Effectiveness of a Community Pharmacy-Based Health Promotion Program on Hypertension in Bangladesh and Pakistan: Study Protocol for a Cluster-Randomized Controlled Trial.

The aim of this multi-country, cluster-randomized trial is to test the impact of pharmacy-based health promotion to reduce the blood pressure of individuals with hypertension over a 12-month period in Bangladesh and Pakistan. The trial will be implemented with two arms. In Bangladesh, the estimated sample size is around 3600 hypertensive patients. In Pakistan, we will select samples equivalent to 10% of the participants from Bangladesh, comprising 360 hypertensive patients from four pharmacies. Community pharmacies will be randomized into one of two parallel groups (allocation ratio 1:1). Pharmacy professionals in the treatment arm will provide their patients with educational training and counseling, as well as phone calls/mobile text messages and care coordination in the health sector, as part of the intervention. The study will be conducted in three phases: a baseline survey with intervention, a midline survey with intervention and follow-up, and an endline survey with impact evaluation. The primary outcome of the study will be BP. The secondary outcomes will be BP controlled to target, treatment adherence, quality of life, mortality or hospital admission rates resulting from hypertension and its related complications, incremental cost per health-related quality of life gained, knowledge on healthy lifestyle and dietary behavior, and change in the prevalence of current smoking status.

[Challenges of Delivering Healthcare from an Economic and Public Finance Perspective].

As populations grow older, the sustainability of current healthcare systems is being questioned. This paper considers what is necessary to ensure the sustainability of the healthcare system in Japan from the perspective of economics and public finance. In particular, it addresses the cost-effective use of limited medical resources. It also considers the problems of current regulations and regulatory regimes, which tend to protect vested interests. It may be necessary to carry out fundamental reforms of the regulatory system to deliver a sustainable healthcare system.

Difference in reaction mechanism between ZnZrOx and InZrOx for CO2 hydrogenation.

Oxide solid-solution catalysts, such as Zn-doped ZrO2 (ZnZrOx) and In-doped ZrO2 (InZrOx), exhibit distinctive catalytic capabilities for CH3OH synthesis via CO2 hydrogenation. We investigated the active site structures of these catalysts and their associated reaction mechanisms using both experimental and computational approaches. Electron microscopy and X-ray absorption spectroscopy reveal that the primary active sites are isolated cations, such as Zn2+ and In3+, dissolved in tetragonal ZrO2. Notably, for Zn2+, decomposition of the methoxy group, which is an essential intermediate in CH4 synthesis, is partially suppressed because of the relatively high stability of the methoxy group. Conversely, the methyl group strongly adsorbs on In3+, facilitating the conversion of the methoxy species into methyl groups. The decomposition of CH3OH is also suggested to contribute to CH4 synthesis. These results highlight the generation of CH4 as a byproduct of the InZrOx catalyst. Understanding the active site structure and elucidating the reaction mechanism at the atomic level are anticipated to contribute significantly to the future development of oxide solid-solution catalysts.

Plant strategies for greatest height: tapering or hollowing.

The tapered form and hollow cross-section of the stem and trunk of wild plants are rational mechanical approaches because they facilitate the plant simultaneously growing taller for photosynthesis and supporting its own weight. The purpose of this study is to clarify the advantages and disadvantages of tapering and hollowing from the perspective of the greatest probable height before self-buckling. We modelled woody plants using tapering or hollow cantilevers, formulated the greatest height before self-buckling, and derived a theoretical formula for the greatest probable height considering tapering and hollowing. This formula theoretically explains why almost all plants exhibit a tapered form: it allows for a greater height at an earlier growth stage than a hollow cross-section.

Mechanics-based classification rule for plants.

