Reasons for Knocking at an Empty House: Visualisation, Representation and Dissemination of Health-Related Public Engagement Media.

Stigma and mistrust generate significant barriers to the uptake of biomedical, clinical and public health measures to combat infectious diseases. Many pandemics such as HIV, TB and COVID-19 disproportionately affect poorer communities, and the social and public health impact is connected through socio-political histories and contexts. This chapter describes activities and reflections of a South African public engagement programme, Eh!woza, that aims to bring together the biomedicine of disease with its social context and impact. We describe experiences working on tuberculosis-related public engagement programmes in South Africa, and how these approaches were refocused to address the COVID-19 pandemic. We reflect on the lesson learned and considerations around visualising the social impact of disease and making the visualisation of accurate information relatable to younger audiences. Much of the discussion is situated within description and reflection, touching on both the historical and contemporary cultural and political conditions in which infectious diseases have flourished. Finally, the challenges we faced when effectively disseminating media on large-scale digital platforms are highlighted, raising important questions around representation, mass targets, and impactful dissemination of public engagement outputs.

Beyond the lab: Eh!woza and knowing tuberculosis.

Eh!woza is a public engagement initiative that explores the biomedical and social aspects of tuberculosis (TB) in South Africa. The project is a collaboration between scientists based in an infectious disease research institute, a local conceptual/visual artist, a youth-based educational non-governmental organization (NGO) and young learners from a high-burden TB community. The learners participate in a series of interactive science and media production workshops: initially presented with biomedical knowledge about TB and, in later sessions, are trained in creating documentary films and engage with ideas around visual representation. The participants are encouraged to make use of this newly acquired knowledge to tell stories from their chosen communities in Khayelitsha, a township in Cape Town. Through its engagement with the complex manner in which TB is experienced, framed and understood by biomedical scientists, young people, and those who have been affected by the disease, Eh!woza presents alternative ways of exploring the complexities of human illness. The integration and interrogation of biomedical understandings, lay narratives and the young participants' framing of the disease poses questions about 'knowing', and the meanings people attribute to ways of 'knowing' and the actions they impel. The project also presents contrasting reflections on cure-from a biomedical perspective, and care-from the perspective of TB-affected young people and community members. In this article, we describe the Eh!woza project, present thoughts from the participating students on the science and media workshops, and detail the narratives of ill-health and disease from people within their neighbourhoods. We conclude with a critical analysis of the complexities of knowledge communication, notions of cure versus care, and a consideration of the potential contribution of this project to the growth of medical humanities in Africa.

Dabigatran attenuates thrombin generation to a lesser extent than warfarin: could this explain their differential effects on intracranial hemorrhage and myocardial infarction?

Compared with warfarin, dabigatran is associated with less intracranial hemorrhage, but an increased risk of myocardial infarction. To explore these phenomena, we compared their effects on thrombin generation. Thrombin generation in plasma from 10 patients taking therapeutic doses of warfarin (mean INR 2.6) was compared with that in plasma containing 250 ng/mL dabigatran. Although lag times were similar when thrombin generation was induced by recalcification or with a range of tissue factor concentrations, there was a greater reduction in peak thrombin generation and endogenous thrombin potential in plasma from warfarin-treated patients than in dabigatran-containing plasma. Similar results were obtained when thrombin generation was determined in plasma samples from 18 warfarin or 36 dabigatran treated patients entered into the RE-LY trial. Warfarin suppresses thrombin generation more efficiently than dabigatran. Greater suppression of normal hemostatic mechanisms in the brain and pathological thrombosis at sites of atherosclerotic plaque disruption may explain the higher rate of intracranial bleeding and lower rate of myocardial infarction with warfarin compared with dabigatran.

The effect of six keyboard designs on wrist and forearm postures.

There is increasing evidence that alternative geometry keyboards may prevent or reduce arm pain or disorders, and presumably the mechanism is by reducing awkward arm postures. However, the effect of alternative keyboards, especially the new designs, on wrist and arm postures are not well known. In this laboratory study, the wrist and forearm postures of 100 subjects were measured with a motion analysis system while they typed on 6 different keyboard configurations. There were significant differences in wrist extension, ulnar deviation, and forearm pronation between keyboards. When considering all 6 wrists and forearm postures together, the keyboard with an opening angle of 12 degrees , a gable angle of 14 degrees , and a slope of 0 degrees appears to provide the most neutral posture among the keyboards tested. Subjects most preferred this keyboard or a similar keyboard with a gable angle of 8 degrees and they least preferred the keyboard on a conventional laptop computer. These findings may assist in recommendations regarding the selection of keyboards for computer usage.

