing.
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- 2021
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12. P.12 Investigating the Role of Glycemic Markers in Pulse Pressure Amplification in Young Adults: The African-PREDICT Study
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Yolandi Breet, Leandi Lammertyn, and Wayne Smith
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Pulse pressure ratio ,diabetes ,Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Pulse pressure amplification (PPA) is described as the amplification of pulse pressure from central arteries to the periphery [1] and individuals with a decreased PPA have an increased risk of cardiovascular disease [2]. Adverse changes in PPA are evident in diabetic populations [3]; however, it is unclear whether PPA differs along varying degrees of glycaemia in young healthy populations. We therefore investigated whether PPA is attenuated with higher levels of glycemic markers and whether PPA is associated with glycemic markers independent of other known risk factors. Methods: We included 1195 men and women from the African-PREDICT study, aged 20–30 years, with no prior diagnosis of chronic disease. We determined supine central PP (cPP) using the SphygmoCor XCEL device and PPA was defined as the ratio of the amplitude of the PP between the distal and proximal locations (bPP/cPP). Fasting glucose and glycated haemoglobin were determined and the study population was stratified by tertiles of each glycemic marker. Results: The mean PPA was lower in the highest tertile of fasting glucose when compared to the lowest tertile (1.11 vs. 1.23; p ≤ 0.001). PPA declined with increasing levels of fasting glucose (p–trend ≤ 0.001) after adjustment for age, sex, ethnicity, height, heart rate and mean arterial pressure. In multivariable adjusted regression, we found an independent inverse association between PPA and fasting glucose (β = −0.15, p ≤ 0.001). Conclusion: PPA decreases with an increase in fasting glucose in adults younger than 30 years, exemplifying early vascular changes which may increase future cardiovascular risk. FigurePulse pressure amplification plotted against tertiles of fasting glucose. Values are adjusted for age, sex, heart rate, height and mean arterial pressure. *indicates p-value < 0.05 between the lowest and highest glucose group. Adjusted R2 Pulse pressure amplification 0.15 β (SE) p Age (years) –0.17 (0.03)
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- 2020
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13. The Exercise, Arterial Modulation and Nutrition in Youth South Africa Study (ExAMIN Youth SA)
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Ruan Kruger, Makama Andries Monyeki, Aletta Elisabeth Schutte, Wayne Smith, Catharina Martha Cornelia Mels, Herculina Salomé Kruger, Anita Elizabeth Pienaar, Lebo Francina Gafane-Matemane, Yolandi Breet, Leandi Lammertyn, Gontse Gratitude Mokwatsi, Ankebé Kruger, Elmari Deacon, and Henner Hanssen
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child health ,blood pressure ,obesity ,arterial stiffness ,retinal vessel diameters ,nutrition ,Pediatrics ,RJ1-570 - Abstract
Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children.Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ~1,000 primary school children (black and white boys and girls between ages 5–9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging.Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs.Trial registration: The study was retrospectively registered on ClinicalTrials.gov on 15 August 2019 (NCT04056377).
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- 2020
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14. A method to improve cotton fiber length measurement for laboratory analysis
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Joao Morais, Jacob James, Zach Hinds, Wayne Smith, Brendan Kelly, and Eric Hequet
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Ginning ,Fiber length distribution ,Lint cleaning ,Trash ,Processing ,Science - Abstract
Cotton fiber length is an essential parameter for the cotton industry and cotton research. However, differences between industry- and laboratory-scale ginning may lead to inconsistencies between research and industry results for measured length. Seedcotton from farms is processed in large industry-scale gins, while researchers typically use small laboratory-scale gins. The proposed method successfully reduces the differences in fiber length parameters between these two types of ginning. Only one new step is needed before assessing fiber quality in lint from a laboratory-scale gin to simulate the processing effect of an industry-scale gin. • Cotton seeds and lint are separated from seedcotton with a laboratory-scale gin. • Lint is post-processed with a laboratory-scale lint cleaner, the micro dust and trash analyzer 3. • The length fiber quality profile resembles the results of industry-scale ginned samples.
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- 2020
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15. A Surface-Enhanced Raman Spectral Library of Important Drugs Associated With Point-of-Care and Field Applications
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Stuart Farquharson, Carl Brouillette, Wayne Smith, and Chetan Shende
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opioids ,buprenorphine ,cannabis ,fentanyl ,SERS ,drug analysis ,Chemistry ,QD1-999 - Abstract
During the past decade, the ability of surface-enhanced Raman spectroscopy (SERS) to measure extremely low concentrations, such as mg/L and below, and the availability of hand-held Raman spectrometers, has led to a significant growth in the number and variety of applications of SERS to real-world problems. Most of these applications involve the measurement of drugs, such as quantifying medication in patients, identifying illicit drugs in impaired drivers, and more recently, identifying drugs used as weapons. Similar to Raman spectroscopy, most of the point-of-care and field applications involve the identification of the drug to determine the course of action. However, unlike Raman spectroscopy, spectral libraries are not readily available to perform the necessary identification. In a large part, this is due to the uniqueness of the commercially available SERS substrates, each of which can produce different spectra for the same drug. In an effort to overcome this limitation, we have measured numerous drugs using the most common, and readily available SERS material and hand-held Raman analyzers, specifically gold colloids and analyzers using 785 nm laser excitation. Here we present the spectra of some 39 drugs of current interest, such as buprenorphine, delta-9 tetrahydrocannabinol, and fentanyl, which we hope will aid in the development of current and future SERS drug analysis applications.
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- 2019
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16. Exploring the factor structure of the Health of the Nation Outcomes Scale (HoNOS) in a sample of patients with schizophrenia, schizotypal and delusional disorders
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Wayne Smith, Silia Vitoratou, Paul McCrone, and Anita Patel
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HoNOS ,Factor analysis ,Bifactor analysis ,Bayesian ,Factor structure ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background The Health of the Nation Outcomes Scale (HoNOS) is recommended for use by the English National Service Framework for Mental Health and by the working group on outcome indicators for severe mental illnesses to the Department of Health. It was developed to measure the health and social functioning of people with severe mental illness. Since the development of the HoNOS many have debated its latent structure. This paper examines the latent structure of the HoNOS using current factor analysis techniques. Method HoNOS data for 12,910 patients with ICD10 diagnoses F20 to F29 at a UK National Health Service Mental Health Trust were analysed using exploratory, confirmatory and bifactor analysis for categorical data. The fit of models was assessed using relative and absolute fit indices. Results Exploratory followed by confirmatory factor analysis identified a four factor solution which fit the data better than existing models. The corresponding bifactor factor solution identified three robust factors and one weak factor after accounting for a general factor. The factor loadings on the general factor were not appreciably different when compared to a unidimensional factor solution indicating the existence of a common trait. Conclusion Existing models proposed in the literature did not fit well in our data. Factor analysis identified a new four factor solution. These factors showed clinical relevance according to published literature. The bifactor model demonstrated that there is not much loss of information when the HoNOS is used as a unidimensional construct. Further studies should explore this structure in larger samples and in alternative sample populations. A bifactor approach may have implications for how the HoNOS is used in practice, since there is ongoing debate on whether HoNOS item scores should be aggregated for interpretation.
