| 1. |
- Anttila, Sten, et al.
(författare)
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Housing programs and case management for reducing homelessness and increasing residential stability for homeless people
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The Universal Declaration of Human Rights (Article 25) states that everyone has a right to housing. Yet according to the UNHCR there are approximately 100 million homeless people worldwide. Homelessness has many negative detrimental consequences on an individual as well as on a societal level. The condition of homeless seriously affects well-being and health in general and may contribute to mental illness in particular. Once homeless, people tend to be deprived of economic, social and psychological resources that are necessary in order to get a new accommodation. If this happens the resources of some clients may be too poor and few to prevent future evictions.Case management is a collaborative process, including assessment, planning, facilitation and advocacy for options and services, intended to make sure that the client’s needs are met. Intensive case management, including assertive community treatment, is intended to ensure that the client receives sufficient services, support and treatment when and where it is needed. In this way intensive case management (case load <1:15, 24-7 availability, and the combined competence of a multidisciplinary team), may help homeless people to obtain accommodation, and once housed avoid eviction.Housing programs are more or less based on housing philosophies. According to one philosophy stable and independent housing is needed for the client to become treatment ready. Housing should neither be contingent on sobriety nor on treatment compliance, but only on rules that apply for ordinary tenants. In other words housing is parallel to and not integrated with treatment, or with other services. An alternative philosophy is based on the assumption that some clients (possibly those with a bio-chemical dependence on drugs) may need a transitional period of sobriety and treatment compliance, before they can live independently in their own apartments. Without this transitional phase the assumption is that they will soon face eviction, and return to homelessness. According to this philosophy housing is integrated with treatment. By combining housing and case management within the framework of a comprehensive program, the work to find accommodation and to prevent eviction is assumed to be facilitated.The objective was to assess the effectiveness of 9 possible combinations of housing programs and case management as means to increase residential stability and reduce homelessness. The possible combinations were based on three housing alternatives and three case management alternatives which entails 36 possible comparisons:Housing parallel to treatment, housing integrated with treatment, and no housingIntensive of case management (ICM and ACT), ordinary case management, and no case management.Electronic databases were searched by means of terms referring to population, intervention, and design (Campbell Library, Cochrane Library (including CENTRAL), PubMed, PsycINFO, Sociological Abstracts, Social Services Abstracts, ASSIA, CINAHL, ERIC, and Dissertation Abstracts International). Reference lists were hand searched, and international experts were contacted. For a study to be included the following criteria had to be met:Population: homeless or at risk of becoming homelessIntervention: housing programs with case management, housing programs without case management, or case management without a housing programComparison: any of the alternative interventions above, plus usual care, waiting lists, or no interventionOutcome: residential stability or homelessnessDesign: randomized controlled trials or observational studies (with comparison groups matched at baseline or on propensity scores)Pairs of reviewers independently screened abstracts, and read full text documents. Data was extracted and coded by two reviewers. Two reviewers also assessed risks of bias for each study and their outcomes. In several cases data had to be recalculated in order to fit the format necessary for meta-analysis based on Review Manager.After screening 1, 764 abstracts and assessing 276 documents in full text, 32 unique studies were included (26 randomized controlled trials and 6 observational studies) in this review. All studies were from the USA except three, which were undertaken in the UK (two randomized controlled trials and one observational study). The number of included studies is thus relatively high, but the body of evidence is poor, as most studies are characterized by high risk of aggregated bias (11 studies) or moderate risk of aggregated bias (15 studies and 19 comparisons). Only 6 studies were classified as having low aggregated risk of bias. In addition, most studies are rather old. The median publication year is 1998. There are 16 studies published between 2000 and 2010 (11 randomized trials and five observational studies). Since 2005 only five included studies were published (three randomized trials and two observational studies). The results can be summarized in seven points:a) Housing parallel to treatment is not superior to housing integrated with treatment or vice versa.b) Empirical results indicate that parallel housing as such is superior to no housing.c) There is not sufficient evidence to conclude that integrated housing as such is superior to no housing.d) Empirical results indicate that intensive case management as such (ACT and ICM) is superior to usual care (such as drop in centers, outpatient treatment, ordinary after care, etc.).e) Empirical results indicate that parallel housing in combination with intensive case management (ACT and ICM) is superior to usual care (such as drop in centers, outpatient treatment, ordinary after care, etc.).f)There is not sufficient evidence to conclude that integrated housing in combination with intensive case management (ACT and ICM) is superior to usual care (such as drop in centers, outpatient treatment, ordinary after care, etc.) Conclusion: Parallel housing, in combination with intensive case management (ICM and ACT), improves housing outcomes in comparison to usual care (outpatient treatment, drop in centers, ordinary after care, brokered case management, etc.). Intensive case management as well as housing contributes to this effect. However, evidence is not decisive when parallel housing is compared to integrated housing. Empirical results are highly contradictory. Studies focusing on specific subgroups such as women and persons with severe substance abuse problems are required.
