Factors determining clinical outcomes in intussusception in the developing world: Experience from Johannesburg, South Africa

Background. Rates of open reduction of intussusception were noted to be unacceptably high during an institutional internal audit.Objectives. To determine the impact of revised protocols to better select patients for pneumatic reduction (PR), and document associated morbidity and mortality, and the factors that affect the above.Methods. Medical records of patients between 3 months and 3 years of age presenting to the Department of Paediatric Surgery at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from 2007 to 2010 were reviewed. Determining factors, including duration of symptoms, admission C reactive protein (CRP) level and weight, were analysed against clinical outcomes, notably PR, bowel resection, relook laparotomy and death.Results. A total of 97 cases were suitable for inclusion. In 62 of these (63.9%), PR was attempted; this was successful in 32 cases (51.6%), giving an overall successful PR rate of 33.0%. In 7 of the 62 patients, a pneumoperitoneum was documented during the reduction attempt. Of the 65 patients who underwent surgery, 53 required intestinal resection and 12 had spontaneous or manual reduction. Ileostomy was necessary in 9 patients, and 7 required relook laparotomy. The overall mortality rate was 9.1%. Averages of ‘determining factors’ assessed against clinical outcome were as follows: mean weight (standard deviation (SD)) 7.4 (4.3) kg, mean duration of symptoms (DOS) 3.0 (SD 2.2) days, and admission CRP level 50.9 mg/L (range 1 - 249.3). Prolonged DOS and a raised CRP level predicted a poor outcome.Conclusions. Despite marked improvements in management and PR outcomes, intussusception remains associated with significant morbidity and mortality. Prolonged DOS and an elevated CRP predict worse outcomes. The use of these markers in association with clinical factors may assist management decisions, specifically with regard to operative or non-operative management. Awareness and education are key to prompt presentation and early diagnosis. Well-defined protocols introduced at all points of contact ensure early recognition and resuscitation as well as prompt referral for definitive management

Risk sharing arrangements for pharmaceuticals: potential considerations and recommendations for European payers

<p>Abstract</p> <p>Background</p> <p>There has been an increase in 'risk sharing' schemes for pharmaceuticals between healthcare institutions and pharmaceutical companies in Europe in recent years as an additional approach to provide continued comprehensive and equitable healthcare. There is though confusion surrounding the terminology as well as concerns with existing schemes.</p> <p>Methods</p> <p>Aliterature review was undertaken to identify existing schemes supplemented with additional internal documents or web-based references known to the authors. This was combined with the extensive knowledge of health authority personnel from 14 different countries and locations involved with these schemes.</p> <p>Results and discussion</p> <p>A large number of 'risk sharing' schemes with pharmaceuticals are in existence incorporating both financial-based models and performance-based/outcomes-based models. In view of this, a new logical definition is proposed. This is "<it>risk sharing' schemes should be considered as agreements concluded by payers and pharmaceutical companies to diminish the impact on payers' budgets for new and existing schemes brought about by uncertainty and/or the need to work within finite budgets</it>". There are a number of concerns with existing schemes. These include potentially high administration costs, lack of transparency, conflicts of interest, and whether health authorities will end up funding an appreciable proportion of a new drug's development costs. In addition, there is a paucity of published evaluations of existing schemes with pharmaceuticals.</p> <p>Conclusion</p> <p>We believe there are only a limited number of situations where 'risk sharing' schemes should be considered as well as factors that should be considered by payers in advance of implementation. This includes their objective, appropriateness, the availability of competent staff to fully evaluate proposed schemes as well as access to IT support. This also includes whether systematic evaluations have been built into proposed schemes.</p

Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities

Background: Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. Methods and Findings: We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009-2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3-21.3) in rural Nigeria, 21.4% (19.8-23.0) in rural Kenya, 23.7% (21.3-26.2) in urban Tanzania, and 38.0% (35.9-40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥160/100 mmHg) or grade 3 hypertension (≥180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). Conclusion: Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed

The Silence of the LANs: Efficient Leakage Resilience for IPsec VPNs

Virtual Private Networks (VPNs) are increasingly used to build logically isolated networks. However, existing VPN designs and deployments neglect the problem of traffic analysis and covert channels. Hence, there are many ways to infer information from VPN traffic with- out decrypting it. Many proposals were made to mitigate network covert channels, but previous works remained largely theoretical or resulted in prohibitively high padding overhead and performance penalties. In this work, we (1) analyse the impact of covert channels in IPsec, (2) present several improved and novel approaches for covert channel mit- igation in IPsec, (3) propose and implement a system for dynamic perfor- mance trade-offs, and (4) implement our design in the Linux IPsec stack and evaluate its performance for different types of traffic and mitigation policies. At only 24% overhead, our prototype enforces tight information- theoretic bounds on all information leakage

