RSS 1.0Medicine, Biological and Life Sciences
Sub-communities within this community
Collections in this community
Recent Submissions
-
Systems thinking in mental health patient safety: A narrative review of complex adaptive systemsDespite the growth of knowledge and interest into safety and quality in healthcare more generally, the exploration in mental healthcare has been deemed to be in a narrow isolated ‘world of its own’. It is possible that relatively little attention is being paid to the processes and interdependencies within the mental health patient safety system. This may result in simplistic static measures of what the system/organisation has, not what it does (or doesn't do). This can limit the potential for learning and affecting change. To investigate systems thinking in mental health patient safety, we conducted a narrative review into the extent of evidence streams supporting systems and complexity thinking approaches. We sourced a total of 89 reports for analysis with six themes identified. These themes included studies evaluating patient safety events that have occurred within mental healthcare, research that has investigated components of the safety system, and studies that have investigated how patient safety incidents are responded to, investigated, and learned from. The review evaluated the use of systems thinking and complexity research in patient safety, and research encapsulating patient and carer involvement. Most research has focused on the analysis of historic approaches to incident investigation and on system‐based factors of patient safety, with little attention being paid to systems and complexity thinking approaches. The relationships between components were often ignored in the non‐systemic studies sourced, with relationships between components not investigated and unknown. With policymakers recommending changes in patient safety practice through system‐based approaches, it is important that its implementation is evaluated robustly with consideration of the multiple levels of the healthcare system. Future research should aim to incorporate systems‐thinking approaches to model the safety system, and to improve our understanding of the highly interconnected technical and social entities that dynamically produce emergent behaviour across the system.
-
Massive declines and local recoveries: First range-wide assessment spotlights ending egg-taking as key to the survival of the Macrocephalon maleo (Maleo)The communally nesting, Critically Endangered Macrocephalon maleo (Maleo) is an iconic species endemic to Sulawesi, Indonesia, yet despite decades of legal protection its populations have declined sharply across its range. We performed the first-ever range-wide field survey of Maleo nesting grounds, visiting 122 known and identifying 58 previously unrecorded sites, collecting physical and biological data and interviewing local informants at each. We added information from the literature for another 48 abandoned sites, documenting a total of 228 historic and current nesting grounds. We then constructed a profile of historic and current populations and area of occupancy (AOO) units across Sulawesi. Between 1980 and 2019, 55% of active nesting grounds became inactive, and all but one of the 94 sites that remained active in 2019 had fewer birds. In 2019, 83% of all nesting grounds active in 1980 were either completely abandoned or just barely active, hosting no more than 2 pairs day–1 at peak season. However, conservation efforts have also produced significant recoveries and discoveries. Our survey increased the range of described landscape types where Maleo nest from 2 to 4, and documented Maleo nesting in previously unrecorded places, including artificially created sandy areas. As the Maleo’s maximum travel distance beyond nesting grounds is unknown, we applied a cost-based approach using possible maximum travel distances of 25, 40, and 50 km to define AOO “Units” that represent a set of separate range-wide subpopulations defined by each maximum travel distance. Between 1980 and 2019, the overall AOO declined by 37%, 26%, and 19% at maximum travel distances of 25, 40, and 50 km, respectively; the number of active nesting grounds in each isolated unit declined by 58%, 78%, and 80%, respectively; and fragmentation (i.e., the total number of units) increased by 5%, 100%, and 125%, respectively. In some areas, Maleo may be changing their behavior in response to egg predation by humans. Ending egg-taking has now clearly been shown to produce Maleo increases in multiple locations and is crucial to range-wide recovery of the species.