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| 2. |
- Burdge, Kevin B., et al.
(författare)
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A 62-minute orbital period black widow binary in a wide hierarchical triple
- 2022
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 605:7908, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- Over a dozen millisecond pulsars are ablating low-mass companions in close binary systems. In the original 'black widow', the eight-hour orbital period eclipsing pulsar PSR J1959+2048 (PSR B1957+20)(1), high-energy emission originating from the pulsar2 is irradiating and may eventually destroy(3) a low-mass companion. These systems are not only physical laboratories that reveal the interesting results of exposing a close companion star to the relativistic energy output of a pulsar, but are also believed to harbour some of the most massive neutron stars(4), allowing for robust tests of the neutron star equation of state. Here we report observations of ZTF J1406+1222, a wide hierarchical triple hosting a 62-minute orbital period black widow candidate, the optical flux of which varies by a factor of more than ten. ZTF J1406+1222 pushes the boundaries of evolutionary models(5), falling below the 80-minute minimum orbital period of hydrogen-rich systems. The wide tertiary companion is a rare low-metallicity cool subdwarf star, and the system has a Galactic halo orbit consistent with passing near the Galactic Centre, making it a probe of formation channels, neutron star kick physics(6) and binary evolution.
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| 3. |
- Dahal, Prabin, et al.
(författare)
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Competing risk events in antimalarial drug trials in uncomplicated Plasmodium falciparum malaria : a WorldWide Antimalarial Resistance Network individual participant data meta-analysis
- 2019
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Ingår i: Malaria Journal. - : BMC. - 1475-2875 .- 1475-2875. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Therapeutic efficacy studies in uncomplicated Plasmodium falciparum malaria are confounded by new infections, which constitute competing risk events since they can potentially preclude/pre-empt the detection of subsequent recrudescence of persistent, sub-microscopic primary infections.Methods: Antimalarial studies typically report the risk of recrudescence derived using the Kaplan-Meier (K-M) method, which considers new infections acquired during the follow-up period as censored. Cumulative Incidence Function (CIF) provides an alternative approach for handling new infections, which accounts for them as a competing risk event. The complement of the estimate derived using the K-M method (1 minus K-M), and the CIF were used to derive the risk of recrudescence at the end of the follow-up period using data from studies collated in the WorldWide Antimalarial Resistance Network data repository. Absolute differences in the failure estimates derived using these two methods were quantified. In comparative studies, the equality of two K-M curves was assessed using the log-rank test, and the equality of CIFs using Gray's k-sample test (both at 5% level of significance). Two different regression modelling strategies for recrudescence were considered: cause-specific Cox model and Fine and Gray's sub-distributional hazard model.Results: Data were available from 92 studies (233 treatment arms, 31,379 patients) conducted between 1996 and 2014. At the end of follow-up, the median absolute overestimation in the estimated risk of cumulative recrudescence by using 1 minus K-M approach was 0.04% (interquartile range (IQR): 0.00-0.27%, Range: 0.00-3.60%). The overestimation was correlated positively with the proportion of patients with recrudescence [Pearson's correlation coefficient (rho): 0.38, 95% Confidence Interval (CI) 0.30-0.46] or new infection [rho: 0.43; 95% CI 0.35-0.54]. In three study arms, the point estimates of failure were greater than 10% (the WHO threshold for withdrawing antimalarials) when the K-M method was used, but remained below 10% when using the CIF approach, but the 95% confidence interval included this threshold.Conclusions: The 1 minus K-M method resulted in a marginal overestimation of recrudescence that became increasingly pronounced as antimalarial efficacy declined, particularly when the observed proportion of new infection was high. The CIF approach provides an alternative approach for derivation of failure estimates in antimalarial trials, particularly in high transmission settings.