The effect of tool handle shape on hand muscle load and pinch force in a simulated dental scaling task.

Work-related upper extremity musculoskeletal disorders, including carpal tunnel syndrome, are prevalent among dentists and dental hygienists. An important risk factor for developing these disorders is forceful pinching which occurs during periodontal work such as dental scaling. Ergonomically designed dental scaling instruments may help reduce the prevalence of carpal tunnel syndrome among dental practitioners. In this study, eight custom-designed dental scaling instruments with different handle shapes were used by 24 dentists and dental hygienists to perform a simulated tooth scaling task. The muscle activity of two extensors and two flexors in the forearm was recorded with electromyography while thumb pinch force was measured by pressure sensors. The results demonstrated that the instrument handle with a tapered, round shape and a 10 mm diameter required the least muscle load and pinch force when performing simulated periodontal work. The results from this study can guide dentists and dental hygienists in selection of dental scaling instruments.

The effects of periodontal instrument handle design on hand muscle load and pinch force.

BACKGROUND: In comparison with people in other occupations, dentists and dental hygienists are at increased risk of developing work-related musculoskeletal disorders, including carpal tunnel syndrome. An important risk factor in dental practice is forceful pinching, which occurs during dental scaling. Ergonomically designed dental instruments may help reduce the prevalence of MSDs among dental practitioners. METHODS: In the authors' study, 24 dentists and dental hygienists used 10 custom-designed dental scaling instruments with different handle diameters and weights to perform a simulated scaling task. The authors recorded the muscle activity of two extensors and two flexors in the forearm with electromyography, while thumb pinch force was measured by pressure sensors. RESULTS: Handle designs of periodontal instruments had significant (P < .05) effects on hand muscle load and pinch force during a manual scaling task. The instrument with a large diameter (10 millimeters) and a light weight (15 grams) required the least amount of muscle load and pinch force. There was a limit to the effect of handle diameter, with diameters larger than 10 mm having no additional benefit; however, the study did not identify a limit to the effect of reducing the weight of the instrument, and therefore instruments lighter than 15 g may require even less pinch force. CLINICAL IMPLICATIONS: The results from this study can guide dentists and dental hygienists in selection of dental scaling instruments.

Subtle differences in commercial heparins can have serious consequences for cardiopulmonary bypass patients: A randomized controlled trial.

OBJECTIVE: To compare the potency, reversibility, and perioperative bleeding risk of Hepalean with those of PPC heparin. METHODS: Because in vitro testing failed to detect differences in the potency or protamine reversibility of the 2 heparin preparations, we conducted a parallel group, single-center, double-blind, randomized, controlled trial to compare the anticoagulant effects of Hepalean to those of PPC heparin in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. RESULTS: From June 1, 2011, to June 30, 2011, we randomly assigned 11 patients to receive PPC heparin and 10 to receive Hepalean. Despite similar initial doses of heparin, the median initial activated clotting time was numerically lower in the PPC heparin group than in the Hepalean group (median, 516.0 seconds; interquartile range, 481.0-633.0; vs median, 584.0 seconds, interquartile range, 520.0-629.0; P = .418). Those given PPC heparin required a greater total heparin dose (median, 46,000.0 U; interquartile range, 39,500.0-60,000.0 vs median, 34,500.0 U; interquartile range, 32,250.0-37,000.0; P = .011) and a greater dose of heparin per kilogram than those given Hepalean (median, 572.9 U/kg; interquartile range, 443.0-659.7 vs median, 401.1 U/kg; interquartile range, 400.0-419.4; P = .003). The key secondary results included an increased median total protamine dose (median, 600.0 mg; interquartile range, 550.0-700.0; vs median, 500.0 mg; interquartile range, 425.0-542.5; P = .026) and a trend toward increased chest tube output within 24 hours (median, 830.0 mL; interquartile range, 425.0-1135.0; vs median, 702.5 mL; interquartile range, 550.0-742.5; P = .324). CONCLUSIONS: PPC heparin use was associated with greater heparin and protamine dose requirements than Hepalean. These findings indicate that heparin preparations are not interchangeable and suggest that a direct comparison of the potency with the brand in use is needed if a change is made to ensure that the agents exert similar anticoagulant effects in vivo.

