Novel Pharmacological Targets of Post-Traumatic Stress Disorders

Post-traumatic stress disorder (PTSD) is a psychopathological condition with a heteroge- neous clinical picture that is complex and challenging to treat. Its multifaceted pathophysiology still remains an unresolved question and certainly contributes to this issue. The pharmacological treatment of PTSD is mainly empirical and centered on the serotonergic system. Since the therapeutic response to prescribed drugs targeting single symptoms is generally inconsistent, there is an urgent need for novel pathogenetic hypotheses, including different mediators and pathways. This paper was conceived as a narrative review with the aim of debating the current pharmacological treatment of PTSD and further highlighting prospective targets for future drugs. The authors accessed some of the main databases of scientific literature available and selected all the papers that fulfilled the purpose of the present work. The results showed that most of the current pharmacological treatments for PTSD are symptom-based and show only partial benefits; this largely reflects the limited knowledge of its neurobiology. Growing, albeit limited, data suggests that the hypothalamic-pituitary-adrenal axis, opioids, glutamate, cannabinoids, oxytocin, neuropeptide Y, and microRNA may play a role in the development of PTSD and could be targeted for novel treatments. Indeed, recent research indicates that examining different pathways might result in the development of novel and more efficient drugs

Quality improvement in ammonium nitrate production using Six Sigma methodology

Six sigma has been used in different industries to reach operational excellence. However, in the chemical industry, the application of this methodology is limited. This research presents an implementation of the six sigma method for ammonium nitrate (AN) content optimization in condensate production for a fertilizer company in Colombia. The paper aims to determine the levels for input variables in the process, to meet desirable standards for condensate quality in terms of ammonium nitrate content. Based on the DMAIC steps implementation, it was possible to establish the main variables affecting the condensate quality and their optimal levels to reach an ammonium nitrate content below 15,000 ppm. These results demonstrate the impact that a six sigma project may have on operational effectiveness and quality improvement for meeting the customer requirements

La aplicación combinada de abonos orgánicos mejora las propiedades físicas del suelo asociado al cultivo de quinua (Chenopodium quinoa Willd.)

The reduced acceleration of the organic matter in the soil has been affecting its properties, making it necessary to repeat the use and management of organic fertilizers. The objective of research was to evaluate the effect of two fertilizers application, Island Guano (IG) and sheep manure (SM), on the following three physical properties of the soil: bulk density, water-stable aggregates and penetration resistance, under quinoa (Chenopodium quinoa Willd) cultivation, Hualhuas variety. These properties were determined by beveled cylinder, Yoder wet-sieving and dynamic cone penetrometer methods and under a completely randomized block design, with factorial arrangement of two factors (IG and SM) and three levels per factor (0; 0.5 and 1 t*ha-1 for IG and 0; 2.5 and 5 t*ha-1 for SM), nine treatments were evaluated, with three repetitions, so 27 total experimental units. Results showed that combined application of different doses of IG and SM does not influence bulk density, but with doses IG 0,5 t*ha-1 with SM 5 t*ha-1 and IG 1 t*ha-1 with SM 5 t*ha-1 water-stable aggregates and penetration resistance improved significantly.La acelerada disminución de la materia orgánica del suelo viene afectando sus propiedades, siendo necesario reincidir en el uso y manejo de abonos orgánicos. El objetivo del presente trabajo fue evaluar el efecto de la aplicación de dos abonos orgánicos combinados, Guano de las Islas (GI) y estiércol de ovino (EO), sobre las siguientes tres propiedades físicas del suelo: densidad aparente, estabilidad de agregados y resistencia mecánica a la penetración, bajo el cultivo de quinua (Chenopodium quinoa Willd) variedad Hualhuas. Estas propiedades se determinaron mediante los métodos de cilindro biselado, Yoder y del penetrómetro dinámico y bajo un diseño en bloques completamente al azar, con arreglo factorial de dos factores (GI y EO) y tres niveles por factor (0; 0,5 y 1 t/hapara GI y 0; 2,5 y 5 t/hapara EO). Los resultados demostraron que la aplicación combinada de las diferentes dosis en estudio no influye sobre la densidad aparente del suelo, pero la aplicación combinada de 0,5 t/ha de GI con 5 t/ha de EO y 1 t/ha de GI con 5 t/hade EO disminuyen significativamente la resistencia mecánica del suelo a la penetración e incrementan la estabilidad de agregados

Designing Transnational Hydroclimatological Observation Networks and Data Sharing Policies in West Africa