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- 2017
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17. A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
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Ryan Matthews, Michael McCaul, and Wayne Smith
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Medicine ,Medicine (General) ,R5-920 - Abstract
Introduction: Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. Methods: A retrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 patient care records were included (n = 530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5 mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4 mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). Discussion: Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.
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- 2017
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18. Pediatric peri-operative fractionated high-dose-rate brachytherapy for recurrent Wilms’ tumor using a reconstructed Freiburg flap
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Emily Flower, Kathy Ngoc Tran, Salman Zanjani, Wayne Smith, Jonathan Karpelowsky, Katie Summerhayes, Edgar Estoesta, and Jennifer Chard
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nephroblastoma ,pediatric brachytherapy ,peri-operative ,Wilms tumor ,Medicine - Abstract
Purpose : To report peri-operative fractionated high-dose-rate (HDR) brachytherapy with a 3D customized Freiburg flap applicator to treat locally recurrent Wilms’ tumor, followed by immediate hyperthermic intraperitoneal chemotherapy for a 16-year-old with a second recurrence of nephroblastoma (Wilms’ tumor). Material and methods: The tumor was excised and surgical bed was treated with fractionated HDR brachytherapy using a Freiburg flap applicator. Hyperthermic intraperitoneal chemotherapy was performed immediately after the removal of brachytherapy applicator. Results: The Freiburg flap was successfully reconstructed to enable delivery of conformable peri-operative HDR brachytherapy. The clinical target volume (CTV) D90 was 26 Gy in 5 fractions. Conclusions : Peri-operative fractionated HDR brachytherapy with a customized Freiburg flap applicator was delivered successfully across a large multi-disciplinary team.
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- 2016
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19. 5.1 STRESS-INDUCED SYMPATHETIC ACTIVITY AND THE RETINAL VASCULATURE: THE SABPA PROSPECTIVE STUDY
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Leoné Malan, Nicolaas Malan, and Wayne Smith
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objectives: Retinal vessels are part of the intracranial vasculature and analysis thereof complements behavioural and brain measures. Mental stress was related to downregulation of norepinephrine in Africans. Hence we continue by assessing prospective associations between sympathetic nervous system activity and retinal vessel calibres. Methods: Black and Caucasian participants (n = 275; 45 ± 9 years) were stratified into tertiles according norepinephrine:creatinine (NE:Cr) ratio at baseline. Three year prospective % changes (Δ) for depression (PHQ-9), urinary NE:Cr, serum cortisol and High-Density-Lipoprotein (HDL, neuronal-membrane-integrity and ischemic stroke risk marker) were obtained. At 3yr-follow-up, retinal microvascular calibres were quantified from digital images in the mydriatic eye and salivary cortisol (sC) and α-amylase (sAA), adrenergic activity marker were obtained. Results: Only the low NE:Cr-tertile group (44% Black; 64% Men), showed chronic depression and hypertension prevalence. Over 3yrs, their NE:Cr increased whereas cortisol and HDL decreased. At 3yr-follow-up, wider venules (stroke risk marker) were apparent in the low- compared to the high-tertile group (Figure 1). In the low-tertile group, chronic depression was associated with stroke risk markers, wider venules [OR 1.7; P = 0.03] and lower HDL [OR 4.8; P = 0.04]. In this group, arteriole narrowing was associated with ΔNE:Cr, Δcortisol and sAA; whilst a wider venule was associated with ΔNE:Cr and sC. Conclusions: In reaction to depression and low NE:Cr levels, homeostatic reflexes facilitated upregulation of norepinephrine and concurrent downregulation of cortisol. Stress-induced sympathetic nervous system activity however disturbed myogenic tone, neuronal-membrane-integrity and retinal venular widening; increasing the susceptibility for ischemic stroke.
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- 2018
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20. P43 MASKED HYPERTENSION AND RETINAL VESSEL STRUCTURE AND FUNCTION IN YOUNG HEALTHY ADULTS: THE AFRICAN-PREDICT STUDY
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Nthai Ramoshaba, Hugo Huisman, Leandi Lammertyn, Konstantin Kotliar, Aletta Schutte, and Wayne Smith
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Masked hypertension (MH) is prevalent in young adults and is associated with similar vascular complications as sustained hypertension, but whether this is already evident in young adults is unclear. We therefore compared retinal vessel calibres and function in response to flicker light induced provocation (FLIP) in young healthy adults stratified by MH status and explored associations between these parameters. Methods: We used data from the first 566 participants (aged 20–30 years) taking part in the African-PREDICT study. Participants were clinically normotensive (70% valid readings) were measured and MH status determined. The central retinal artery (CRAE) and vein equivalent (CRVE) were calculated from fundus images and retinal vessel dilation responses to FLIP determined. Results: MH showed a prevalence of 16%. MHs’ had a lower CRAE (155 ± 10 MU vs. 160 ± 12 MU, p = 0.002), but similar CRVE and vessel dilation in response to FLIP when compared to normotensives. The latter findings remained consistent upon adjustment for sex, ethnicity, age and body mass index. Multivariate regression analysis demonstrated an independent association between CRAE and the presence of MH (R2 = 0.07, β = −0.10 (−0.20; −0.01)). No further associations existed between retinal vessel parameters and MH status. Conclusion: Already at a young age, healthy adults with MH show slight adverse changes in the retinal microvasculature. Considering the prevalence of MH in young adults, and the predictive value of reduced CRAE, our data emphasize the early identification of altered 24 hr blood pressure patterns.