-
"This disease has made me lose the belief I had in myself": qualitative analysis of experiences among buruli ulcer disease patients in Nigeria using the socioecological model of healthIntroduction: Buruli Ulcer Disease is a debilitating neglected tropical disease caused by “Mycobacterium ulcerans”, predominantly affecting marginalized populations in tropical and subtropical regions, including Nigeria. Previous studies have reported a prevalence rate of 61.3% for the disease, highlighting its significant burden on affected communities. Much of the existing research has focused on the biomedical aspects of BUD, often neglecting the sociocultural and environmental dimensions crucial to patient experiences and outcomes. This study utilizes the socioecological model of health to explore the complex interplay of individual, interpersonal, community, and societal factors shaping the experiences of buruli ulcer disease patients in Nigeria. Methods: Our qualitative study was conducted among people living with buruli ulcer disease in Enugu state. Data collection involved only one Focus Group Discussion with eight discussants due to the sensitive nature of the topic, and six Key Informant Interviews, encompassing a diverse group of buruli ulcer disease patients. The WHO Quality of Life-BREF was adapted for data collection, which was conducted by a trained team. Data were analyzed using content analysis to inductively code themes and identify overarching categories, supported by NVivo (version 12). Results: Our findings reveal the diverse experiences of patients across various levels of socioecological model. At the individual level: participants reported significant physical and psychological challenges, including persistent pain, discomfort, disfigurement, and the emotional toll of stigmatization. Interpersonal level: experiences of social rejection, loss of social roles, and abandonment by family members were reported. These interpersonal challenges were exacerbated by the stigma surrounding the disease, leading to strained relationships and a sense of isolation within their social circles. At the organizational level: some individuals experienced compassion and assistance, others faced social isolation, discrimination, and exclusion due to misconceptions. Broader community level included limited awareness, which resulted in a lack of resources and formal support systems. Conclusion: BUD patients in Nigeria endure considerable negative psychosocial experiences, particularly at the interpersonal and community levels. Enhancing community awareness and support is crucial to mitigating these impacts. Further research should explore family-level psychosocial experiences and other contributing factors to provide a more comprehensive understanding and inform effective intervention strategies.
-
PhyBaSE: A Bayesian structural equation model approach to causal inference in phylogenetic comparative analysesOne of the main limitations of phylogenetic comparative analyses is that associations between traits can only be interpreted as correlations. Here, we present a novel Bayesian structural equation model (PhyBaSE) which allows us to disentangle direct from indirect relationships among variables to propose potential causal hypotheses while accounting for phylogenetic non‐independence. Compared with the existing maximum‐likelihood based approach, PhyBaSE models are more flexible, allowing the inclusion of trait and phylogenetic uncertainty, as well as non‐continuous variables. To facilitate the application of the method, we provide worked examples, data and code. We exemplify the method both with simulated as well as empirical data. Our analyses with simulated data indicate that PhyBaSE models have higher power than classic Phylogenetic Path Analysis to discriminate between competing models. As an example of PhyBaSE using empirical data, we revisit different hypotheses proposed to explain the relationship between relative brain size and group size in Bovids. Our results challenge the previously supported social brain hypothesis and provide support for an allometric effect of body size on social group size and an effect of brain size on life span, as predicted by the cognitive buffer hypothesis. The flexibility of PhyBaSE models will allow researchers to explore more complex hypotheses on the evolution of behavioural, ecological and life history traits at a macroevolutionary level and how these are linked to anthropogenic drivers of biodiversity loss and extinction, taking full advantage of the increasing number of publicly available species‐specific datasets.