Surface observations provide ground evidence of climate change to support the scientific guidance paving the way to better adaptation and mitigation actions. The West African Science Service Centre on Climate Change and Adapted Land Use (WASCAL) has designed a multi-stakeholder initiative to rescue the deteriorated near-surface weather, climate and hydrological equipment of West African countries. The main goal for this multi-stakeholder framework was to monitor the climate and collect long term and high-quality records of essential climate variables in support of research, education, capacity building, and climate services provision. Proactive and inclusive partnership initiatives were developed to jointly (re)design and (re)implement near surface observatiories with the national meteorological and hydrological services or agencies (NMHS/As) in West Africa. The co-production scheme used by this framework succeeded in evaluating the existing observations networks, to modernizing sensors and field equipment, and densifying the sites in order to improve the quality of data collection, transmission, archiving, processing and sharing policies. After more than four years of community-of-practice, the existing regional basic hydroclimatic was increased/upgraded by 45% with automatic weather observing systems while fifty automatic water level, ten water quality sensors, three mesoscale research catchments, and several pilot sites to benefit countries’ services provision, research infrastructure, education, and capacity building. Country-specific data sharing policies were harmonized and signed to support data services delivery. This practice paper exposes the concepts, outcomes, challenges, lessons learned and the ways forward in setting-up the framework and keeping it on working to leverage the co-production of data & information services for better-informed decision-making in the field of sustainable development in West Africa

Community participation for reproductive, maternal, newborn and child health: insights from the design and implementation of the BornFyne-prenatal management system digital platform in Cameroon

IntroductionAcross communities in low-middle income countries, digital health is currently revolutionizing the delivery of health services, particularly in the field of reproductive, maternal, newborn, and child health (RMNCH) services. While studies have shown the effectiveness of mHealth in delivering RMNCH services, there is little information about factors that enhance mHealth services utilization in low-cost settings including stakeholders’ level of influence on the implementation of digital health intervention in sub–Saharan Africa. This paper seeks to describe important lessons on the levels of stakeholders’ direct or indirect influence on the design and implementation of the BornFyne-PNMS digital health platform to support RMNCH services.MethodsA participatory research (PR) design approach was employed to explore stakeholders’ perspectives of a new initiative, through direct engagement of local priorities and perspectives. The process of introducing the digital application called the BornFyne-PNMS for district health delivery system and the community, and integrating it within the district health delivery system was guided by research-to-action, consistent with the PR approach. To explore stakeholders’ perspectives through a PR approach, we conducted a series of stakeholder meetings fashioned after focus group discussions.ResultsIssues around male involvement in the program, sensitization and equity concerns arose. Emergent challenges and proposed strategies for implementation from diverse stakeholders evidently enriched the design and implementation process of the project intervention. Stakeholder meetings informed the addition of variables on the mobile application that were otherwise initially omitted, which will further enhance the RMNCH electronic data collection for health information systems strengthening in Cameroon.DiscussionThis study charts a direction that is critical in digital health delivery of RMNCH in a rural and low-income community and describes the important iterative stakeholder input throughout the study. The strategy of stakeholders’ involvement in the BornFyne PNMS implementation charts a direction for ownership and sustainability in the strengthening of Cameroon's health information system

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Beyond coverage: a qualitative study exploring the perceived impact of Gabon’s health insurance plan on access to and quality of prenatal care

Abstract Background Access to affordable and adequate healthcare in a health system determines the universal health coverage achievement for all residents in a country. Achieving access to healthcare requires the availability of a financing system that ensures access to and provision of adequate care, regardless of the ability to pay. In sub-Saharan Africa, accessibility, use and coverage of prenatal visits are very low and poor, which reduces the quality of care. This paper explored the impact of a social health insurance scheme on the quality of antenatal care in Gabon. Methods This qualitative study involved the analysis of data collected from semi-structured interviews and non-participant observations to assess the quality of antenatal care. The study elicited perceptions on the demand side (pregnant women) and the supply side (health professionals) in health facilities. Fifteen semi-structured interviews were conducted with pregnant women (aged between 15 and 49) and 5 with health professionals, who each had a seniority of at least 10 years, at different levels of care. Nine non-participant observations were also conducted. Coded transcripts were reviewed and analyzed using the Canadian Institute for Public Administration of Citizen-Centered Services model as an analytical guide. Results On the demand side, women were generally satisfied with the prenatal services they receive in health facilities. However, complaints were made about the rudeness of some nurses, the high price of the delivery kit (50,000 XAF), and the fact that some essential medicines for maternity are not covered. On the supply side, participants agreed that compulsory health insurance is important in providing antenatal care access to those who need it the most. However, some problems remain. The participants outlined some logistical problems and a lack of medical equipment, including the stock of drugs, disinfectants, and the absence of clean water. Conclusion Understanding the perceptions of pregnant women and health professionals regarding the quality of antenatal care can help to inform refinements to methods through which the services can be better provided. In addition, the study findings are vital to increasing the use of care, as well as combating high maternal mortality rates. Compulsory health insurance has improved the accessibility and utilization of healthcare services and has contributed to improved quality of care