• Energy Research
• medical and health sciences close
• GB close
• Imperial College London close

This study assessed the hand hygiene performance in French nursing homes using the consumption of alcohol-based hand rubs (AHRs) as a surrogate. Nursing homes from the 17 French regions were contacted to collect their AHR consumption and occupancy in 2018 and 2019. A total of 1290 nursing homes from 15 French regions participated in the survey. The estimated median number of hand hygiene actions per resident-day was 1.48 (interquartile range: 1.04-2.03) in 2018 and 1.60 (1.10-2.26) in 2019. A significantly higher AHR consumption was observed in public nursing homes with an infection control team or link nurse.

AbstractBuddleja davidii is a unique biomass that has many attractive agroenergy features, especially its wide range of growth habitat. The anatomical characteristics of B. davidii were investigated before and after ethanol organosolv pretreatment (one of the leading pretreatment technologies) in order to further understand the alterations that occur to the cellular structure of the biomass which can then be correlated with its enzymatic digestibility. Results showed that the ethanol organosolv pretreatment of B. davidii selectively removes lignin from the middle lamella (ML), which does not significantly disrupt the crystalline structure of cellulose. The removal of ML lignin is a major factor in enhancing enzymatic cellulose‐to‐glucose hydrolysis. The pretreatment also causes cell deformation, resulting in cracks and breaks in the cell wall. These observations, together with characterization analysis of the cell wall polymer material, lend support to the hypothesis that the physical distribution of lignin in the biomass matrix is an important structural feature affecting biomass enzymatic digestibility. Biotechnol. Bioeng. 2010;107: 795–801. © 2010 Wiley Periodicals, Inc.

Background: Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. Aims: To confirm the SMO effect on (sustained) MoA in detoxified alcohol-dependent patients. Methods: Large double-blind, randomized, placebo-controlled trial in detoxified adult alcohol-dependent outpatients (80% men) from 11 sites in four European countries. Patients were randomized to 6 months SMO (3.3–3.9 g/day) or placebo followed by a 6-month medication-free period. Primary outcome was the cumulative abstinence duration (CAD) during the 6-month treatment period defined as the number of days with no alcohol use. Secondary outcomes included CAD during the 12-month study period. Results: Of the 314 alcohol-dependent patients randomized, 154 received SMO and 160 received placebo. Based on the pre-specified fixed-effect two-way analysis of variance including the treatment-by-site interaction, SMO showed efficacy in CAD during the 6-month treatment period: mean difference +43.1 days, 95% confidence interval (17.6–68.5; p = 0.001). Since significant heterogeneity of effect across sites and unequal sample sizes among sites ( n = 3–66) were identified, a site-level random meta-analysis was performed with results supporting the pre-specified analysis: mean difference +32.4 days, p = 0.014. The SMO effect was sustained during the medication-free follow-up period. SMO was well-tolerated. Conclusions: Results of this large RCT in alcohol-dependent patients demonstrated a significant and clinically relevant sustained effect of SMO on CAD. Trial registration: ClinicalTrials.gov Identifier: NCT04648423

Strengthening resilience—elasticity or adaptive capacity—is essential in responding to the wide range of natural hazards and anthropogenic changes humanity faces. Chemistry's roles in resilience are explored for the first time, with its technical capacities set in the wider contexts of cross-disciplinary working and the intersecting worlds of science, society and policy. The roles are framed by chemistry's contributions to the sustainability of people and planet, examined via the human security framework's four material aspects of food, health, economic and environmental security. As the science of transformation of matter, chemistry is deeply involved in these material aspects and in their interfacing with human security's three societal and governance aspects of personal, community and political security. Ultimately, strengthening resilience requires making choices about the present use of resources as a hedge against future hazards and adverse events, with these choices being co-determined by technical capacities and social and political will. It is argued that, to intensify its contributions to resilience, chemistry needs to take action along at least three major lines: (i) taking an integrative approach to the field of ‘chemistry and resilience’; (ii) rethinking how the chemical industry operates; and (iii) engaging more with society and policy-makers.

As several contributions in this issue of International Journal of Public Health suggest (in particular that from Kjellstrom 2009), there is a wide range of potential—direct and indirect—health consequences of climate change. However, the science of such effects is still in its infancy and faces considerable challenges, as we try to suggest in our contribution (Xun et al. 2009). Possible events attributable to climate change range from rapid and catastrophic to slow and mild. For example, IPCC does not rule out (though it is very unlikely) a cascade of events leading to Bangladesh being swept away because of rapid Himalayan glacier melting. Apart from extreme and unlikely effects, some of the direct consequences of climate change are rather obvious and can be easily perceived, such as the deaths related to heat waves in Europe in 2003. The causal pathway in these cases is clear, and does not require any particularly sophisticated epidemiological technique. Confounding is irrelevant as far as we consider the causal association between the climate event (heat wave) and its direct health consequences. But still: were all heat waves in the recent past due to what we call climate change, i.e. a man-made trend in temperature and its related epiphenomena? Was the flood in Bangladesh in 1974 the first attributable to climate change, or the last not due to it? And what about the one in 1998? Clearly borders are fuzzy, and causal chains intricate. Uncertain inferences on the causal nature of events also concern the attribution to climate change of indirect health effects, such as infectious disease outbreaks, changes in food quality and availability, water salinization and the ensuing epidemic of hypertension (Xun et al. 2009). Even wars and conflicts (like in Darfur), mass migrations and effects on mental health have been attributed to climate change. In a survey conducted among children aged between 2 and 9 in Bangladesh, Durkin et al. (1993) found post-flood changes in behaviour and bedwetting. Children were reported to have ‘‘very aggressive behaviour’’ after floods, with a significant increase compared to the preflood situation. A qualitative study explored the experiences of female adolescents during the 1998 floods in Bangladesh, focusing on the implications of sociocultural norms related to notions of honour, shame, purity and pollution. A number of the girls were vulnerable to sexual and mental harassment through exposure to unfamiliar environment of flood shelters and relief camps. Common mental health disorders following climate-induced displacement include anxiety, depression, post-traumatic stress disorder, irritability, sleeplessness and suicide. Moreover, conflict situations that may arise among farmers in times of climate-induced natural disasters like droughts and floods need to be addressed. Is all of this attributable to what we call climate change? Where are the borders between the burden of events that would occur anyhow, particularly in low-income countries, even in the absence of climate change, and those attributable to the latter? How can we identify the chain of events that eventually explains the local outbreak? Again, fuzzy borders have to be acknowledged. It should be noted that the effects we have described are mainly occurring or Paolo Vineis is Chair of Environmental Epidemiology at Imperial College, London. His main interests are in the field of molecular epidemiology and gene–environment interactions. He also works on climate change with the Grantham Institute for Climate Change in London.