-
Potential for behaviour change among Kenyan type 2 diabetes service users and to understand behaviour change from healthcare professionals’ perspectivesIntroduction: The rising type two diabetes mellitus (T2DM) prevalence is largely due to unhealthy dietary practices, lack of physical activity, economic development, urbanisation, and an ageing population. Management of T2DM involves pharmacological treatment and or lifestyle behaviour changes focusing on diet and physical activity behaviour modifications. Diet and physical activity behaviour modifications are crucial in T2DM management. However, behaviour change is complex and challenging and more so in diet and physical activity behaviours as these are influenced by a myriad of behavioural, social, emotional and environmental, neuroendocrine and genetic factors. Behaviour change thus remains one of the most significant public health concerns. Underpinning this research study is the continued challenge with behaviour change among T2DM service users that leads to development of T2DM related complications and even death. The purpose of this study was therefore to examine the likelihood to change behaviour so as to avoid T2DM related complications and to explore whether being in receipt of the recommended care services had any influence on likelihood to change behaviour. This is particularly important because numerous interventions have been carried out but while change may be initially noted, the positive behaviour is in many cases not sustained over time. The main impact of this study to provide an understanding on the influences of behaviour change as influenced by the health belief model and to explore hinderances to access to the diabetes recommended care services. Methods: The study utilised a mixed-method approach to gain an in-depth comprehension of the topic. The target population for the study comprised of T2DM service users at the Thika Level 5 Hospital diabetes comprehensive clinic and healthcare professionals directly involved in T2DM management. Through power calculations, a sample size of 346 service users was determined. Forty three healthcare professionals were also included in the study as key informants. The inclusion criterion for the diabetes clinic service users was persons diagnosed with type two diabetes and aged 20-70. The inclusion criterion for the healthcare professionals was those who directly worked with service users with regards to behaviour change. Purposive sampling was used in selecting the participants for the study. The exclusion criterion for the service users was those who had type one diabetes or were aged below 20 or above 70 years. For the healthcare professionals, those not directly involved with type two diabetes service users behaviour change (diet and physical activity) were not included in the study. Questionnaires were used to collect quantitative data from the service users. Semi-structured individual interviews were used to collect data from the healthcare professionals. Quantitative data was coded and entered into the Statistical Package for Social Sciences, Version 28.0, for analysis. Qualitative data was entered into Nvivo 13 for thematic analysis. Findings: Behaviour change among healthcare professionals and T2DM service users is based on four constructs of the health belief model: susceptibility to complications, intention to exercise, perceived benefits of exercise and health eating and healthy eating intentions (likened to cues to action). Different factors that affect T2DM management are categorised into predisposing factors, reinforcing factors and enabling factors. Management processes of T2DM should include primary targets to prevent T2DM, primary targets towards promoting behaviour change, actions engaged in the management of T2DM, multi-sectorial approaches and actions by other sectors. Conclusion: According to the study, behaviour change is perceived differently among healthcare professionals and service users. The study therefore recommends that tailored messages should be delivered to different categories of patients so as to enhance behaviour change. The health belief model should be adopted in crafting the messages so as to so as to effectively address complications (perceived susceptibility and severity) associated with T2DM, perceived barriers, perceived benefits, and self-efficacy for behaviour change to be effective. A “one size fits all” approach is not recommended when coming up with interventions towards behaviour change. Further, the study also concludes that policy makers in the Kenyan health system should consider predisposing factors, reinforcing factors and enabling factors towards T2DM management policy making. Since T2DM management involves different targets, the Kenyan health system should engage different stakeholders. A “one size fits all” approach is therefore not appropriate towards T2DM management.