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| 4. |
- Dahal, Prabin, et al.
(författare)
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Temporal distribution of Plasmodium falciparum recrudescence following artemisinin-based combination therapy : an individual participant data meta-analysis
- 2022
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Ingår i: Malaria Journal. - : Springer Nature. - 1475-2875 .- 1475-2875. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: The duration of trial follow-up affects the ability to detect recrudescent infections following anti-malarial treatment. The aim of this study was to explore the proportions of recrudescent parasitaemia as ascribed by genotyping captured at various follow-up time-points in treatment efficacy trials for uncomplicated Plasmodium falciparum malaria.Methods: Individual patient data from 83 anti-malarial efficacy studies collated in the WorldWide Antimalarial Resistance Network (WWARN) repository with at least 28 days follow-up were available. The temporal and cumulative distributions of recrudescence were characterized using a Cox regression model with shared frailty on study-sites. Fractional polynomials were used to capture non-linear instantaneous hazard. The area under the density curve (AUC) of the constructed distribution was used to estimate the optimal follow-up period for capturing a P. falciparum malaria recrudescence. Simulation studies were conducted based on the constructed distributions to quantify the absolute overestimation in efficacy due to sub-optimal follow-up.Results: Overall, 3703 recurrent infections were detected in 60 studies conducted in Africa (15,512 children aged < 5 years) and 23 studies conducted in Asia and South America (5272 patients of all ages). Using molecular genotyping, 519 (14.0%) recurrences were ascribed as recrudescent infections. A 28 day artemether-lumefantrine (AL) efficacy trial would not have detected 58% [95% confidence interval (CI) 47-74%] of recrudescences in African children and 32% [95% CI 15-45%] in patients of all ages in Asia/South America. The corresponding estimate following a 42 day dihydroartemisinin-piperaquine (DP) efficacy trial in Africa was 47% [95% CI 19-90%] in children under 5 years old treated with > 48 mg/kg total piperaquine (PIP) dose and 9% [95% CI 0-22%] in those treated with <= 48 mg/kg PIP dose. In absolute terms, the simulation study found that trials limited to 28 days follow-up following AL underestimated the risk of recrudescence by a median of 2.8 percentage points compared to day 63 estimates and those limited to 42 days following DP underestimated the risk of recrudescence by a median of 2.0 percentage points compared to day 42 estimates. The analysis was limited by few clinical trials following patients for longer than 42 days (9 out of 83 trials) and the imprecision of PCR genotyping which overcalls recrudescence in areas of higher transmission biasing the later distribution.Conclusions: Restricting follow-up of clinical efficacy trials to day 28 for AL and day 42 for DP will miss a proportion of late recrudescent treatment failures but will have a modest impact in derived efficacy. The results highlight that as genotyping methods improve consideration should be given for trials with longer duration of follow-up to detect early indications of emerging drug resistance.
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| 5. |
- Färnert, Anna, et al.
(författare)
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Transmission-dependent tolerance to multiclonal Plasmodium falciparum infection
- 2009
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Ingår i: Journal of Infectious Diseases. - Chicago : University of Chicago Press. - 0022-1899 .- 1537-6613. ; 200:7, s. 1166-1175
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Tidskriftsartikel (refereegranskat)abstract
- Whether the number of concurrent clones in asymptomatic Plasmodium falciparum infections reflects the degree of host protection was investigated in children living in areas with different levels of transmission on the coast of Kenya. The number of concurrent clones was determined on the basis of polymorphism in msp2, which encodes the vaccine candidate antigen merozoite surface protein 2. In a low-transmission area, most children had monoclonal infections, and diversity did not predict a risk of clinical malaria. In an area of moderate transmission, asymptomatic infections with 2 clones were, compared with 1 clone, associated with an increased risk of subsequent malaria. In a comparative assessment in a high-transmission area in Tanzania, multiclonal infections conferred a reduced risk. The different nonlinear associations between the number of clones and malaria morbidity suggest that levels of tolerance to multiclonal infections are transmission dependent as a result of cumulative exposure to antigenically diverse P. falciparum infections.
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| 6. |
- Hudson, Lawrence N, et al.
(författare)
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The database of the PREDICTS (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems) project
- 2017
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Ingår i: Ecology and Evolution. - : John Wiley & Sons. - 2045-7758. ; 7:1, s. 145-188
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Tidskriftsartikel (refereegranskat)abstract
- The PREDICTS project-Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)-has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity.
