Tailoring consent to context: designing an appropriate consent process for a biomedical study in a low income setting

Background Currently there is increasing recognition of the need for research in developing countries where disease burden is high. Understanding the role of local factors is important for undertaking ethical research in developing countries. We explored factors relating to information and communication during the process of informed consent, and the approach that should be followed for gaining consent. The study was conducted prior to a family-based genetic study among people with podoconiosis (non-filarial elephantiasis) in southern Ethiopia. Methodology/Principal Findings We adapted a method of rapid assessment validated in The Gambia. The methodology was entirely qualitative, involving focus-group discussions and in-depth interviews. Discussions were conducted with podoconiosis patients and non-patients in the community, fieldworkers, researchers, staff of the local non-governmental organisation (NGO) working on prevention and treatment of podoconiosis, and community leaders. We found that the extent of use of everyday language, the degree to which expectations of potential participants were addressed, and the techniques of presentation of information had considerable impact on comprehension of information provided about research. Approaching podoconiosis patients via locally trusted individuals and preceding individual consent with community sensitization were considered the optimal means of communication. Prevailing poverty among podoconiosis patients, the absence of alternative treatment facilities, and participants' trust in the local NGO were identified as potential barriers for obtaining genuine informed consent. Conclusions Researchers should evaluate the effectiveness of consent processes in providing appropriate information in a comprehensible manner and in supporting voluntary decision-making on a study-by-study basis

Evaluation of diazepam-ketamine combination for immobilization of African land tortoise (Testudo graeca)

Zoo and wildlife practitioners are constantly exposed to persistent dangers during physical restraint of wild animals. Chemical immobilization in reptiles is unpredictable due to their ectothermic nature. This study aims to  determine a safe and effective anesthetic protocol for immobilization in chelonians and other reptiles. Varied doses of diazepam ketamine  combinations were administered and evaluated in 16 healthy land tortoises (Testudo graeca). The tortoises were divided into four groups (4 per group) labeled DK-1 through DK-4. DK-1 had a combination of 44mg/kg of  ketamine with 0.25mg/kg of diazepam. DK-2 had 22mg/kg of ketamine with 0.25mg/kg of diazepam. DK-3 had 44mg/kg of ketamine with  0.5mg/kg diazepam while DK-4 had 22mg/kg of ketamine with 0.5mg/kg of diazepam. Anesthetic effects were monitored to determine the duration required for partial extension of the head and limbs, full extension of limbs, and complete recovery from anesthesia. These visual inspection of partial recovery and full extension were adapted as surface and deep anaesthesia respectively in describing the depth of anaesthesia. All the time intervals were recorded in minutes, and summarized as mean and standard deviation. ANOVA was used to test for significance across the groups. Full extension of head and limbs was achieved within mean periods of 10, 15.5 and 13 minutes in DK-1, DK-3 and DK-4 respectively. Tortoises in DK-2, which were only sedated, demonstrated only surface depth of anaesthesia. Complete recovery occurred in mean periods of 128, 25, 158 (p < 0.05) and 132 minutes for groups DK-1, DK-2, DK-3, and DK-4 respectively. Diazepam-Ketamine anaesthetic cocktail provides a safe protocol for chemical restraint in tortoises. A higher dose of diazepam produced a longer duration of complete recovery.Keywords: Anaesthesia, Diazepam, Immobilization, Ketamine, <i>Testudo graeca</i&gt

A Survey of Passiflora foetida L. and Associated Weed Species on Arable Crops in Ballah, Southern Guinea Savanna Zone of Nigeria.

A survey was conducted in the research field of the Institute of Agricultural Research and Training, Obafemi Awolowo University Ile-Ife, Ballah sub-station in southern Guinea savanna of Nigeria during 2010 to 2011 cropping season with an objective to determine the relative abundance of Passiflora foetida L. and predict the potential of the weed species dominating arable fields. Passiflora foetida L. was found to be with a high percentage frequency of occurrence (16.99 %) and relative abundance ranging from 27.05 to 62.29 % at crop vegetative stage and 17.49 to 74.75 % during harvesting of arable crops. The fields of cowpea and soyabean had higher frequencies of occurrence of the alien weed compare with sole cassava and  maize plots and theirintercrops with lower frequencies of occurrence. This study advocated periodic observation of weed flora by farmers to ascertain cases of invasion of farmlands by alien  weed species to facilitate early management strategy that could limit spread of such weed species.Keywords : Passiflora foetida, arable crop fields, associated weed species, Balla