-
Circulating angiopoietin-like protein 8 (ANGPTL8) and steatotic liver disease related to metabolic dysfunction: an updated systematic review and meta-analysisBackground: Steatotic liver disease related to metabolic dysfunction is the most common cause of chronic liver disease globally. The spectrum of this condition includes steatosis and steatohepatitis and was previously referred to as non-alcoholic fatty liver disease (NAFLD) but has been renamed as metabolic dysfunction-associated fatty liver disease (MAFLD) and more recently as metabolic dysfunction-associated steatotic liver disease (MASLD). Angiopoietin-like protein 8 (ANGPTL8), also known as betatrophin or lipasin, regulates triglycerides and has emerged as a potential novel biomarker for steatosis/steatohepatitis. Therefore, this systematic review aimed to identify and synthesize the evidence on the possible association of circulating ANGPTL8 concentrations with NAFLD, MAFLD or MASLD. Methods: PubMed/MEDLINE, Cochrane Library, EMBASE, and Web of Science were searched for studies published in English reporting circulating ANGPTL8 concentrations in adults with NAFLD or MAFLD or MASLD and controls. A meta-analysis was performed, reporting the standardized mean difference (SMD) of circulating ANGPTL8 concentrations between these two groups. Study quality and risk of bias were assessed using the NIH quality assessment tool and RoBANS 2, respectively. Results: Of the 104 identified publications, eight studies were eligible for this systematic review, whilst seven were also eligible for meta-analysis (543 NAFLD or MAFLD cases vs. 352 controls). Circulating ANGPTL8 concentrations were significantly higher in patients with NAFLD or MAFLD compared with controls (SMD: 0.62, 95%CI: 0.28-0.97; p<0.001). Considerable heterogeneity was noted among these studies, with six studies having high risk of bias in at least one RoBANS 2 domain. Conclusion: These findings present up-to-date comprehensive evidence indicating that adults with steatotic liver disease related to metabolic dysfunction exhibit higher circulating ANGPTL8 concentrations compared with controls. Given the need for novel screening/diagnostic biomarkers for steatosis/steatohepatitis, as well for additional drug targets, large and prospective studies are required to confirm this association and explore its temporal direction, particularly under the new MASLD diagnosis/term.
-
A systematic environmental intervention, nidotherapy, given to whole communities: protocol for a randomised stepped-wedge trialEnvironmental changes can be positive in mental illness. Systematic, planned and guided environmental change in all its aspects is called nidotherapy. It has shown some benefit but has not been extended to whole communities. A cluster-randomised step-wedge trial is planned in six village communities in Nottinghamshire, England, covering an adult population of 400. Adults in six villages will be offered a full personal environmental assessment followed by agreed change in different 3-month periods over the course of 1 year. All six villages have populations between 51 and 100 residents and are similar demographically. Assessments of mental health, personality status, social function, quality of life and environment satisfaction will be made. After the initial baseline period of 3 months, two villages will be randomised to nidotherapy for 3 months, a further two at 6 months and the last two at 9 months. The primary outcome will be change in social function; secondary outcomes include health-related quality of life, anxiety and depressive symptoms, personality status, costs of nidotherapy and life satisfaction. Adverse events will also be recorded. The analysis will be carried out using a multimodal statistical approach examining (a) the change in scores of the primary outcome (social function); (b) change in scores of all secondary outcomes, including costs; and (c) changes in environmental satisfaction. The findings of this study should help to determine whether nidotherapy has a place in the early detection and treatment of mental pathology.
-
Macaque mothers’ responses to the deaths of their infantsAlthough it is understood that all humans grieve the death of close social partners, little empirical research has addressed animals’ responses to death. In this study, we collected quantitative data on the behaviour of 11 bereaved rhesus macaque (Macaca mulatta) mothers at Cayo Santiago to the natural deaths of their infants and matched, non-bereaved controls. Our research focused on behavioural signs of grief, including loss of appetite, lethargy, increased stress and social withdrawal, highlighting that such responses are documented in the human literature, but could be found in mammalian taxa. Using mixed models, we found that, contrary to prediction, bereaved mothers spent less time resting than the non-bereaved control females in the first two weeks after their infants’ deaths. There were no other behavioural markers of grief. We conclude that mothers showed a short-term behavioural response to their bereavement that does not match human’s prolonged ‘despair’ grief. We propose that mothers’ behavioural responses might be a form of ‘protest’ grief, as is seen in primate infants when separated from mothers and in humans, or do not grieve. We hope to advance the field of comparative thanatology by providing a framework and novel predictions for future studies in this area.
