Burden of cervical cancer in Northern Nigeria

Background: Data regarding burden of illness borne by women affected with cancer of the cervix (CaCvx) has been largely anecdotal. This study aimed to evaluate disability and cost burden of the illness in northern Nigeria.Materials and Methods: Cost of illness was determined using the bottom‑up approach and involved estimating costs of managing various stages of the illness while disability adjusted life year (DALY) was estimated sing CaCvx survival data from northern Nigeria.Results: Overall cost of illness ranged from ₦191,338 ($524) to ₦1,001,298 ($2,743) for local to metastatic diseases, respectively. Of these, direct medical costs accounted for up to 75.4% while indirect costs accounted for up to 48% in different stages of the disease. Productivity losses ranged from 18.3% to 43.1%, while surgical, medical, and radiotherapies accounted for losses between 37.2% and 46%. Estimated DALY was 269 years/100,000 women with cost/DALY saved on treatment estimated at between $19 and$1,443 for different stages. At the discounted rate, it was estimated that it would be 16 to 902 times cheaper to screen for the disease than to treat (P < 0.0001).Conclusion: Though burden of illness borne by women with CaCvx in northern Nigeria is similar to that borne by women in other developing countries, it is still too high; and the only panacea to this is institution of early screening programs and immunization. In addition, concerted effort is needed to ensure extension of health insurance coverage for cancer therapy and increase in availability of radiotherapy service as a means of reducing waiting times for treatment.Keywords: Cervical cancer; cost of illness; disability adjusted life year; productivit

A Model of Competitive Intelligence for e-Health Technologies

Competitive intelligence is an important part in enterprises’ competitive strategy and decision support. It entails the collection of data, analyzing the data and delivering the analyzed data by means of available information on the behavior outside the organization. The study is based on research where competitive intelligence has been explored. The study also reviews e-Health technology and its impact. A proposed model is developed from Technology, Organization and Environment (TOE) framework for competitive intelligence for e-Health technologies. Subsequently, efforts made extend to elaborate on the construct, measurement items, hypotheses and research questions which will be used in the validation of the framework. Future work will use confirmatory factor analysis to reduce the variables from the constructs and Structure Equation Modeling (SEM) will also be used for the reliability and the validity of the construct of the framework

A Functionally-Fitted Block Numerov Method for Solving Second-Order Initial-Value Problems with Oscillatory Solutions

[EN] A functionally-fitted Numerov-type method is developed for the numerical solution of second-order initial-value problems with oscillatory solutions. The basis functions are considered among trigonometric and hyperbolic ones. The characteristics of the method are studied, particularly, it is shown that it has a third order of convergence for the general second-order ordinary differential equation, y′′=f(x,y,y′), it is a fourth order convergent method for the special second-order ordinary differential equation, y′′=f(x,y). Comparison with other methods in the literature, even of higher order, shows the good performance of the proposed method.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Perspectives of Zambian Clinical Oncology Trainees in the MD Anderson and Zambia Virtual Clinical Research Training Program (MOZART)

Published in The Oncologist, 2022;, oyac110, https://doi.org/10.1093/oncolo/oyac110 PMID 35689473https://openworks.mdanderson.org/mozart/1025/thumbnail.jp

The potential of chalcone-capped gold nanoparticles for the management of diabetes mellitus

Searching for new natural bioactive capping agents represent an urgent priority in the green synthesis of metal nanoparticles. Additionaly, the biosaftey of metal nanparticles is a major concern especially in medical applications. Recently, the use of pharmacollogicaly active natural products as capping agents has been deployed to avoid toxic effects during the nanoparticles preparation and to enhance their drugability compared with convential drugs. Helichrysum foetidum is a South African medicinal plant used in folk medicine for the treatment of different human pathologies, and it is known to contain a variety of bioactive compounds. Herein, the total extract and two pure chalcones, helichrysetin and helichrysin, isolated from the same plant were successfully used to synthesize quasi-monodispersed gold nanoparticles in the size range of 2–12 nm. The bio-evaluation of samples indicated that the AuNP/capping agent conjugates are biostable, and have different biological profiles from the total extract/pure compounds. The enzymatic inhibition assays showed significant inhibition by the total extract, helichrysetin and their gold nanoparticles. Interestingly, a similar activity was observed for glucose uptake in HEK293 treated cells. On the other hand, all the tested samples relatively demonstrated no cytotoxicity when tested against the HaCaT keratinocytes. In conclusion, the study demonstrated potential enhancement of glucose uptake in mammalian kidney cells, and inhibition of carbohydrate-hydrolysing enzymes by green synthesized gold nanoparticles of H. foetidum. It also provides a therapeutic appraisal of AuNPs/chalcones conjugate towards the development of antidiabetes drugs derived from H. foetidum and its gold nanoparticles