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- 2018
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21. P105 PULSE PRESSURE AMPLIFICATION AND PHYSICAL ACTIVITY IN YOUNG BLACK AND WHITE ADULTS: THE AFRICAN-PREDICT STUDY
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Johannes van Rooyen, Anika Kaufman, Wayne Smith, and Yolandi Breet
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background and Objectives: It is known that physical activity is inversely associated with arterial stiffness in healthy adults 1. Data regarding the effect of physical activity on PPA is limited. Such data is of importance especially in South Africa, where alarming rates of physical inactivity have been reported 2,3. The aim of this study was to determine the relationship between pulse pressure amplification (PPA) and physical activity in a young, healthy black and white South African cohort. Methods: The sub-study was embedded in the African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) and included 591 white and 604 black participants aged 20–30 years. Systolic, diastolic and central blood pressures were determined with the SphygmoCor apparatus. Biochemical variables were analysed with known methods. Results: The SBP (124 vs. 121 mmHg, p < 0.001), DBP (76 vs. 71 mmHg, p < 0.001) and central SBP (110 vs. 105 mmHg, p < 0.001) were significant higher in the black compared to white participants. No differences were encountered in c-fPWV and PPA. The physical activity levels did not differ but the total energy expenditure was significant lower in the blacks compared to whites (2205.5 vs. 2373.6 kCal, p < 0.001). After multiple regression analysis only in black participants the PPA showed an independent and significant negative association with age (ß = −0.282, p < 0.001) and a positive association with height (ß = 0.247, p < 0.001). In whites the PPA only associated positively with sex (ß = 0.180, p = 0.032). Conclusion: No association was encountered between arterial stiffness (PPA) and physical activity markers.
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- 2018
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22. Drug Content Uniformity: Quantifying Loratadine in Tablets Using a Created Raman Excipient Spectrum
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Amelia Farquharson, Zachery Gladding, Gary Ritchie, Chetan Shende, Joseph Cosgrove, Wayne Smith, Carl Brouillette, and Stuart Farquharson
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active pharmaceutical ingredient ,drug content uniformity ,acceptance value ,process control ,Raman spectroscopy ,loratadine ,Pharmacy and materia medica ,RS1-441 - Abstract
Raman spectroscopy has proven valuable for determining the composition of manufactured drug products, as well as identifying counterfeit drugs. Here we present a simple method to determine the active pharmaceutical ingredient (API) mass percent in a sample that does not require knowledge of the identities or relative mass percents of the inactive pharmaceutical ingredients (excipients). And further, we demonstrated the ability of the method to pass or fail a manufactured drug product batch based on a calculated acceptance value in accordance with the US Pharmacopeia method for content uniformity. The method was developed by fitting the Raman spectra of 30 Claritin® tablets with weighted percentages of the Raman spectrum of its API, loratadine, and a composite spectrum of the known excipients. The mean loratadine mass of 9.79 ± 40 mg per 100 mg tablet compared favorably to the 10.21 ± 0.63 mg per 100 mg tablet determined using high-performance liquid chromatography, both of which met the acceptance value to pass the 10 mg API product as labelled. The method was then applied to a generic version of the Claritin product that employed different excipients of unknown mass percents. A Raman spectrum representative of all excipients was created by subtracting the API Raman spectrum from the product spectrum. The Raman spectra of the 30 generic tablets were then fit with weighted percents of the pure loratadine spectrum and the created excipient spectrum, and used to determine a mean API mass for the tablets of 10.12 ± 40 mg, again meeting the acceptance value for the 10 mg API product. The data suggest that this simple method could be used to pass or fail manufactured drug product batches in accordance with the US Pharmacopeia method for content uniformity, without knowledge of the excipients.
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- 2021
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23. The Cardiotonic Steroid Marinobufagenin Is a Predictor of Increased Left Ventricular Mass in Obesity: The African-PREDICT Study
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Michél Strauss-Kruger, Ruan Kruger, Wayne Smith, Lebo F. Gafane-Matemane, Gontse Mokwatsi, Wen Wei, Olga V. Fedorova, and Aletta E. Schutte
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body mass index ,cardiotonic steroids ,left ventricular mass ,marinobufagenin ,obesity ,dietary salt intake ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The endogenous Na+/K+-ATPase inhibitor, marinobufagenin (MBG), strongly associates with salt intake and a greater left ventricular mass index (LVMi) in humans and was shown to promote cardiac fibrosis and hypertrophy in animals. The adverse effects of MBG on cardiac remodeling may be exacerbated with obesity, due to an increased sensitivity of Na+/K+-ATPase to MBG. This study determined whether MBG is related to the change in LVMi over time in adults with a body mass index (BMI) ≥30 kg/m2 (obese) and 2 (non-obese). The study followed 275 healthy participants (aged 20–30 years) from the African-Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) study over 4.5 years. At baseline, we measured 24 h urine MBG excretion. MBG levels were positively associated with salt intake. LVMi was determined by two-dimensional echocardiography at baseline and after >4.5 years. With multivariate adjusted analyses in obese adults (N = 56), we found a positive association of follow-up LVMi (Adjusted (Adj.) R2 = 0.35; Std. β = 0.311; p = 0.007) and percentage change in LVMi (Adj. R2 = 0.40; Std. β = 0.336; p = 0.003) with baseline MBG excretion. No association of LVMi (Adj. R2 = 0.37; p = 0.85) or percentage change in LVMi (Adj. R2 = 0.19; p = 0.68) with MBG excretion was evident in normal weight adults (N = 123). These findings suggest that obese adults may be more sensitive to the adverse cardiac effects of MBG and provide new insight into the potential role of dietary salt, by way of MBG, in the pathogenesis of cardiac remodeling in obese individuals.
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- 2020
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24. Effects of a community-based salt reduction program in a regional Australian population
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Mary-Anne Land, Jason H. Y. Wu, Adriana Selwyn, Michelle Crino, Mark Woodward, John Chalmers, Jacqui Webster, Caryl Nowson, Paul Jeffery, Wayne Smith, Victoria Flood, and Bruce Neal
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Salt ,Sodium ,24-hour urine ,Cardiovascular disease prevention ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs. Methods A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected. Results Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (−0.80, 95 % confidence interval −1.2 to −0.3;p
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- 2016
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25. Climate change and health in Bangladesh: a baseline cross-sectional survey
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Md Iqbal Kabir, Md Bayzidur Rahman, Wayne Smith, Mirza Afreen Fatima Lusha, and Abul Hasnat Milton
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climate change ,health ,adaptation ,household ,vulnerable community ,Bangladesh ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Bangladesh is facing the unavoidable challenge of adaptation to climate change. However, very little is known in relation to climate change and health. This article provides information on potential climate change impact on health, magnitude of climate-sensitive diseases, and baseline scenarios of health systems to climate variability and change. Design: A cross-sectional study using multistage cluster sampling framework was conducted in 2012 among 6,720 households of 224 rural villages in seven vulnerable districts of Bangladesh. Information was obtained from head of the households using a pretested, interviewer-administered, structured questionnaire. A total of 6,720 individuals participated in the study with written, informed consent. Results: The majority of the respondents were from the low-income vulnerable group (60% farmers or day labourers) with an average of 30 years’ stay in their locality. Most of them (96%) had faced extreme weather events, 45% of people had become homeless and displaced for a mean duration of 38 days in the past 10 years. Almost all of the respondents (97.8%) believe that health care expenditure increased after the extreme weather events. Mean annual total health care expenditure was 6,555 Bangladeshi Taka (BDT) (1 USD=77 BDT in 2015) and exclusively out of pocket of the respondents. Incidence of dengue was 1.29 (95% CI 0.65–2.56) and malaria 13.86 (95% CI 6.00–32.01) per 1,000 adult population for 12 months preceding the data collection. Incidence of diarrhoea and pneumonia among under-five children of the households for the preceding month was 10.3% (95% CI 9.16–11.66) and 7.3% (95% CI 6.35–8.46), respectively. Conclusions: The findings of this survey indicate that climate change has a potential adverse impact on human health in Bangladesh. The magnitude of malaria, dengue, childhood diarrhoea, and pneumonia was high among the vulnerable communities. Community-based adaptation strategy for health could be beneficial to minimise climate change attributed health burden of Bangladesh.