-
Daily variability in sedentary behaviour and physical activity responsiveness in older womenFree-living physical behaviour (PB), from sedentarism through to vigorous physical activity (PA), is increasingly studied due to its links to health outcomes. However, it remains unclear whether pre-existing day-to-day regularity in certain PB patterns influences intervention responsiveness. Therefore, this study hypothesized that (1) inter-day variability in certain PBs would decrease following a sedentary behaviour (SB) reduction intervention, and (2) those with high inter-day variability (low regularity) at baseline would be less likely to alter their behaviour compared to those with low inter-day variability (high regularity). Thirty-six older women (73 ± 5 years) were allocated to one of three groups: (1) daily SB fragmentation (SBF) (n = 14), (2) single daily bout of continuous light-intensity PA/LIPA (n = 14), or (3) control (n = 8), where no instructions vis-à-vis altering daily physical activity or sedentary behaviour were given. PB was objectively assessed (weeks 0 and 8) using three-dimensional accelerometry. Participants (48% of the study sample) with high regularity at baseline (<25th sample percentile for SB and PA bout length), showed greater SB reduction, and increased average PA bout length (p < 0.05) at week 8. These findings suggest that baseline regularity in physical behaviour may enhance intervention responsiveness. This aligns with theories of habit formation and self-regulation, indicating that personalised interventions would benefit a wider range of populations.
-
Mean stability and between-session reliability of cycling biomechanics variables in elite pursuit cyclistsThe purpose of this study was to determine the number of crank revolutions required to obtain stable mean values of sagittal plane biomechanics variables, and the between-session reliability of these variables, whilst cyclists used an aerodynamic position. Eighteen elite cyclists completed a 3-min maximal bout on a cycling ergometer. Lower-limb kinematic and kinetic data were captured using 2D motion capture and force pedals. Raw data were filtered using a 4th order Butterworth low-pass filter (6 hz) and interpolated to 100 points per revolution. The middle 60 revolutions of each trial were extracted and 37 discrete and 15 time-series variables were calculated. Mean stability was assessed in all participants, and between-session reliability was analysed in a subset of 11 participants. Sequential averaging indicated more revolutions to stability than iterative intra-class correlation coefficients. Crank kinetics were more stable than joint kinematics and kinetics. For stable discrete and time-series variables, 30 and 38 revolutions are recommended, respectively. Between-day reliability for all variables was moderate to excellent, and good to excellent for crank kinetics and joint kinematics variables. Hip flexion-extension and ankle dorsiflexion kinetics were least reliable. Researchers and applied practitioners should consider these findings when planning, and interpreting results from, cycling biomechanics interventions.
-
UPLC-Q-TOF-MS/MS identification, antioxidant, and alpha-glucosidase inhibition activities of three forms of phenolic compounds from Yemeni jujube fruit: In vitro and in silico investigationsJujube fruits have rich medicinal value due to their biological properties which are affected mainly by geographical locations. This study investigates the antioxidant properties of free fraction (FF), esterified fraction (EF), bound fraction (BF), and other metabolites prepared from dried Yemeni jujube fruit and compare to those previously reported in the literature. Results from UPLC-Q-TOF-MS/MS analysis showed that this fruit consists of a total of 33, 26, and 27 free, esterified, and bound compounds identified, respectively. In terms of ABTS, DPPH, FRAP, and H<sub>2</sub>O<sub>2</sub> assays, the BF exhibited values 1.2, 1.3,1.3, and 1.4 times higher than those of the FF, and similarly, 1.8, 1.9,2.0, and 2.5 times higher than the EF. A similar trend was observed in the inhibition of α-glucosidase (α-Glu), where the BF was 1.6, and 2.4 times more effective compared to the FF and EF, respectively. In silico analysis showed that flavonoids, the key active compounds, had substantial α-glucosidase binding capacity. In the meat model, all fractions inhibited protein and lipid oxidation during storage, and the BF exhibited the highest antioxidant capacity. This study provides the first investigation of the structure of active compounds and their biological properties in Yemeni jujube fruit. Yemeni fruits can be utilized as natural antioxidants, and nutraceuticals in food preservation, and medicine respectively.