Impact of social stigma on the process of obtaining informed consent for genetic research on podoconiosis: a qualitative study

Background The consent process for a genetic study is challenging when the research is conducted in a group stigmatized because of beliefs that the disease is familial. Podoconiosis, also known as 'mossy foot', is an example of such a disease. It is a condition resulting in swelling of the lower legs among people exposed to red clay soil. It is a very stigmatizing problem in endemic areas of Ethiopia because of the widely held opinion that the disease runs in families and is untreatable. The aim of this study was to explore the impact of social stigma on the process of obtaining consent for a study on the genetics of podoconiosis in Southern Ethiopia. Methods We adapted a rapid assessment tool validated in The Gambia. The methodology was qualitative involving focus-group discussions (n = 4) and in-depth interviews (n = 25) with community members, fieldworkers, researchers and staff of the Mossy Foot Treatment and Prevention Association (MFTPA) working on prevention and treatment of podoconiosis. Results We found that patients were afraid of participation in a genetic study for fear the study might aggravate stigmatization by publicizing the familial nature of the disease. The MFTPA was also concerned that discussion about the familial nature of podoconiosis would disappoint patients and would threaten the trust they have in the organization. In addition, participants of the rapid assessment stressed that the genetic study should be approved at family level before prospective participants are approached for consent. Based on this feedback, we developed and implemented a consent process involving community consensus and education of fieldworkers, community members and health workers. In addition, we utilized the experience and established trust of the MFTPA to diminish the perceived risk. Conclusion The study showed that the consent process developed based on issues highlighted in the rapid assessment facilitated recruitment of participants and increased their confidence that the genetic research would not fuel stigma. Therefore, investigators must seek to assess and address risks of research from prospective participants' perspectives. This involves understanding the issues in the society, the culture, community dialogues and developing a consent process that takes all these into consideration

Prediction of HLA class II alleles using SNPs in an African population

BACKGROUND: Despite the importance of the human leukocyte antigen (HLA) gene locus in research and clinical practice, direct HLA typing is laborious and expensive. Furthermore, the analysis requires specialized software and expertise which are unavailable in most developing country settings. Recently, in silico methods have been developed for predicting HLA alleles using single nucleotide polymorphisms (SNPs). However, the utility of these methods in African populations has not been systematically evaluated. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we investigate prediction of HLA class II (HLA-DRB1 and HLA-DQB1) alleles using SNPs in the Wolaita population, southern Ethiopia. The subjects comprised 297 Ethiopians with genome-wide SNP data, of whom 188 had also been HLA typed and were used for training and testing the model. The 109 subjects with SNP data alone were used for empirical prediction using the multi-allelic gene prediction method. We evaluated accuracy of the prediction, agreement between predicted and HLA typed alleles, and discriminative ability of the prediction probability supplied by the model. We found that the model predicted intermediate (two-digit) resolution for HLA-DRB1 and HLA-DQB1 alleles at accuracy levels of 96% and 87%, respectively. All measures of performance showed high accuracy and reliability for prediction. The distribution of the majority of HLA alleles in the study was similar to that previously reported for the Oromo and Amhara ethnic groups from Ethiopia. CONCLUSIONS/SIGNIFICANCE: We demonstrate that HLA class II alleles can be predicted from SNP genotype data with a high level of accuracy at intermediate (two-digit) resolution in an African population. This finding offers new opportunities for HLA studies of disease epidemiology and population genetics in developing countrie

Determinants of adoption and intensity of use of balanced nutrient management systems technologies in the northern Guinea savanna of Nigeria