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- 2016
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26. Knowledge and perception about climate change and human health: findings from a baseline survey among vulnerable communities in Bangladesh
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Md Iqbal Kabir, Md Bayzidur Rahman, Wayne Smith, Mirza Afreen Fatima Lusha, Syed Azim, and Abul Hasnat Milton
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Climate change ,Health ,Knowledge ,Perception ,Adaptation ,Bangladesh ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Bangladesh is one of the countries most vulnerable to climate change (CC). A basic understanding of public perception on vulnerability, attitude and the risk in relation to CC and health will provide strategic directions for government policy, adaptation strategies and development of community-based guidelines. The objective of this study was to collect community-based data on peoples’ knowledge and perception about CC and its impact on health. Methods In 2012, a cross-sectional survey was undertaken among 6720 households of 224 enumeration areas of rural villages geographically distributed in seven vulnerable districts of Bangladesh, with total population of 19,228,598. Thirty households were selected randomly from each enumeration area using the household listing provided by the Bangladesh Bureau of Statistics (BBS). Information was collected from all the 6720 research participants using a structured questionnaire. An observation checklist was used by the interviewers to collect household- and community-related information. In addition, we selected the head of each household as the eligible participant for an interview. Evidence of association between sociodemographic variables and knowledge of CC was explored by cross-tabulation and measured using chi-square tests. Logistic regression models were used to further explore the predictors of knowledge. Results The study revealed that the residents of the rural communities selected for this study largely come from a low socioeconomic background: only 9.6 % had postsecondary education or higher, the majority worked as day labourer or farmer (60 %), and only 10 % earned a monthly income above BDT 12000 (equivalent to US $150 approx.). The majority of the participants (54.2 %) had some knowledge about CC but 45.8 % did not (p
- Published
- 2016
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27. Vitamin K Dependent Protection of Renal Function in Multi-ethnic Population Studies
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Fang-Fei Wei, Nadja E.A. Drummen, Aletta E. Schutte, Lutgarde Thijs, Lotte Jacobs, Thibaut Petit, Wen-Yi Yang, Wayne Smith, Zhen-Yu Zhang, Yu-Mei Gu, Tatiana Kuznetsova, Peter Verhamme, Karel Allegaert, Rudolph Schutte, Evelyne Lerut, Pieter Evenepoel, Cees Vermeer, and Jan A. Staessen
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Chronic kidney disease ,Glomerular filtration rate ,Matrix Gla protein ,Population science ,Vitamin K ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: Following activation by vitamin K (VK), matrix Gla protein (MGP) inhibits arterial calcification, but its role in preserving renal function remains unknown. Methods: In 1166 white Flemish (mean age, 38.2 years) and 714 South Africans (49.2% black; 40.6 years), we correlated estimated glomerular filtration (eGFR [CKD-EPI formula]) and stage of chronic kidney disease (CKD [KDOQI stages 2–3]) with inactive desphospho-uncarboxylated MGP (dp-ucMGP), using multivariable linear and logistic regression. Results: Among Flemish and white and black Africans, between-group differences in eGFR (90, 100 and 122 mL/min/1.73 m2), dp-ucMGP (3.7, 6.5 and 3.2 μg/L), and CKD prevalence (53.5, 28.7 and 10.5%) were significant, but associations of eGFR with dp-ucMGP did not differ among ethnicities (P ≥ 0.075). For a doubling of dp-ucMGP, eGFR decreased by 1.5 (P = 0.023), 1.0 (P = 0.56), 2.8 (P = 0.0012) and 2.1 (P
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- 2016
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28. Dietary Salt Intake and Discretionary Salt Use in Two General Population Samples in Australia: 2011 and 2014
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Caryl Nowson, Karen Lim, Carley Grimes, Siobhan O’Halloran, Mary Anne Land, Jacqui Webster, Jonathan Shaw, John Chalmers, Wayne Smith, Victoria Flood, Mark Woodward, and Bruce Neal
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salt ,sodium ,sodium chloride ,diet ,regional ,urinary sodium ,Australia ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.
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- 2015
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29. P47 TETRAHYDROBIOPTERIN AND MARKERS OF OXIDATIVE STRESS IN A YOUNG BI-ETHNIC POPULATION: THE AFRICAN-PREDICT STUDY
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Hugo Huisman, Carina Mels, Johannes Van Rooyen, Ruan Kruger, Carla Fourie, Lebo Gafane, Wayne Smith, and Alta Schutte
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background/Objectives: Tetrahydrobiopterin (BH4) is a cofactor for nitric oxide synthase (NOS). Oxidative stress, reported in black populations (1), may lead to the oxidation of BH4, the uncoupling of eNOS, decreased NO and increased superoxide levels (2,3). We compared BH4 and markers of oxidative stress and their association, between black and white cohorts. Methods: In the African-PREDICT study, we included black (n = 300) and white (N = 297) participants (aged 20–30 years). We measured blood pressure, and determined serum levels of BH4 and markers of oxidative stress. Results: Blacks had higher blood pressure (p < 0.001). In blacks the following serum levels were lower: BH4 (p < 0.0001), total antioxidant status (TAS) (p < 0.0001), glutathione peroxidase (GPx), while reactive oxygen species (ROS) (p < 0.03) was higher. In blacks BH4 related positively with GPx in single, partial (adjusted for socio-economic status, sex, age, BMI, GGT and cotinine) and multiple regression (R2 = 0.16, β = 0.17, p = 0.02) and glutathione reductase (GR) (R2 = 0.16, β = 0.15, p = 0.05). We found a negative correlation between BH4 and GPx (R2 = 0.07, β = −0.26, p = 0.0006) in whites. Conclusions: Higher oxidative stress levels in young blacks (increased ROS, lower TAS and GPx) could explain the low concentrations of BH4, the possible uncoupling of eNOS, resulting in higher blood pressure. The uncoupling of eNOS may explain the production of ROS and peroxinitrite and may be linked to the positive correlation of BH4 with GPx and GR found in blacks, that may lead to early vascular changes.