-
Population dynamics of the Rodrigues fruit bat (Pteropus rodricensis): An analysis of long-term island wide bat count dataThe Rodrigues fruit bat (Pteropus rodricensis) is an insular Old-World fruit bat endemic to the Island of Rodrigues. The Mauritian Wildlife Foundation implemented a population monitoring program in 1974 and an estimate of less than 80 individuals was recorded in 1979. Following conservation efforts of reforestation of native flora, the population has experienced a steady increase, subject to decreases in numbers after severe cyclones. A standardized methodology was applied in 2016 creating a dataset suitable for population modelling and statistical analysis. The most recent population census (2022) revealed that the population has remained stable at around 20,000 individuals for the last 5 years. This study uses Generalised Linear Mixed Models (GLMMs) to analyse 17 years of population monitoring data in order to identify the climatic factors potentially driving the population trend. We identified that the strongest factors driving changes in the population numbers were linked to resource availability. Most notable were annual precipitation levels, which had a positive relationship with population size (β=1.745, P<0.001), and cyclones, specifically relating to cyclonic strength, which was negatively related with the population size (β=-0.205, P<0.0001). This study also critically analyses the population count methodology and offers recommendations and suggestions for future research to be conducted on the species.
-
Temporomandibular joint degeneration arises spontaneously in STR/Ort mice and is prevented by targeted aggrecanase inhibitionOBJECTIVE: Temporomandibular joint osteoarthritis (TMJ-OA) is painful and causes masticatory dysfunction, but current treatment is limited to symptom relief due to an incomplete appreciation of aetiology. Herein, we develop morphological and histological methods for quantitative evaluation of TMJ-OA severity and examine whether STR/Ort mice, which are genetically predisposed to spontaneous knee OA, exhibit protection against TMJ-OA upon genetic gain-of-function modification of an aggrecanase-selective mutant of tissue inhibitor of metalloproteinase (TIMP)-3. DESIGN: We established morphological changes in mandibular condylar head adapted from human TMJ-OA criteria, and developed and verified the utility of TMJ-OA histological damage scoring adapted from the OARSI system. Mutant TIMP3 containing an extra alanine at the N-Terminus ([-1A] TIMP-3 was overexpressed in STR/Ort and CBA mice. Morphological changes in mandibular condyle and TMJ cartilage degradation were evaluated and quantified using micro-CT and histology in mice aged 10, 20 and 40 weeks. RESULTS: Whilst no evidence of TMJ-OA was observed in STR/Ort mice aged 10 weeks, bone erosion and osteophyte formation appeared in the mandibular condyle by 20 weeks, with remarkable deformity and bone resorption at 40 weeks in STR/Ort, but not the parental CBA strain. TMJ-OA was less severe in 40 week-old [-1A]TIMP-3 overexpressing STR/Ort and CBA compared to wild-type mice. CONCLUSIONS: Using our new mouse TMJ-OA scoring system we have found that OA affects joints other than the knee in the STR/Ort strain. Genetic gain-of-function modification of STR/Ort mice with an aggrecanase-selective mutant of tissue inhibitor of metalloproteinase (TIMP)-3 also affords in vivo chondroprotection against this TMJ-OA.