Effect of the Growth Assessment Protocol on the DEtection of Small for GestatioNal age fetus: process evaluation from the DESiGN cluster randomised trial

BACKGROUND: Reducing the rate of stillbirth is an international priority. At least half of babies stillborn in high-income countries are small for gestational-age (SGA). The Growth Assessment Protocol (GAP), a complex antenatal intervention that aims to increase the rate of antenatal detection of SGA, was evaluated in the DESiGN type 2 hybrid effectiveness-implementation cluster randomised trial (n = 13 clusters). In this paper, we present the trial process evaluation. METHODS: A mixed-methods process evaluation was conducted. Clinical leads and frontline healthcare professionals were interviewed to inform understanding of context (implementing and standard care sites) and GAP implementation (implementing sites). Thematic analysis of interview text used the context and implementation of complex interventions framework to understand acceptability, feasibility, and the impact of context. A review of implementing cluster clinical guidelines, training and maternity records was conducted to assess fidelity, dose and reach. RESULTS: Interviews were conducted with 28 clinical leads and 27 frontline healthcare professionals across 11 sites. Staff at implementing sites generally found GAP to be acceptable but raised issues of feasibility, caused by conflicting demands on resource, and variable beliefs among clinical leaders regarding the intervention value. GAP was implemented with variable fidelity (concordance of local guidelines to GAP was high at two sites, moderate at two and low at one site), all sites achieved the target to train > 75% staff using face-to-face methods, but only one site trained > 75% staff using e-learning methods; a median of 84% (range 78–87%) of women were correctly risk stratified at the five implementing sites. Most sites achieved high scores for reach (median 94%, range 62–98% of women had a customised growth chart), but generally, low scores for dose (median 31%, range 8–53% of low-risk women and median 5%, range 0–17% of high-risk women) were monitored for SGA as recommended. CONCLUSIONS: Implementation of GAP was generally acceptable to staff but with issues of feasibility that are likely to have contributed to variation in implementation strength. Leadership and resourcing are fundamental to effective implementation of clinical service changes, even when such changes are well aligned to policy mandated service-change priorities. TRIAL REGISTRATION: Primary registry and trial identifying number: ISRCTN 67698474. Registered 02/11/16. https://doi.org/10.1186/ISRCTN67698474

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Evaluation of the Growth Assessment Protocol (GAP) for antenatal detection of small for gestational age: The DESiGN cluster randomised trial