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- 2017
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30. Are Australians concerned about nanoparticles? A comparative analysis with established and emerging environmental health issues
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Adam Capon, Margaret Rolfe, James Gillespie, and Wayne Smith
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risk ,perception ,nanoparticles ,environmental health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: Introducing new technologies into society raises considerable public concern. We determine the public concern about nanoparticles, and compare this concern to other environmental health issues such as wind farms and coal seam gas production. Methods: A repeat cross sectional survey examining views on environmental health issues, risk, chemicals and trust was undertaken in more than 1,300 Australian residents in 2000 and 2013. Logistic regression and principal component analysis was used to investigate predictors of nanoparticle concern and identify a component structure for environmental health issues that could explain a trend of future nanoparticle concern. Results: Australians have a relatively low level of concern about the risks of nanoparticles to health when compared to their concerns about other environmental health issues. Items associated with concern included gender, a general wish to avoid chemicals and possibly trust in politicians. Concern over nanoparticles clustered with similar views on technological risks. Conclusions: Current public concern over the risks of nanoparticles is low. However, a reframing of the issue towards ‘chemicals’ is likely to have a negative effect on risk perceptions. This paper raises questions about appropriate channels for the effective communication of risk.
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- 2015
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31. Drug Stability Analysis by Raman Spectroscopy
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Chetan Shende, Wayne Smith, Carl Brouillette, and Stuart Farquharson
- Subjects
drug stability analysis ,drug degradation ,Raman spectroscopy ,multivariate analysis ,astronaut health ,Pharmacy and materia medica ,RS1-441 - Abstract
Pharmaceutical drugs are available to astronauts to help them overcome the deleterious effects of weightlessness, sickness and injuries. Unfortunately, recent studies have shown that some of the drugs currently used may degrade more rapidly in space, losing their potency before their expiration dates. To complicate matters, the degradation products of some drugs can be toxic. Here, we present a preliminary investigation of the ability of Raman spectroscopy to quantify mixtures of four drugs; acetaminophen, azithromycin, epinephrine, and lidocaine, with their primary degradation products. The Raman spectra for the mixtures were replicated by adding the pure spectra of the drug and its degradant to determine the relative percent contributions using classical least squares. This multivariate approach allowed determining concentrations in ~10 min with a limit of detection of ~4% of the degradant. These results suggest that a Raman analyzer could be used to assess drug potency, nondestructively, at the time of use to ensure crewmember safety.
- Published
- 2014
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32. 7.5 RETINAL VESSEL RESPONSES TO FLICKERING LIGHT PROVOCATION IN A COHORT OF BLACK AND WHITE TEACHERS: THE SABPA STUDY
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Wayne Smith, Walthard Vilser, and Konstantin Kotliar
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Specialties of internal medicine ,RC581-951 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Retinal microvascular function can be assessed using flicker light induced provocation (FLIP). Reduced vessel dilation responses to FLIP are noted in various disease conditions. Comparative studies between ethnic groups are scarce, while the importance of different phases of the vessel responses during and following FLIP are not well studied. We compared retinal vessel dilation, constriction and vessel diameter parameters following FLIP in a cohort of black (n=152) and white (n=178) teachers. Methods: Retinal vessel responses to FLIP were assessed using the Dynamic Vessel Analyzer (IMEDOS Systems, Jena, Germany). Ambulatory blood pressure (BP), anthropometry and blood sampling were performed. Results: Black participants displayed a better maximum percentage dilation (artery: 4.1±3.5% vs. 3.5±2.0%, p
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- 2016
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33. Quantitative Measurements of Codeine and Fentanyl on a Surface-Enhanced Raman-Active Pad
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Chetan Shende, Amelia Farquharson, Carl Brouillette, Wayne Smith, and Stuart Farquharson
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SERS ,Raman ,opioid detection ,codeine ,fentanyl ,forensics ,Organic chemistry ,QD241-441 - Abstract
The USA is in the midst of an opioid crisis that included over 60,000 overdose fatalities in 2017, mostly unintentional. This is due to excessive use of prescription opioids and the use of very strong synthetic opioids, such as fentanyl, mixed with illicit street drugs. The ability to rapidly determine if people or packages entering the country have or contain drugs could reduce their availability, and thereby decrease the use of illicit drugs. In an effort to address this problem, we have been investigating the ability of surface-enhanced Raman spectroscopy to detect trace amounts of opioids on clothing and packages. Here, we report the measurement of codeine and fentanyl at 100 ng/mL for 5 min on a pad impregnated with gold colloids, as well as a preliminary measurement of 500 pg of fentanyl on a glass surface using one of these pads. The calculated limit of detection for this measurement was 40 pg. This data strongly suggests that these pads, used with portable Raman analyzers, would be invaluable to airport security, drug raids, crime scenes, and forensic analysis.
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- 2019
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34. Child Centred Approach to Climate Change and Health Adaptation through Schools in Bangladesh: A Cluster Randomised Intervention Trial.
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Md Iqbal Kabir, Md Bayzidur Rahman, Wayne Smith, Mirza Afreen Fatima Lusha, and Abul Hasnat Milton
- Subjects
Medicine ,Science - Abstract
Bangladesh is one of the most vulnerable countries to climate change. People are getting educated at different levels on how to deal with potential impacts. One such educational mode was the preparation of a school manual, for high school students on climate change and health protection endorsed by the National Curriculum and Textbook Board, which is based on a 2008 World Health Organization manual. The objective of this study was to test the effectiveness of the manual in increasing the knowledge level of the school children about climate change and health adaptation.This cluster randomized intervention trial involved 60 schools throughout Bangladesh, with 3293 secondary school students participating. School upazilas (sub-districts) were randomised into intervention and control groups, and two schools from each upazila were randomly selected. All year seven students from both groups of schools sat for a pre-test of 30 short questions of binary response. A total of 1515 students from 30 intervention schools received the intervention through classroom training based on the school manual and 1778 students of the 30 control schools did not get the manual but a leaflet on climate change and health issues. Six months later, a post-intervention test of the same questionnaire used in the pre-test was performed at both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model.None of the various school level and student level variables were significantly different between the control and intervention group. However, the intervention group had a 17.42% (95% CI: 14.45 to 20.38, P =
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- 2015
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35. Comparisons of Costs between Black Caribbean and White British Patients with Advanced Multiple Sclerosis in the UK
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Wayne Smith, Paul McCrone, Cassie Goddard, Wei Gao, Rachel Burman, Diana Jackson, Irene Higginson, Eli Silber, and Jonathan Koffman
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Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background. Multiple sclerosis (MS) is now more common among black and minority ethnic groups in the UK but little is known about the costs of care amongst different ethnic groups. Objective. This study examined and compared service use and costs for people severely affected with MS from Black Caribbean (BC) and White British (WB) backgrounds in the UK and identified predictors of cost for both groups. Method. Population-based cross-sectional study of 43 BC and 43 WB patients with MS (EDSS ≥ 6) and their informal caregivers recruited from an MS service in southeast London. Interviews collected data on health and social service use and informal care support. Costs were calculated using UK unit cost data. Using regression analyses we compared costs between the ethnic groups and identified possible predictors of cost. Results. The mean (SD) costs for the WB and BC groups were £25,778 (£39,387) and £23,186 (£30,433), respectively. Results identified no significant difference in total cost between the two ethnic groups. The EDSS score alone was a significant predictor of cost. Conclusion. Similar costs between ethnic groups indicate that with regard to this MS service and geographical area, access to care was not affected by ethnicity.