-
Developing and validating attention bias tools for assessing trait and state affect in animals: A worked example with Macaca mulattaAttention bias is a new approach to assessing animal affect that has shown promising results in several animal species. It describes a tendency to preferentially attend to emotional compared to neutral cues and is influenced by underlying affect. It is important in the early days of this new field that we develop widely utilisable methods and incorporate lessons from the human literature from which tasks are adapted. This fundamental knowledge is critical to the development of standardised and sensitive tools, and the validation of experimental protocols to ensure best practice. Here, we describe protocols for two preferential-looking attention bias tasks. Study 1 involved a manual task using freely available low-cost materials. Study 2 used an automated task requiring specialist equipment and programming, but presumably less prone to noisy data. Tasks were tested with 109 socially housed rhesus macaques, Macaca mulatta, who had been trained to sit by a target, but received no other training. Tasks involved showing animals emotional face pairs (threat-neutral), and subsequent blind coding of video for duration of looking at either face. Three measures of social attention were examined: time spent looking at the threat face (THR), total time looking at the threat-neutral face pair overall (TL), and attention bias difference score (ABD) calculated as time spent looking at the neutral face subtracted from time spent looking at the threat face. Based on the human literature and early primate work, the influence of five potential confounding factors on attention was assessed: trial number, stimulus ID, previous testing experience, time of day and visual field to which the threat face was presented; as were several life history factors: sex, age, and social rank. Both tasks revealed stable individual differences in baseline social attention (THR and TL: effect sizes = 0.15−0.31; repeatabilities = 0.12−0.26; suggesting sensitivity to trait affect), but not ABD (which may be more sensitive to brief shifts in emotion state). All potential confounding factors had a significant effect on at least one measure of social attention. For a subset of monkeys who took part in both Study 1 and Study 2 several years apart (n = 18), there was significant reproducibility between tasks for all three measures (R = 0.15−0.63), supporting an argument for stable individual differences in baseline attention bias, and validating the two tasks for measuring the same trait. The attention bias method shows promise for further development of standardised protocols with animals. We provide framework and recommendations for future method development.
-
Proteomic analysis and effects on osteogenic differentiation of exosomes from patients with ossification of the spinal ligamentLay Summary: Ossification of ligamentum flavum (OLF) is a hyperostotic spinal condition that compresses the spinal cord, leading to progressive motor and sensory dysfunction. Progression of ossification varies widely among individuals, making it important to identify factors that regulate disease activity. The study focused on exosomes, crucial for intercellular communication during disease development and progression. By comparing exosomes from patients with and without OLF, the study identified specific proteins that may play a role in spinal ligament ossification. These findings could help identify new markers to track disease progression and potential targets for treatment.
-
Analytical study on secondary metabolites extraction and characterization from Acacia Gums (AGs)Acacia gums (AGs), derived from Acacia senegal, Acacia seyal, and Acacia polyacantha trees, are widely used in various industries, including food, pharmaceuticals, and cosmetics. They serve as emulsifiers, stabilizers, thickeners, and soluble dietary fibers. This study aimed to optimize the extraction process of secondary metabolites extracted (SME) from AGS to enhance their efficiency and quality for industrial applications. Gum arabic, primarily composed of D-galactose, L-arabinose, L-rhamnose, D-glucuronic acid, and 4-O-methyl-D-glucuronic acid with a small fraction of proteins, is a multifunctional ingredient known for its emulsifying activity, attributed to its amphiphilic nature. Its effectiveness as an emulsifier stems from its high water solubility, low-viscosity, good surface activity, and ability to form a protective film around emulsion droplets. AGS in Sudan play crucial ecological roles by providing fodder, firewood, gums, and soil erosion control, which are essential for gum arabic production. Sudan’s diverse biodiversity hosts many plant species traditionally used for medicinal purposes, with extensive knowledge of medicinal plant species stemming from their widespread use among different ethnic groups. This study highlights the importance of optimizing the extraction of secondary metabolites from AGS for industrial applications, and the significance of AGS in Sudan’s ecological balance and economic stability.