The height of thick and solid plants, such as woody plants, is proportional to two-thirds of the power of their diameter at breast height. However, this rule cannot be applied to herbaceous plants that are thin and soft because the mechanisms supporting their bodies are fundamentally different. This study aims to clarify the rigidity control mechanism resulting from turgor pressure caused by internal water in herbaceous plants to formulate the corresponding scaling law. We modeled a herbaceous plant as a cantilever with the ground side as a fixed end, and the greatest height was formulated considering the axial tension force from the turgor pressure. The scaling law describing the relationship between the height and diameter in terms of the turgor pressure was theoretically derived. Moreover, we proposed a plant classification rule based on stress distribution.

Reproductive, maternal, newborn, and child health intervention coverage in 70 low-income and middle-income countries, 2000-30: trends, projections, and inequities.

BACKGROUND: Monitoring the progress in reproductive, maternal, newborn, and child health (RMNCH) using the composite coverage index (CCI) is crucial to evaluate the advancement of low-income and middle-income countries (LMICs) towards the attainment of Sustainable Development Goal target 3. We present current benchmarking for 70 LMICs, forecasting to 2030, and an analysis of inequities within and across countries. METHODS: In this cross-sectional secondary data analysis, we extracted 291 data points from the WHO Equity Monitor, and Demographic and Health Survey Statcompiler for 70 LMICs. We selected countries on the basis of whether they belonged to LMICs, had complete information about the predictors between 2000 and 2030, and had at least one data point related to CCI. CCI was calculated on the basis of eight types of RMNCH interventions in four domains, comprising family planning, antenatal care, immunisations, and management of childhood illnesses. This study examined CCI as the main outcome variable. Bayesian hierarchical models were used to estimate trends and projections of the CCI at regional and national levels, as well as the area of residence, educational level, and wealth quintile. FINDINGS: Despite progress, only 18 countries are projected to reach the 80% CCI target by 2030. Regionally, CCI is projected to increase in all regions of Asia (in southern Asia from 51·8% in 2000 to 89·2% in 2030; in southeastern Asia from 58·8% to 84·4%; in central Asia from 70·3% to 87·0%; in eastern Asia from 76·8% to 82·1%; and in western Asia from 56·5% to 72·1%), Africa (in sub-Saharan Africa from 46·3% in 2000 to 72·2% in 2030 and in northern Africa from 55·0% to 81·7%), and Latin America and the Caribbean (from 67·0% in 2000 to 83·4% in 2030). By contrast, southern Europe is predicted to experience a decline in CCI over the same period (70·1% in 2000 to 55·2% in 2030). Across LMICs, CCIs are higher in urban areas, in populations in which women have higher education levels, and in populations with a high income. INTERPRETATION: Governments of countries where the universal target of 80% CCI has not yet been reached must develop evidence-based policies aimed at enhancing RMNCH coverage. Additionally, they should focus on reducing the extent of existing inequalities within their populations to drive progress in RMNCH. FUNDING: Hitotsubashi University and Japan Society for the Promotion of Science.

Rigidity control mechanism by turgor pressure in plants.

The bodies of herbaceous plants are slender, thin, and soft. These plants support their bodies through the action of turgor pressure associated with their internal water stores. The purpose of this study was to apply the principles of structural mechanics to clarify the underlying mechanism of rigidity control that is responsible for turgor pressure in plants and the reason behind the self-supporting ability of herbaceous plants. We modeled a plant a horizontally oriented thin-walled cylindrical cantilever with closed ends enclosing a cavity filled with water that is acted on by its own weight and by internal tension generated through turgor pressure. We derived an equation describing the plant's consequent deflection, introducing a dimensionless parameter to express the decrease in deflection associated with the action of turgor pressure. We found that the mechanical and physical characteristics of herbaceous plants that would appear to be counter-productive from a superficial perspective increase the deflection decreasing effect of turgor pressure.

Global, regional, and national progress in financial risk protection towards universal health coverage, 2000-2030.