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- 2014
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36. Should primary school PE be outsourced? An analysis of students’ perspectives
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Cheng Deng, Rod Allan Philpot, Maureen Legge, Alan Ovens, and Wayne Smith
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Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Education - Published
- 2022
37. Willingness-To-Pay vs Actual Behavior: Sustainable Procurement at Festivals
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Robert E. Pitts, Wayne Smith, Brittany Jenkins, and Rachel Dodds
- Abstract
Sales and purchases of socially and environmentally responsible festival clothing are a way for festival attendees to engage in ethical consumption and for event organizers to undertake sustainable procurement. Although there have been a number of studies examining willingness-to-pay (WTP), few of them examine this in a festival setting, and there is a gap in existing research regarding the determination of actual behavior. The goal of this study is therefore to explore participants’ willingness-to-pay for apparel based on more external motivations (visible environmental messages) and then ascertain whether this behavior was actually replicated in a natural field setting. This study first collected surveys from 427 festival-goers in 2015, then used a natural field experiment in 2016 to investigate whether attendees at the Mariposa Folk Festival in Ontario, Canada, would actually be prepared to pay a premium for ethical festival T-shirts over a conventional alternative. The findings reveal that attendees not only showed a willingness-to-pay but they also did actually pay a premium for such T-shirts.
- Published
- 2023
38. Sales Leadership in Tourism: A Review and Propositions for Future Research
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Wayne Smith, Rebekah Gledhill, Frederic Dimanche, and Karen Boehnke peesker
- Abstract
Sales and sales leadership are essential business functions and concepts. Research on the extant sales literature is necessary and timely to academics and tourism professionals due to extensive advances in the sales profession resulting from the rapid development of technology and the significant changes brought on by COVID-19 in business to consumer (B2C) and business to business (B2B) contexts. This study examines the current state of the sales-related literature in tourism and propos es future research areas on this topic. The authors performed a systematic literature review on sales and sales leadership in tourism to identify research gaps and opportunities. This paper identifies areas from the academic and business sales leadership literature that tour ism researchers should address and provides a research call based on seven specific propositions related to human-driven interactions, technology, consolidation, and leadership.
- Published
- 2023
39. Obesity, blood pressure and retinal microvascular phenotype in a bi-ethnic cohort of young children
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Sabrina Köchli, Wayne Smith, Giulia Lona, Gaizka Goikoetxea-Sotelo, Yolandi Breet, Shani Botha-Le Roux, Gontse G. Mokwatsi, Ruan Kruger, and Henner Hanssen
- Subjects
Pediatric Obesity ,Phenotype ,Child, Preschool ,Hypertension ,Ethnicity ,Humans ,Retinal Vessels ,Blood Pressure ,Child ,Cardiology and Cardiovascular Medicine - Abstract
Childhood obesity and high blood pressure (BP) are main determinants for cardiovascular disease development with regional and ethnic differences. Narrower arteriolar (CRAE) and wider venular (CRVE) retinal vessel diameters are sensitive markers of early vascular compromise in children. We aimed to compare retinal vessel diameters and investigate associations and odds ratios with body mass index (BMI) and BP in a multi-national/ethnic childhood study.BMI, systolic (SBP) and diastolic BP (DBP) were screened in 929 black and white South African (SA) and 1171 Swiss children (aged 5-9 years). Retinal assessments were performed using a retinal vessel analyzer to determine CRAE and CRVE.Black SA children had wider CRVE compared to white SA and Swiss children (all p 0.001). However, BMI or BP was not associated with CRVE in black SA children. Higher BMI and BP associated with narrower CRAE in all children, except for BMI in black SA children, in whom narrower CRAE was found for every unit increase in SBP (β = -0.199 μm, p = 0.001) and DBP (β = -0.312 μm, p 0.001). Obesity (OR:1.38[1.01; 1.89]), hypertension (OR:1.90[1.53; 2.36]) and black ethnicity (OR:1.50[1.18; 1.92]) increased the likelihood for arteriolar narrowing.Black SA children presented with wider retinal venules compared to their white SA and Swiss peers, which was unexplained by conventional risk factors. The overall risk of arteriolar narrowing was driven by obesity, hypertension and ethnicity. Our findings indicate the importance to differentiate cardiovascular risk by microvascular phenotype in different populations and ethnicity early in life.
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- 2022
40. Abstract P331: Higher Allostatic Load Score is Associated With Early Cardiovascular Risk in Young South Africans. The AfricanPREDICT Study
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Annemarie Wentzel, Ruan Kruger, Wayne Smith, Esme Jansen van Vuren, Aruba Chowdry, Edmond Wonkamtingang, Niel A Hanchard, and Stephanie T Chung
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: The Allostatic load score (ALS) is a composite score that measures the cumulative physiological burden of sustained exposure to stress and biological dysregulation. ALS has markers capture risk in 4 domains (neuro-endocrine, metabolic, cardiovascular, and immunological). Higher ALS in adults predict cardiovascular disease (CVD), but it is unknown whether ALS is associated with CVD risk in youth and young adults (YA), and whether the risk and association would differ at such an early age. Aims: In youth and YA we compared 1) the total ALS; 2) the cardiovascular profile according to high and low ALS; and 3) the association of ALS with markers of CVD. Methods: Participants in the African PRospective study on the Early Detection and Identification of Cardiovascular disease and HyperTension (AfricanPREDICT) were 587 youth Results: ALS median range was 1-8, and a high ALS of >3 was observed in 35% of youth, and 47% YA. In youth with high ALS, ALS associated with narrower retinal arteries (Adj R 2 :0.16, β-coefficient, -1.73, (95%CI), -2.95, -0.94), P =0.052), greater pulse wave velocity (Adj R 2 :0.56, 0.75 (0.48, 1.98), P =0.021), increased left ventricular mass index (Adj R 2 :0.61, 2.21 (0.43, 8.46) P =0.048), lower left ventricular function (global longitudinal strain) (Adj R 2 :0.37, -0.45 (-1.06, -0.06) P =0.015). Similarly, in YA with high ALS, ALS associated with narrower retinal arteries (Adj R 2 :0.43, -4.54 (-6.58, -2.50), P 2 :0.44, 0.62 (0.09, 1.17), P =0.043), increased left ventricular mass index (Adj R 2 :0.53, 2.62 (1.52, 5.76) P =0.032), lower diastolic function (E/A ratio) (Adj R 2 :0.27, -0.11 (-0.18, -0.04) P =0.002). Conclusion: Youth and YA with high ALS had a more adverse CVD risk profile and greater association with markers of cardiovascular aging compared to their low ALS counterparts. ALS and allostatic dysregulation should be evaluated in youth and YA, when assessing current and future cardiovascular risk.