-
Gut microbiota and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Emerging pathogenic mechanisms and therapeutic ImplicationsNon-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD), is the most common cause of chronic liver disease worldwide. Characterized by excessive hepatic fat accumulation, this disease encompasses a spectrum from simple steatosis to more severe forms, including steatohepatitis, fibrosis, and cirrhosis. Emerging evidence highlights the pivotal role of gut dysbiosis in the pathogenesis of MASLD. Dysbiosis disrupts the gut–liver axis, an intricate communication network that regulates metabolic, immune, and barrier functions. Alterations in gut microbiota composition, increased gut permeability, and translocation of pro-inflammatory metabolites/factors have been shown to trigger liver inflammatory and fibrotic cascades, exacerbating hepatic inflammation and injury. Recent studies have identified microbiome signatures associated with MASLD, offering promise as non-invasive diagnostic biomarkers and paving the way for new potential therapeutic strategies targeting gut dysbiosis. This review explores the crucial role of the gut microbiota in MASLD pathogenesis and highlights the need for further targeted research in this field to validate microbial biomarkers and optimize therapeutic strategies. Comprehensive understanding of the gut–liver axis may enable innovative diagnostic and therapeutic approaches, transforming the clinical management of MASLD.
-
Homocysteine levels and cardiovascular disease risk factors in chronic kidney disease (CKD), hypertensive and healthy Nigerian adults: A comparative retrospective studyOBJECTIVES: To investigate homocysteine (Hcy) levels in individuals with chronic kidney disease (CKD), hypertension and a healthy Nigerian population, and to assess their association with cardiovascular disease (CVD) risk. SETTING: The study was conducted using data from the Ibadan CRECKID (Cardiovascular and Renal Event in People with Chronic Kidney Disease) study in Nigeria. Participants: A total of 420 adults (aged 18+) categorised into three groups: individuals with stage 2 CKD or higher, hypertensive non-CKD individuals and normotensive individuals. OUTCOMES: The primary outcome was the difference in serum Hcy levels across the groups; secondary outcomes included the prevalence of hyperhomocysteinaemia (HHcy) and correlation with fibroblast growth factor (FGF). RESULTS: No significant difference in mean serum Hcy levels among the CKD, hypertensive and healthy groups (p=0.39) was observed. However, HHcy (≥15 µmol/L) prevalence was significantly higher in the hypertensive group (p<0.05). A strong positive correlation between Hcy levels and FGF was identified across all groups (p<0.001). CONCLUSIONS: The present study indicates that Hcy levels may not serve as a reliable predictor of CVD outcomes across populations with varying kidney function and CVD risk profiles.
-
Risks to the clinician of risk management: Recalled and anticipated consequences of decision-makingBACKGROUND: Despite extensive literature studying how we make decisions in the face of uncertainty, the empirical study of real-world clinical decision-making in mental health practice remains limited. Decisions in clinical settings are not just made on the basis of clinical factors. A key non-clinical influence on decision making is the clinician’s concerns about the ‘threat’ to themselves from a future adverse incident and the subsequent retrospective scrutiny of their decision-making. A better understanding of non-clinical processes is essential to inform better ways of guiding effective decision-making. More specifically, delineating the nature of this ‘threat’ process will also inform approaches to patient safety. AIMS: The objective of the current study was to delineate consequences recalled and anticipated by mental health clinicians making decisions under uncertainty. METHODS: This was an analysis of data arising from six focus group discussions with professionals involved in decisions to admit patients to psychiatric hospitals (consultant psychiatrists, approved mental health practitioners, crisis resolution home treatment teams, and liaison psychiatry practitioners) in one National Health Service Trust, UK. The data were thematically analyzed to identify the nature of ‘threat’ processes that arise in clinical decision-making. RESULTS: Themes identified included (i) the location of the effect of the anticipated/recalled consequence(s), (ii) the location of the origin of the consequence, and (iii) the nature of the consequence. The recalled and anticipated consequences of decision-making were overwhelmingly, but not exclusively, negative. The consequences were largely perceived to be directed towards the self (i.e., the clinician) and were considered to originate from external scrutiny by peers, organizational leadership, and the patient safety system/processes. CONCLUSIONS: The process of making decisions to admit patients to hospital consistently involved the decision-maker’s concern with the future consequences for them, either from a prior or future adverse event. The findings of this study, alongside other evidence of the complexity of decision-making, have implications for improving and studying clinical decision-making (and, by extension, patient care and outcomes), patient safety responses, and professional well-being.