IntroductionNigeria faces enormous challenges to meet the growing demands for maternal healthcare. This has necessitated the need for digital technologies such as mobile health, to supplement existing maternal healthcare services. However, mobile health programs are tempered with gender blind spots that continue to push women and girls to the margins of society. Failure to address underlying gender inequalities and unintended consequences of mobile health programs limits its benefits and ultimately its sustainability. The importance of understanding existing gender dynamics in mobile health interventions for maternal health cannot be overstated.ObjectiveThis study explores the gender dimensions of Text4Life, a mobile health intervention for maternal healthcare in Edo State, Nigeria by capturing the unique perspectives of women who are the primary beneficiaries, their spouses who are all men, and community leaders who oversaw the implementation and delivery of the intervention.MethodThis qualitative study used criterion-based purposive sampling to recruit a total of 66 participants: 39 women, 25 men, and two ward development committee chairpersons. Data collection involved 8 age and sex desegregated focus group discussions with women and men and in-depth interviews with ward development committee chairpersons in English or Pidgin English. Translated and transcribed data were exported to NVivo 1.6 and data analysis followed a conventional approach to thematic analysis.ResultsWomen had some of the necessary resources to participate in the Text4Life program, but they were generally insufficient thereby derailing their participation. The program enhanced women's status and decision-making capacity but with men positioned as heads of households and major decision-makers in maternal healthcare, there remained the possibility of deprioritizing maternal healthcare. Finally, while Text4Life prioritized women's safety in various contexts, it entrenched systems of power that allow men's control over women's reproductive lives.ConclusionAs communities across sub-Saharan Africa continue to leverage the use of mHealth for maternal health, this study provides insights into the gender implications of women's use of mHealth technologies. While mHealth programs are helpful to women in many ways, they are not enough on their own to undo entrenched systems of power through which men control women's access to resources and their reproductive and social lives.

AbstractThe aim of this study was to investigate the effects of ethanol exposure on the location and number of apoptotic bodies in murine liver. Livers from 21 control mice were compared with those of 41 animals exposed to ethanol vapour by inhalation for up to 23 days. In the control livers, apoptotic bodies were identified in association with 36 per cent of the terminal hepatic venules examined and 88 per cent of these bodies were located in the first two rows of perivenular hepatocytes. By comparison, in the ethanol‐exposed group, apoptotic bodies were observed in association with 72 per cent of the terminal hepatic venules examined and more were found further from them. This increase in the number of apoptotic bodies was shown to depend on the duration of ethanol exposure and, furthermore, the effects of ethanol were shown to be completely reversed by a period of abstinence. These results indicate that ethanol exposure has time‐dependent, reversible effects on both the location and the number of apoptotic bodies in murine liver. This extends knowledge gained from previous work on rat livers.

AbstractBackgroundTemperature and precipitation are known to affectVibrio choleraeoutbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought.MethodsHere, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO2emissions, socio-economic development, and population growth.ResultsThe best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous.ConclusionsDespite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis.

The use of Bacillus subtilis in synthetic biology and metabolic engineering is highly desirable to take advantage of the unique metabolic pathways present in this organism. To do this, an evaluation of B. subtilis' intrinsic biological parts is required to determine the best strategies to accurately regulate metabolic circuits and expression of target proteins. The strengths of promoter candidates were evaluated by measuring relative fluorescence units of a green fluorescent protein reporter, integrated into B. subtilis' chromosome. A total of 84 predicted promoter sequences located upstream of different classes of proteins including heat shock proteins, cell-envelope proteins, and proteins resistant against toxic metals (based on similarity) and other kinds of genes were tested. The expression levels measured ranged from 0.0023 to 4.53-fold of the activity of the well-characterized strong promoter P43. No significant shifts were observed when strains, carrying different promoter candidates, were cultured at high temperature or in media with ethanol, but some strains showed increased activity when cultured under high osmotic pressure. Randomly selected promoter candidates were tested and found to activate transcription of thermostable β-galactosidase (bgaB) at a similar level, implying the ability of these sequences to function as promoter elements in multiple genetic contexts. In addition, selected promoters elevated the final production of both cytoplasmic bgaB and secreted protein α-amylase to about fourfold and twofold, respectively. The generated data allows a deeper understanding of B. subtilis' metabolism and will facilitate future work to develop this organism for synthetic biology.