INTRODUCTION: Complete (100%) protection against catastrophic health expenditure (CHE) and impoverishment is the main target of universal health coverage (UHC). Evidence-based estimates must be at the heart of policy development for UHC, further research using updated data is essential to monitor, track, and compare country progress up to 2030. We estimate global, regional, and country-level CHE and impoverishment during 2000-2030. METHODS: We aggregated 636 data points from 140 countries that were conducted between 2000 and 2021. We used Bayesian hierarchical model for trend and projection analysis. Furthermore, we constructed scenario-based projections of CHE and impoverishment based on 5% GDP spending on health and per capita health expenditure (PCHE) of $86. RESULTS: Most countries fail to achieve financial protection targets by 2030, with the global incidence of CHE predicted to persist around 7% at 10% threshold. CHE is predicted to increase in most of Asia (Southern: 8.1% in 2000 to 13.4% in 2030; Central: 3.6%-23.2%; Eastern: 8.3%-14.4%; and Western: 7.3%-20.2%), Northern Africa (12.4%-27.2%), Eastern (7.1%-14.9%) and Northern Europe (6.6%-13.2%). In contrast, a decrease is predicted in Oceania, Latin America and the Caribbean, and Northern America. By 2030, incidence of impoverishment is predicted to be 0% worldwide at $3.10 poverty line, however in several African and Soth Asian countries is predicted to be high impoverishment. The scenario-based analysis indicated that CHE and impoverishment is expected to decrease in 41 and 42 countries for GDP increase and 43 and 62 for PCHE increase respectively compared to current spending on health. CONCLUSION: To accelerate progress towards reducing financial protection, governments should carefully assess the country context to determine how health can be prioritised through government spending to reduce out-of-pocket payments.

Mathematical modelling to determine the greatest height of trees.

This study aimed to analyse the critical height of a column whose weight varies vertically in order to obtain a simple scaling law for a tree where the weight distribution considered. We modelled trees as cantilevers that were fixed to the ground and formulated a self-buckling problem for various weight distributions. A formula for calculating the critical height was derived in a simple form that did not include special functions. We obtained a theoretical clarification of the effect of the weight distribution of heavy columns on the buckling behaviour. A widely applicable scaling law for trees was obtained. We found that an actual tree manages to distribute the weight of its trunk and branches along its vertical extent in a manner that adequately secures its critical height. The method and findings of this study are applicable to a wide range of fields, such as the simplification of complicated buckling problems and the study of tree shape quantification.

Structural rationalities of tapered hollow cylindrical beams and their use in Japanese traditional bamboo fishing rods.

Bamboo has historically been used in Japan as a structural material and for building tools such as fishing rods owing to its remarkable structural properties. In recent years, the materials used for manufacturing fishing rods have changed greatly owing to the development of composite materials; however, the basic slender tapered hollow cylindrical fishing rod design has remained unchanged throughout the long history of fishing. However, the mechanical rationale behind this structural design has not yet been sufficiently verified, and this study clarifies this. The analysis was performed by solving the nonlinear bending equation of a slender tapered cantilever beam with a concentrated load at the tip, which causes large deflection, using the Runge-Kutta method. The deflection curves and bending stresses were obtained, and the structural design to minimize the stresses was explored. Our results may prove useful for bamboo-inspired bionic design and bring to light our ancestors' deep knowledge of natural materials and their advanced technological capabilities.

Bamboo-inspired optimal design for functionally graded hollow cylinders.

The optimal distribution of the reinforcing fibers for stiffening hollow cylindrical composites is explored using the linear elasticity theory. The spatial distribution of the vascular bundles in wild bamboo, a nature-designed functionally graded material, is the basis for the design. Our results suggest that wild bamboos maximize their flexural rigidity by optimally regulating the radial gradation of their vascular bundle distribution. This fact provides us with a plant-mimetic design principle that enables the realization of high-stiffness and lightweight cylindrical composites.

Dynamics of washboard road formation driven by a harmonic oscillator.