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- 2023
41. The Bankruptcy of Economics: Ecology, Economics and the Sustainability of the Earth
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Joseph Wayne Smith, Graham Lyons, Gary Sauer-Thompson and Joseph Wayne Smith, Graham Lyons, Gary Sauer-Thompson
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- 2016
42. Serum L‐arginine and endogenous methylarginine concentrations predict irritable bowel syndrome in adults: A nested case‐control study
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Arduino A. Mangoni, Nicholas J. Talley, Marjorie M. Walker, Wayne Smith, Christopher Oldmeadow, Roseanne Peel, Mark McEvoy, Stephen Hancock, Elizabeth G. Holliday, and John Attia
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Male ,medicine.medical_specialty ,Methylarginine ,Arginine ,Nitric Oxide ,Psychological Distress ,Gastroenterology ,Nitric oxide ,Cohort Studies ,Neurogastroenterology ,chemistry.chemical_compound ,L‐arginine ,Internal medicine ,Odds Ratio ,medicine ,Humans ,older adults ,Irritable bowel syndrome ,Aged ,Aged, 80 and over ,irritable bowel syndrome ,business.industry ,Odds ratio ,Middle Aged ,methylarginine ,medicine.disease ,Logistic Models ,ROC Curve ,Oncology ,chemistry ,Case-Control Studies ,Nested case-control study ,Cohort ,Female ,Original Article ,business ,Asymmetric dimethylarginine ,Biomarkers - Abstract
BACKGROUND AIMS: Nitric oxide, a major inhibitory nonadrenergic, noncholinergic neurotransmitter that relaxes smooth muscle, may be implicated in the pathophysiology of visceral hypersensitivity in irritable bowel syndrome (IBS). Impaired bioavailability of the nitric oxide precursor molecule L-arginine and higher concentrations of methylarginines (endogenous inhibitors of nitric oxide synthesis) are known to impair nitric oxide synthesis in numerous gastrointestinal cell types. We therefore examined serum concentrations of L-arginine and the methylarginines in a nested case-control study, to assess whether these factors are associated with adult IBS.Data on clinical characteristics, methylarginines, and L-arginine (measured using LC-MS/MS) were collected from a random population-based cohort of Australian adults (median age = 64 years; IQR = 60-70). Cases of IBS, defined according to Rome III criteria (N = 156), and controls (N = 332) were identified from within the cohort at the 5-year follow-up.In adjusted logistic regression analyses, L-arginine, asymmetric dimethylarginine, symmetric dimethylarginine, L-arginine/asymmetric dimethylarginine ratio, and Kessler-10 psychological distress scores were significantly associated with IBS (p 0.05). [Correction added on 18 September 2021, after first online publication: In the preceding sentence, the value (p 0.05) has been changed to (p 0.05)]. Similar results were found for IBS subtypes. Higher serum L-arginine concentration had the strongest association with IBS diagnosis, with an odds ratio of 9.03 for those with serum L-arginine at the 75th (84 μmol/L) versus 25th (46 μmol/L) percentile (95% CI: 5.99-13.62). L-arginine had the best discriminative ability with a bias-adjusted area under the receiver operator characteristic curve of 0.859.Higher serum concentrations of L-arginine and endogenous methylarginines are strongly associated with IBS in adults.
- Published
- 2021
43. Elevated blood pressure positively associates with alpha-1 microglobulin in prepubescent children: the ExAMIN Youth SA study
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Lisa Uys, Wayne Smith, Gonste Mokwatsi, Ashleigh Craig, Henner Hanssen, Sanette Brits, Lebo F. Gafane-Matemane, Carina Mels, Yolandi Breet, and Ruan Kruger
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medicine.medical_specialty ,Adolescent ,Physiology ,African descent ,Black People ,Blood Pressure ,Logistic regression ,Elevated blood ,Internal medicine ,Ethnicity ,Internal Medicine ,Humans ,Medicine ,Early childhood ,Child ,Kidney ,business.industry ,Beta-2 microglobulin ,Body Height ,medicine.anatomical_structure ,Blood pressure ,Child, Preschool ,Hypertension ,Cardiology and Cardiovascular Medicine ,business ,Alpha-1-microglobulin - Abstract
OBJECTIVES AND METHODS Hypertension is a growing health concern in childhood populations and individuals of African descent. As the kidneys play a significant role in blood pressure regulation, we compared alpha-1 microglobulin (A1M) as a marker of proximal tubular function between young healthy black and white children (n = 957; aged: 5-9 years) and explored its association with blood pressure. RESULTS The black children had higher levels of A1M (P
- Published
- 2021
44. Enactive cognition and physical education – a natural coupling
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Wayne Smith
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Structural coupling ,Cognitive science ,Enactivism ,Embodied cognition ,Natural (music) ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Cognition ,Psychology ,Education ,Physical education - Abstract
In this article, I argue for the adoption of enactive cognition (which includes emotional and social components) as a basis for understanding the nature of learning in, through and about movement i...