As part of a major effort to address soil fertility decline in West Africa, a project on Balanced Nutrient Management Systems (BNMS) has since 2000 been implemented in the northern Guinea savanna (NGS) of Nigeria. The project has tested and promoted two major technology packages, including a combined application of inorganic fertilizer and manure (BNMS-manure) and a soybean/maize rotation practice referred to as BNMS-rotation. This study employed Tobit model to examine factors that influence the adoption and intensity of utilization of BNMS technologies in the NGS of Nigeria. Results showed that less than 10% of the sample households adopted at least one of the two components of the technology package by the end of 2002. However, by 2005 the adoption of BNMS-rotation had reached 40% while that of BNMS-manure had reached 48%. A number of factors such as access to credit, farmers’ perception of the state of land degradation, and assets ownership were found to be significant in determining farmers’ adoption decisions on BNMS-manure while off-farm income was found to be significant in determining farmers’ adoption decisions on BNMS-rotation. Extension services and farmer-to-farmer technology diffusion channels were the major means of transfer of BNMS technologies.Adoption, BNMS-manure, BNMS-rotation, Northern Guinea Savanna (NGS)., Agricultural and Food Policy, Community/Rural/Urban Development, Crop Production/Industries, Environmental Economics and Policy, Farm Management, Food Consumption/Nutrition/Food Safety, Food Security and Poverty, Health Economics and Policy, Institutional and Behavioral Economics, International Relations/Trade, Livestock Production/Industries, Productivity Analysis, Research and Development/Tech Change/Emerging Technologies, Research Methods/ Statistical Methods,

Multivariate pattern classification of pediatric Tourette syndrome using functional connectivity MRI

Tourette syndrome (TS) is a developmental neuropsychiatric disorder characterized by motor and vocal tics. Individuals with TS would benefit greatly from advances in prediction of symptom timecourse and treatment effectiveness. As a first step, we applied a multivariate method - support vector machine (SVM) classification - to test whether patterns in brain network activity, measured with resting state functional connectivity (RSFC) MRI, could predict diagnostic group membership for individuals. RSFC data from 42 children with TS (8-15 yrs) and 42 unaffected controls (age, IQ, in-scanner movement matched) were included. While univariate tests identified no significant group differences, SVM classified group membership with ~70% accuracy (p < .001). We also report a novel adaptation of SVM binary classification that, in addition to an overall accuracy rate for the SVM, provides a confidence measure for the accurate classification of each individual. Our results support the contention that multivariate methods can better capture the complexity of some brain disorders, and hold promise for predicting prognosis and treatment outcome for individuals with TS

Factors Influencing the Use of Information and Communication Technology in Real Estate Practice in Minna

The study explored motivating factors influencing the use of ICT in Minna.The target population were registered Estate Surveyors and Valuers domiciled and operating within the Minna property market. The respondents were extracted from the 2011 NIESV membership Directory.Survey data from 15 estate firms were collected to analyze the vital motivating factors influencing the use of ICT in real estate practice. A five point Likert scale was used to examine their opinions and spearman rank correlation was used to test if there is any relationship between internal and external motivating factors. The result indicated that increased productivity of staff, enhanced quality of customer services, knowledge sharing factor, information accessibility, improved decision making and time saving are the most influencing motivating factors while competitors' pressure, availability of ICT infrastructure, management and business size, reduced overall cost are less influencing motivating factors. The study further revealed that internal motivating factors strengthened the use of ICT in their domain. There is negative correlation between the internal and external motivating factors. Niger state branch of NIESV and ESVARBON should recommend the use of ICT to all estate firms and estate surveyors and valuers. Also, the work concludes by recommending further conduct of comprehensive indigenous research and development (R&D) in ICT driven real estate practice in Minna by liaison with various educational institutions offering estate management in their domain in order to be abreast of global best practices.Keywords: ICT, Real Estate Practice, Motivating Factors, Nigeri

Multiple maxillofacial fractures in a patient undergoing orthodontic treatment: a case report

Severe maxillofacial injuries among patients receiving orthodontic treatment are very rare. When they occur, they can be life threatening with several complications which include neurologic deficits, malunion of fracture segments secondary to delay in reduction and immobilization of fracture segments and massive blood loss. Delay in treatment of such maxillofacial injuries in the presence of other life threatening injuries predisposes the patient to residual and minor malocclusion. The interdisciplinary management of injuries sustained by an orthodontic patient and the challenges associated with its management are highlighted in this report.Reduction and immobilization was carried out under general anaesthesia using an arch bar in the mandibular arch. Direct bonded brackets in the maxillary arch with additional eyelet wires were used in the management of the fractures. An acceptable reduction of bilateral parasympseal fractures was obtained with available intermaxillary fixation. There was some residual and minor malocclusion attributed to the delay in treatment and possibly the method used.A multi-disciplinary team approach for the management of maxillofacial fractures in patients undergoing orthodontic treatment with fixed appliances is suggested. Orthodontic treatment with surgical involvement has been found to improve both facial aesthetics and occlusal function