Granular surfaces subjected to repeated passage often spontaneously develop a corrugated pattern. In this study, we scrutinized the growth dynamics of surface corrugation in a self-rotating sand bed that is traced by the edge of a vertically oscillating arm. We found that both the rotation velocity and the frequency of the oscillator strongly affect the occurrence rate of corrugation as well as the time evolution in the corrugation pattern, due to the intermittent collision between the oscillator and sand bed. We also discovered that the growth dynamics involves two distinct collective modes that describe the translational motion of the corrugation pattern on the sand bed.

Impact of Fluorine-18 2-Fluoro-2-Deoxy-D-Glucose Uptake on Preoperative Positron Emission Tomography/Computed Tomography in the Lymph Nodes of Patients with Primary Colorectal Cancer.

BACKGROUND/AIMS: Although the diagnostic value of fluorine-18 2-fluoro-2-deoxy-D-glucose (F-18-FDG) positron emission tomography/computed tomography (F-18-FDG-PET/CT) in patients with colorectal cancer (CRC) has been reported, the association between the F-18-FDG uptake in metastatic lymph nodes (FDGLN) and clinicopathological variables has not been fully investigated. We evaluated the diagnostic value of F-18-FDG-PET/CT in detecting LN metastasis from CRC, and the relationship between F-18-FDG-PET/CT-detecting LN metastasis and prognosis. METHODS: We retrospectively analyzed the medical records of 370 patients who underwent preoperative F-18-FDG-PET/CT, followed by surgical resection for CRC between January 2007 and December 2010. We analyzed the sensitivity, specificity, and accuracy of F-18-FDG-PET/CT and CT in diagnosing metastatic LNs. Survival was analyzed in 115 patients with stage III CRC. RESULTS: The sensitivity, specificity, and accuracy for detecting metastatic LNs using F-18-FDG-PET/CT were 56.8, 90.3, and 74.2%, and those for contrast-enhanced CT were 38.4, 95.5, and 65.0%, respectively. The accuracy of F-18-FDG-PET/CT was significantly associated with tumor depth and lymphatic involvement. In the survival analysis, cancer-specific survival and the disease-free survival were significantly shorter in patients with stage III CRC with FDGLN than in those without FDGLN. CONCLUSION: F-18-FDG-PET/CT had low sensitivity and high specificity for detecting metastatic LNs from CRC. FDGLN independently predicted poor prognosis in patients with stage III CRC.

Self-adaptive formation of uneven node spacings in wild bamboo.

Bamboo has a distinctive structure wherein a long cavity inside a cylindrical woody section is divided into many chambers by stiff diaphragms. The diaphragms are inserted at nodes and thought to serve as ring stiffeners for bamboo culms against the external load; if this is the case, the separation between adjacent nodes should be configured optimally in order to enhance the mechanical stability of the culms. Here, we reveal the hitherto unknown blueprint of the optimal node spacings used in the growth of wild bamboo. Measurement data analysis together with theoretical formulations suggest that wild bamboos effectively control their node spacings as well as other geometric parameters in accord with the lightweight and high-strength design concept.

Collision lung cancer on F-18 FDG PET/CT.

We report a case of a primary collision lung cancer consisting of squamous cell carcinoma and adenocarcinoma. A 73-year-old man with an abnormality found on chest radiograph in the right lower lobe was examined by FDG PET/CT (F-18 fluorodeoxyglucose positron emission tomography/computed tomography). The tumor was composed of 2 different morphologic and FDG accumulation portions and a collision tumor was suspected. Histopathologically, this tumor was composed of squamous cell carcinoma and adenocarcinoma. Each element was clearly distinguished but touched. FDG PET/CT is a useful tool to diagnose collision tumor as it shows morphologic and metabolic differences between 2 distinct tumor components.

F-18 FDG accumulation in mucinous cystic neoplasm of pancreas.