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| 7. |
- Jallow, Muminatou, et al.
(författare)
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Genome-wide and fine-resolution association analysis of malaria in West Africa.
- 2009
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; , s. 657-665
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Tidskriftsartikel (refereegranskat)abstract
- We report a genome-wide association (GWA) study of severe malaria in The Gambia. The initial GWA scan included 2,500 children genotyped on the Affymetrix 500K GeneChip, and a replication study included 3,400 children. We used this to examine the performance of GWA methods in Africa. We found considerable population stratification, and also that signals of association at known malaria resistance loci were greatly attenuated owing to weak linkage disequilibrium (LD). To investigate possible solutions to the problem of low LD, we focused on the HbS locus, sequencing this region of the genome in 62 Gambian individuals and then using these data to conduct multipoint imputation in the GWA samples. This increased the signal of association, from P = 4 x 10(-7) to P = 4 x 10(-14), with the peak of the signal located precisely at the HbS causal variant. Our findings provide proof of principle that fine-resolution multipoint imputation, based on population-specific sequencing data, can substantially boost authentic GWA signals and enable fine mapping of causal variants in African populations.
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| 8. |
- Kattge, Jens, et al.
(författare)
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TRY plant trait database - enhanced coverage and open access
- 2020
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Ingår i: Global Change Biology. - : Wiley-Blackwell. - 1354-1013 .- 1365-2486. ; 26:1, s. 119-188
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Tidskriftsartikel (refereegranskat)abstract
- Plant traits-the morphological, anatomical, physiological, biochemical and phenological characteristics of plants-determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait-based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits-almost complete coverage for 'plant growth form'. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait-environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives.
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| 9. |
- Lundblom, Klara, et al.
(författare)
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Plasmodium falciparum infection patterns since birth and risk of severe malaria : a nested case-control study in children on the coast of Kenya
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:2, s. e56032-
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Tidskriftsartikel (refereegranskat)abstract
- Children in malaria endemic areas acquire immunity to severe malaria faster than to mild malaria. Only a minority of children suffers from severe malaria and it is not known what determines this. The aim of this study was to establish how P. falciparum infections during the first years of life affect the risk of severe malaria. A matched case-control study was nested within a large birth cohort set up to study the immunoepidemiology of pneumococci on the Kenyan coast. Infection patterns in three-monthly blood samples in cohort children admitted to hospital with severe malaria were compared to controls matched on age, residential location and time of sampling. P. falciparum detected at least once from birth conferred an increased risk of severe malaria and particularly if multiclonal infections, as characterized by genotyping of a polymorphic antigen gene, were ever detected. The results show for the first time that children with severe malaria have more infections early in life compared to community controls. These findings provide important insights on the immunity to severe disease, knowledge essential for the development of a vaccine against severe malaria.
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| 10. |
- Mangano, Valentina D, et al.
(författare)
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Lack of association of Interferon Regulatory Factor 1 with severe malaria in affected child‐parental trio studies across three African populations
- 2009
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 4:1, s. e4206-
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Tidskriftsartikel (refereegranskat)abstract
- Interferon Regulatory Factor 1 (IRF-1) is a member of the IRF family of transcription factors, which have key and diverse roles in the gene-regulatory networks of the immune system. IRF-1 has been described as a critical mediator of IFN-gamma signalling and as the major player in driving TH1 type responses. It is therefore likely to be crucial in both innate and adaptive responses against intracellular pathogens such as Plasmodium falciparum. Polymorphisms at the human IRF1 locus have been previously found to be associated with the ability to control P. falciparum infection in populations naturally exposed to malaria. In order to test whether genetic variation at the IRF1 locus also affects the risk of developing severe malaria, we performed a family-based test of association for 18 Single Nucleotide Polymorphisms (SNPs) across the gene in three African populations, using genotype data from 961 trios consisting of one affected child and his/her two parents (555 from The Gambia, 204 from Kenya and 202 from Malawi). No significant association with severe malaria or severe malaria subphenotypes (cerebral malaria and severe malaria anaemia) was observed for any of the SNPs/haplotypes tested in any of the study populations. Our results offer no evidence that the molecular pathways regulated by the transcription factor IRF-1 are involved in the immune-based pathogenesis of severe malaria.
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