- Published
- 2021
45. Characterization of the Renin-Angiotensin-Aldosterone System in Young Healthy Black Adults: The African Prospective Study on the Early Detection and Identification of Hypertension and Cardiovascular Disease (African-PREDICT Study)
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Gontse G. Mokwatsi, Johannes M. Van Rooyen, Aletta S. Uys, Ruan Kruger, Wayne Smith, Lebo F. Gafane-Matemane, Catharina M. C. Mels, Sanette Brits, and Aletta E. Schutte
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Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,Urinary system ,Diastole ,Black People ,Blood Pressure ,030204 cardiovascular system & hematology ,White People ,Renin-Angiotensin System ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Renin–angiotensin system ,Internal Medicine ,Natriuretic peptide ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aldosterone ,business.industry ,Angiotensin II ,Healthy Volunteers ,Early Diagnosis ,Endocrinology ,Blood pressure ,chemistry ,Cardiovascular Diseases ,Hypertension ,End-diastolic volume ,Female ,business - Abstract
This study presents a detailed profile of the renin-angiotensin-aldosterone system (RAAS), electrolytes, volume loading, blood pressure (BP), and total peripheral resistance in healthy young Black and White adults. We also explored longitudinal associations between BP and RAAS. We included normotensive Black (N=543) and White (N=573) adults (20–30 years) and followed N=324 over ≈4.5 years. We measured clinic (central, brachial) and 24-hour BP, total peripheral resistance and left ventricular dimensions. We determined serum NT-proBNP (N-terminal prohormone B-type natriuretic peptide), RAAS, and 24-hour urinary and serum Na + and K + . RAAS components, left ventricular internal diameter (diastole), end diastolic volume and NT-proBNP were lower ( P P P >0.05) only in quartile 1 of Na + /K + values. In both groups, RAAS was lower in the higher quartiles of 24-hour Na + and NT-proBNP (all P -trend≤0.014). Over 4.5 years, all BPs increased in the Black ( P P =0.038). We found that RAAS concentrations in healthy Black adults were half of those of White participants, which may not be explained by volume expansion. Yet, baseline aldosterone predicted BP elevation over time in Black adults. RAAS was similar in Black and White adults only at low Na + /K + scenarios, suggesting an essential role of potassium. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03292094.
- Published
- 2021
46. The clinical, humanistic, and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions. A narrative synthesis systematic literature review
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Andrea Bertuzzi, Alison Martin, Nicola Clarke, Cassandra Springate, Rachel Ashton, Wayne Smith, Andi Orlowski, and Duncan McPherson
- Abstract
ObjectivesAssess the impact of single rooms versus multioccupancy accommodation on inpatient health-care outcomes and processes.DesignSystematic review.SettingHospitals and secondary care units.ParticipantsInpatients receiving routine, emergency, high-dependency, or intensive care with a named type of hospital accommodation.Main outcome measuresQualitative synthesis of findings.ResultsOf 4,861 citations initially identified, 215 were deemed suitable for full-text review, of which 145 were judged to be relevant to this review. Five main method types were reported: 60 before - and-after comparisons, 75 contemporaneous comparisons, 18 qualitative studies of accommodation preferences, 10 evidence syntheses. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation, but no clearly consistent conclusions could be drawn about overall benefits of single rooms versus shared accommodation (multioccupancy rooms, bays, or wards). Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy, and for reduced disturbances. By contrast, men, older adults, children, and adolescents were more likely to prefer shared accommodation to avoid loneliness. While shared accommodation seemed to be the most cost-effective approach for construction, greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.ConclusionsThe lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.SummaryWhat is already known on this topicThe effects of single rooms versus shared accommodation on hospital inpatients’ outcomes are not well understoodMany studies are qualitative or narrative because randomised controlled trials are not practical and most comparative studies have only become possible after relocation to new facilitiesThis systematic review investigated the potential range of impacts that inpatient single rooms and shared accommodation have on the health-care processes, outcomes, and costsWhat this study addsThe evidence, though extensive, revealed no clear advantage for one type of inpatient hospital accommodation for many of the areas assessed.There was weak evidence indicating advantages for single bedrooms in some areas, such as lower risk of hospital acquired infection in adult intensive care and a range of outcomes in neonatal intensive care.Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.
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- 2022
47. Corrigendum to Potassium excretion and blood pressure are associated with heart rate variability in healthy black adults: The African-PREDICT study Nutrition, Metabolism and Cardiovascular Diseases 31 (4), 1071–1080
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Sabrina Köchli, Aletta E. Schutte, Shani Botha-Le Roux, Lebo F. Gafane-Matemane, Wayne Smith, Johannes M. van Rooyen, Gontse G. Mokwatsi, and Ruan Kruger
- Subjects
Adult ,Male ,Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) ,Black People ,Natriuresis ,Blood Pressure ,Autonomic Nervous System ,Risk Assessment ,White People ,South Africa ,Young Adult ,Heart Rate ,Risk Factors ,Humans ,Prospective Studies ,Nutrition and Dietetics ,Sodium ,Age Factors ,Health Status Disparities ,Healthy Volunteers ,Renal Elimination ,Cross-Sectional Studies ,Hypertension ,Potassium ,Female ,Cardiology and Cardiovascular Medicine ,Corrigendum - Abstract
Heart rate variability (HRV) is a main determinant of autonomic function and related to the development of hypertension and cardiovascular (CV) disease. Hypertension develops in black populations at an earlier age, which could be due to differences in the autonomic nervous system activity and sodium/potassium handling in black and white populations. We investigated whether HRV is associated with 24 h urinary sodium and potassium excretion and blood pressure (BP) in a young bi-ethnic cohort.We examined 423 black and 483 white healthy adults (aged 24.5 ± 3.1 years) for 24 h HRV, including standard deviation of normal RR intervals (SDNN) reflecting autonomic variations over time, and root mean square of successive differences (RMSSD) reflecting parasympathetic activity. We measured 24 h urinary sodium and potassium concentration and BP. The black group had lower SDNN and potassium excretion as well as higher RMSSD, sodium and Na/k ratio compared to the white group (all p 0.05). Only in black individuals, urinary potassium excretion was independently and negatively associated with SDNN (β[95% CI];-0.26[-0.50;-0.02]ms) and RMSSD (-0.14[-0.27;-0.01]ms, p 0.05). One unit increase in sodium/potassium (Na/K) ratio was associated with higher SDNN (β[95% CI]; 3.04[0.89; 5.19]ms) and RMSSD (1.60[0.41; 2.78]ms) in the black cohort only (both p 0.001). In both groups elevated 24 h diastolic BP was associated with lower RMSSD (p 0.05).Lower potassium excretion and higher Na/K ratio related independently to higher HRV in young and healthy black adults. A better ethnic-specific understanding of sodium and potassium handling is required as part of preventive cardiology, especially in black individuals.ClinicalTrials.gov Identifier: NCT03292094; URL: https://clinicaltrials.gov/ct2/show/NCT03292094.
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- 2022
48. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis
- Author
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Andrea Bertuzzi, Alison Martin, Nicola Clarke, Cassandra Springate, Rachel Ashton, Wayne Smith, Andi Orlowski, and Duncan McPherson
- Subjects
General Medicine - Abstract
ObjectivesAssess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022.Eligibility criteriaEligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread.Data extraction and synthesisData were extracted and synthesised narratively, according to the methods of Campbellet al.ResultsOf 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.ConclusionsThe lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.PROSPERO registration numberCRD42022311689.
- Published
- 2023
49. Title Page, Copyright, Dedication
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Chris Wayne Smith
- Published
- 2003
50. Cover
- Author
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Chris Wayne Smith
- Published
- 2003
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