We report a case of mucinous cystic neoplasm which showed FDG accumulation in its cyst wall. MRI revealed that this tumor had repeated intracystic hemorrhage. Inhomogeneous FDG accumulation was found in the cyst wall. The epithelium was focally denuded and ovarian-like stroma with macrophage migration, which phagocytosed red blood cells, and fibrosis were recognized on histopathological examination. These histopathological findings suggested that FDG accumulates not in the monolayer epithelium but in ovarian-like stroma with macrophage migration and fibrosis. Macrophage migration and fibrosis were considered to have contributed to FDG accumulation in this mucinous cystic neoplasm.

F-18 FDG PET/CT in relapsing polychondritis.

We report a case of relapsing polychondritis for which fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) showed increased FDG accumulation in all rib cartilages, as well as in the larynx, trachea, and major bronchi. Contrast-enhanced CT during PET/CT showed smooth tracheal and bronchial wall thickening with calcification and airway narrowing. After steroid therapy, clinical symptoms and laboratory data were improved and cartilaginous FDG accumulation had completely disappeared. FDG PET/CT is considered to be a powerful radiological tool to assess the disease activity of relapsing polychondritis.

Usefulness of F-18 FDG PET/CT in the assessment of disseminated Mycobacterium avium complex infection.

A patient showing abnormal fluorine-18-fluorodeoxyglucose (FDG) uptake due to disseminated Mycobacterium avium complex (MAC) infection is presented. Increased focal FDG uptake was demonstrated in the cervical and supraclavicular lymph nodes, spleen, and diffuse bone marrow. FDG PET/CT is considered as a useful diagnostic tool to assess the exact extent and activity of disseminated MAC infection. Moreover, it is advantageous over CT and magnetic resonance imaging to assess the treatment response and time course of the disease.

Structure-effect relationship in the down-regulation of glutaminase in cultured human cells by phenylarsenic compounds.

Diphenylarsinic acid [DPAA(V)] was detected in ground water used as drinking water after a poisonous incident in Kamisu, Japan. An approach to define the target molecules of DPAA(V) with a high throughput analysis of proteins from cultured human cells demonstrated down-regulation of glutaminase C (GAC). GAC is a splicing variant of the kidney-type glutaminase (KGA) gene and has the enzyme activity of phosphate-activated glutaminase (PAG). To gain some insights into the mechanism of arsenic intoxication in Kamisu, the effects of various arsenic compounds, including arsenicals that were detected in ground water ([DPAA(V)], phenylarsonic acid [PAA(V)] and bis(diphenylarsine)oxide [BDPAO(III)]) and rice (phenylmethylarsinic acid [PMAA(V)]), were investigated for the expression of GAC and PAG activity. When cultured human HepG2 cells were incubated with arsenicals for 24h, the pentavalent phenylarsenic form of PAA(V) and PMAA(V) as well as DPAA(V) suppressed the expression of GAC protein and PAG activity in a concentration-dependent manner. On the other hand, the trivalent phenylarsenic form of BDPAO(III) had no suppressive effect on GAC and PAG. In addition, trivalent phenylarsenic compounds, such as the glutathione (GSH) conjugate of DPAA(V) [DPA-GS (III)] and triphenylarsine [TPA(III)], and the inorganic arsenics, iAs(V) and iAs(III), and methylated metabolites of inorganic arsenics, dimethylarsinic acid [DMA(V)] and dimethylarsinous acid [DMA(III)], had no suppressive effect on glutaminase. Likewise, methyl substituents of the hydroxyl groups of DPAA(V), PAA(V) and PMAA(V), diphenylmethylarsine oxide [DPMAO(V)] and phenyldimethylarsine oxide [PDMAO(V)], did not have any suppressive effects. These results suggest that pentavalent arsenic compounds with both phenyl groups and hydroxyl groups are effective in the suppression of glutaminase. In addition, the fact that it was only the arsenicals detected in Kamisu that were effective in suppressing glutaminase provides insights into the cause of the arsenic intoxication at Kamisu.