Cytokine elevations in acute coronary syndrome and ovarian cancer: a mechanism for the up-regulation of the acute phase proteins in these different disease etiologies.

OBJECTIVES: To identify if a common set of cytokines is elevated in both ovarian cancer and acute coronary syndrome (ACS). DESIGN AND METHODS: A cytokine array (Randox Ltd) was measured in healthy women (n=33), women with ACS (n=21) and ovarian cancer (n=45). RESULTS: Women with ACS or ovarian cancer had higher concentrations of IL-6, IL-8, VEGF, MCP-1, and EGF as compared to healthy volunteers. DISCUSSION: Common cytokine elevations are present in both ACS and ovarian cancer.

The uses of heparin to treat burn injury.

OBJECTIVES: To assess the evidence for using heparin in the treatment of burn injury or the complications of burn injury in adults and children. DATA SOURCES: The following databases were searched: MEDLINE (1966-current), EMBASE (1980-current), Cumulative Index to Nursing & Allied Health (CINAHL) (1982-current), The Cochrane Central Database of Controlled Trials (1995-current), Web of Science (1976-current), and BIOSIS (1976-current). Additional data sources included the U.S. and European Patent Offices, technical experts, the partner organization, and reference lists. REVIEW METHODS: Studies identified from the data sources went through two levels of title and abstract screening. Passing studies advanced to full text screening. Studies that met the full text screening criteria were abstracted. Criteria for abstraction included publication in any language, human patients of any age, and burns of any type, grade, or total body surface area. All formulations of heparin, and all application methods (e.g., topical, subcutaneous), were eligible for inclusion in the report. Abstracted studies required a comparison group. Outcomes of interest included mortality, pain, length of stay in hospital, thrombosis and emboli, psychiatric adjustment, and adverse effects (e.g., bleeding). RESULTS: Nineteen articles from 18 unique studies were abstracted and included in this report. In these articles, there were multiple uses of heparin to treat burns (e.g., wound healing, inhalation injury, sepsis, pain). However, the overall quality of the articles was weak. Examples of weakness included unclear or inappropriate treatment allocation, no blinding, no control of confounding, poorly defined burn characteristics (e.g., thickness), unclear duration of treatment, incomplete description of heparin treatment, and use of inadequately described or invalid outcome measures. Overall, the evidence from these weak articles was insufficient to determine whether the effectiveness of heparin to treat burn injury was different from the effectiveness of other treatments, or whether treatment effectiveness varied according to (a) the method of applying heparin to (b) burn etiology. Four studies mentioned contraindications to using heparin to treat burns. These contraindications were bleeding diathesis, bleeding history, active bleeding or associated trauma with potential bleeding, active intestinal ulcer, thrombocytopenia, liver disease, renal disorders, or allergy to heparin. CONCLUSIONS: There is no strong evidence in the 19 abstracted articles to suggest that heparin should be used in the treatment of burn injury on account of its non-anticoagulant properties.

Oxygen reservoirs in the early solar nebula inferred from an allende CAI

Ultraviolet laser microprobe analyses of a calcium-aluminum-rich inclusion (CAI) from the Allende meteorite suggest that a line with a slope of exactly 1.00 on a plot of delta17O against delta18O represents the primitive oxygen isotope reservoir of the early solar nebula. Most meteorites are enriched in 17O and 18O relative to this line, and their oxygen isotope ratios can be explained by mass fractionation or isotope exchange initiating from the primitive reservoir. These data establish a link between the oxygen isotopic composition of the abundant ordinary chondrites and the primitive 16O-rich component of CAIs.

Fluid flow in chondritic parent bodies: deciphering the compositions of planetesimals

Alteration of the Allende meteorite caused shifts in oxygen isotope ratios along a single mass fractionation line. If alteration was caused by aqueous fluid, the pattern of oxygen isotope fractionation can be explained only by flow of reactive water down a temperature gradient. Down-temperature flow of aqueous fluid within planetesimals is sufficient to explain the mineralogical and oxygen isotopic diversity among CV, CM, and CI carbonaceous chondrites and displacement of the terrestrial planets from the primordial slope 1. 00 line on the oxygen three-isotope plot.