Toward a telco cloud environment for service functions

Deploying service functions, SFs, is an essential action for a network provider. However, the action of creating, modifying and removing network SFs is traditionally very costly in time and effort, requiring the acquisition and placement of specialized hardware devices and their interconnection. Fortunately, the emergence of concepts like cloud computing, SDN, and ultimately NFV is expected to raise new possibilities for the management of SFs with a positive impact in terms of agility and cost. From a telco viewpoint these concepts can help to both reduce OPEX and open the door to new business opportunities. In this article, we identify how téleos can benefit from the abovementioned paradigms, and explore some of the aspects that still need to be addressed in the NFV domain. We focus on two major aspects: enabling telco infrastructures to adopt this new paradigm, and orchestrating and managing SFs toward telco-ready cloud infrastructures. The technologies we describe enable a telco to deploy and manage SFs in a distributed cloud infrastructure. In this context, the Cloud4NFV platform is presented. Special attention is given to the way SFs are modeled toward cloud infrastructure resources. In addition, we explore the ability to perform service function chaining as one of the fundamental features in the composition of SFs. Finally, we describe a proof of concept that demonstrates how a telco can benefit from the described technologies

Personal dose equivalent HP(10) in patient’s family members after 131I therapy in thyroid cancer and benign thyroid diseases

Aim of the study - The aim is to quantify the personal equivalent dose Hp(10) of the family members (FMs) of patients submitted to iodine-131 therapy (RAIT): thyroid cancer (TC) or benign thyroid diseases (BTD) and compare Hp(10) values of children and adults.info:eu-repo/semantics/publishedVersio

131I therapy in thyroid cancer and benign thyroid diseases: personal dose equivalent HP(10) assessment in patient’s close family members

Introduction - The aim is to quantify the personal dose equivalent HP(10) in the family members (FMs) of the patients (PATs) undergoing iodine-131 thyroid cancer (TC) therapy and benign thyroid diseases (BTD) and to compare the HP(10) values of children and adults. Methods - An observational study with convenience sampling was performed, including 83 FMs (59% ♂) of 48 PATs (72.9% ♀). All FMs wore a whole body TLD for 21 days and received instructions on radiation protection, based on Euratom recommendations. All FMs were provided with relevant instructions for TLD use and answered a questionnaire. Two groups were defined: Group-TC, included 65 FMs (5 children below the age of 10) of 37 PATs treated for TC with average (ᾱ) activity of 3434MBq (range 1110–5920MBq); Group-BTD included 18 FMs adults of 11 PATs treated for BTD with ᾱ activity of 336.4MBq (range 185–555MBq). The in-PATs of Group-TC were discharged 48h after therapy. All ethical principles of the investigation were respected. Results - When the PATs of Group-TC were discharged the ᾱ effective dose rate measured at a 1-metre distance was 10.4μSv/h (range 2–28μSv/h). The ᾱ value of HP(10) in FMs were: 0.14mSv (range 0.00-3.37mSv) for Group-TC and 0.37mSv (range 0.01-2.40mSv) for Group-BTD. The HP(10) value depended on the degree of relationship (p=0.008) and the age of the FMs (p=0.007). HP(10) of the FMs were moderately associated to administered activity (ρsp=-0.319; p=0.010) in Group-TC. No association was found between HP(10) FMs and the administered activity in Group-BTD (ρsp=0.139; p=0.583). Conclusions - The FMs of the PATs submitted 131I therapy for BTD received higher doses when compared to FMs of TC PATs. The HP(10) of the FMs depended to the degree of relationship and the age of the FMs. In the PATs submitted 131I therapy for BTD, the HP(10) of the FMs is not associated with the administered activity. The personal dose equivalent in these FMs does not reach the dose limits recommended by ICRP 97 and ICRP 94.info:eu-repo/semantics/publishedVersio

Listening to the voice - and the fears - of the elderly. Good practices supported by creative social research methodologies

This paper showcases the exploratory results of a pedagogical exercise developed with people aged 65 and over, aiming to understand their fears and its impact in the experience of the everyday life. The exercise was carried in the spring semester 2021, by students enrolled in the Sociology course at the University of Évora, Portugal. Against the background of a major project with the aim of studying fear in contemporary society, the students developed data collection procedures based on creative social research methodologies. The results show that putting creativity in social research methodologies allow us to listen more attentively to older people’s voices, while adding depth compared to more traditional social research instruments. Ultimately, the ar ticle intends to share good practices of listening to elderly voices capable of informing sustainably both scientific and social intervention projects