BACKGROUND: Antenatal detection and management of small for gestational age (SGA) is a strategy to reduce stillbirth. Large observational studies provide conflicting results on the effect of the Growth Assessment Protocol (GAP) in relation to detection of SGA and reduction of stillbirth; to the best of our knowledge, there are no reported randomised control trials. Our aim was to determine if GAP improves antenatal detection of SGA compared to standard care. METHODS AND FINDINGS: This was a pragmatic, superiority, 2-arm, parallel group, open, cluster randomised control trial. Maternity units in England were eligible to participate in the study, except if they had already implemented GAP. All women who gave birth in participating clusters (maternity units) during the year prior to randomisation and during the trial (November 2016 to February 2019) were included. Multiple pregnancies, fetal abnormalities or births before 24+1 weeks were excluded. Clusters were randomised to immediate implementation of GAP, an antenatal care package aimed at improving detection of SGA as a means to reduce the rate of stillbirth, or to standard care. Randomisation by random permutation was stratified by time of study inclusion and cluster size. Data were obtained from hospital electronic records for 12 months prerandomisation, the washout period (interval between randomisation and data collection of outcomes), and the outcome period (last 6 months of the study). The primary outcome was ultrasound detection of SGA (estimated fetal weight <10th centile using customised centiles (intervention) or Hadlock centiles (standard care)) confirmed at birth (birthweight <10th centile by both customised and population centiles). Secondary outcomes were maternal and neonatal outcomes, including induction of labour, gestational age at delivery, mode of birth, neonatal morbidity, and stillbirth/perinatal mortality. A 2-stage cluster-summary statistical approach calculated the absolute difference (intervention minus standard care arm) adjusted using the prerandomisation estimate, maternal age, ethnicity, parity, and randomisation strata. Intervention arm clusters that made no attempt to implement GAP were excluded in modified intention to treat (mITT) analysis; full ITT was also reported. Process evaluation assessed implementation fidelity, reach, dose, acceptability, and feasibility. Seven clusters were randomised to GAP and 6 to standard care. Following exclusions, there were 11,096 births exposed to the intervention (5 clusters) and 13,810 exposed to standard care (6 clusters) during the outcome period (mITT analysis). Age, height, and weight were broadly similar between arms, but there were fewer women: of white ethnicity (56.2% versus 62.7%), and in the least deprived quintile of the Index of Multiple Deprivation (7.5% versus 16.5%) in the intervention arm during the outcome period. Antenatal detection of SGA was 25.9% in the intervention and 27.7% in the standard care arm (adjusted difference 2.2%, 95% confidence interval (CI) -6.4% to 10.7%; p = 0.62). Findings were consistent in full ITT analysis. Fidelity and dose of GAP implementation were variable, while a high proportion (88.7%) of women were reached. Use of routinely collected data is both a strength (cost-efficient) and a limitation (occurrence of missing data); the modest number of clusters limits our ability to study small effect sizes. CONCLUSIONS: In this study, we observed no effect of GAP on antenatal detection of SGA compared to standard care. Given variable implementation observed, future studies should incorporate standardised implementation outcomes such as those reported here to determine generalisability of our findings. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry, ISRCTN67698474

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Effect of the Growth Assessment Protocol on the DEtection of Small for GestatioNal age fetus: process evaluation from the DESiGN cluster randomised trial

Background Reducing the rate of stillbirth is an international priority. At least half of babies stillborn in high-income countries are small for gestational-age (SGA). The Growth Assessment Protocol (GAP), a complex antenatal intervention that aims to increase the rate of antenatal detection of SGA, was evaluated in the DESiGN type 2 hybrid effectiveness-implementation cluster randomised trial (n = 13 clusters). In this paper, we present the trial process evaluation. Methods A mixed-methods process evaluation was conducted. Clinical leads and frontline healthcare professionals were interviewed to inform understanding of context (implementing and standard care sites) and GAP implementation (implementing sites). Thematic analysis of interview text used the context and implementation of complex interventions framework to understand acceptability, feasibility, and the impact of context. A review of implementing cluster clinical guidelines, training and maternity records was conducted to assess fidelity, dose and reach. Results Interviews were conducted with 28 clinical leads and 27 frontline healthcare professionals across 11 sites. Staff at implementing sites generally found GAP to be acceptable but raised issues of feasibility, caused by conflicting demands on resource, and variable beliefs among clinical leaders regarding the intervention value. GAP was implemented with variable fidelity (concordance of local guidelines to GAP was high at two sites, moderate at two and low at one site), all sites achieved the target to train > 75% staff using face-to-face methods, but only one site trained > 75% staff using e-learning methods; a median of 84% (range 78–87%) of women were correctly risk stratified at the five implementing sites. Most sites achieved high scores for reach (median 94%, range 62–98% of women had a customised growth chart), but generally, low scores for dose (median 31%, range 8–53% of low-risk women and median 5%, range 0–17% of high-risk women) were monitored for SGA as recommended. Conclusions Implementation of GAP was generally acceptable to staff but with issues of feasibility that are likely to have contributed to variation in implementation strength. Leadership and resourcing are fundamental to effective implementation of clinical service changes, even when such changes are well aligned to policy mandated service-change priorities. Trial registration Primary registry and trial identifying number: ISRCTN 67698474. Registered 02/11/16. https://doi.org/10.1186/ISRCTN67698474