2,231 research outputs found
Quality of life and visual function in Nigeria: findings from the National Survey of Blindness and Visual Impairment
Aims To assess associations of visual function (VF) and quality of life (QOL) by visual acuity (VA), causes of blindness and types of cataract procedures in Nigeria. Methods Multi-stage stratified cluster random sampling was used to identify a nationally representative sample of persons aged >= 40 years. VF/QOL questionnaires were administered to participants with VA = 6/12. Results VF/QOL questionnaires were administered to 2076 participants. Spearman's rank correlation showed a strong correlation between decreasing VA and VF/QOL scores (p< 0.0001) with greatest impact on social (p< 0.0001) and mobility-related activities (p< 0.0001). People who were blind due to glaucoma had lower VF and QOL scores than those who were blind due to cataract. Mean VF and QOL scores were lower after couching compared with conventional cataract surgery (mean VF score=51.0 vs 63.0 and mean QOL score=71.3 vs 79.3). Finally, VF and QOL scores were lower among populations with specific characteristics. Conclusions Populations with the following characteristics should be targeted to improve VF and QOL: people who are blind, older people, women, manual labourers, people living in rural areas, those living in the northern geopolitical zones, those practising Islamic and Traditionalism faith, those not currently married and those who have undergone couching
Comparison of laboratory costs of rapid molecular tests and conventional diagnostics for detection of tuberculosis and drug-resistant tuberculosis in South Africa.
BACKGROUND: The World Health Organization has endorsed the use of molecular methods for the detection of TB and drug-resistant TB as a rapid alternative to culture-based systems. In South Africa, the Xpert MTB/Rif assay and the GenoType MTBDRplus have been implemented into reference laboratories for diagnosis of TB and drug-resistance, but their costs have not been fully elucidated. METHODS: We conducted a detailed reference laboratory cost analysis of new rapid molecular assays (Xpert and MTBDRplus) for tuberculosis testing and drug-resistance testing in South Africa, and compared with the costs of conventional approaches involving sputum microscopy, liquid mycobacterial culture, and phenotypic drug sensitivity testing. RESULTS: From a laboratory perspective, Xpert MTB/RIF cost 23.46/sample, compared to $16.88/sample using conventional automated liquid culture-based methods. Laboratory costs of Xpert and MTBDRplus were most influenced by cost of consumables (60-80%). CONCLUSIONS: At current public sector pricing, Xpert MTB/RIF and MTBDRplus are comparable in cost to mycobacterial culture and conventional drug sensitivity testing. Overall, reference laboratories must balance costs with performance characteristics and the need for rapid results
Patients with severe acuteâonâchronic liver failure are disadvantaged by model for endâstage liver diseaseâbased organ allocation policy
Background: Mortality for patients with acuteâonâchronic liver failure (ACLF) may be underestimated by the model for endâstage liver diseaseâsodium (MELDâNa) score. /
Aim: To assess waitlist outcomes across varying grades of ACLF among a cohort of patients listed with a MELDâNa score â„35, and therefore having similar priority for liver transplantation. /
Methods: We analysed the United Network for Organ Sharing (UNOS) database, years 2010â2017. Waitlist outcomes were evaluated using Fine and Gray's competing risks regression. /
Results: We identified 6342 candidates at listing with a MELDâNa score â„35, of whom 3122 had ACLFâ3. Extraâhepatic organ failures were present primarily in patients with four to six organ failures. Competing risks regression revealed that candidates listed with ACLFâ3 had a significantly higher risk for 90âday waitlist mortality (Subâhazard ratio (SHR) = 1.41; 95% confidence interval [CI] 1.12â1.78) relative to patients with lower ACLF grades. Subgroup analysis of ACLFâ3 revealed that both the presence of three organ failures (SHR = 1.40, 95% CI 1.20â1.63) or four to six organ failures at listing (SHR = 3.01; 95% CI 2.54â3.58) was associated with increased waitlist death. Candidates with four to six organ failures also had the lowest likelihood of receiving liver transplantation (SHR = 0.61, 95% CI 0.54â0.68). The Share 35 rule was associated with reduced 90âday waitlist mortality among the full cohort of patients listed with ACLFâ3 and MELDâNa score â„35 (SHR = 0.59; 95% CI 0.49â0.70). However, Share 35 rule implementation was not associated with reduced waitlist mortality among patients with four to six organ failures (SHR = 0.76; 95% CI 0.58â1.02). /
Conclusion: The MELDâNa score disadvantages patients with ACLFâ3, both with and without extraâhepatic organ failures. Incorporation of organ failures into allocation policy warrants further exploration
Parkinsonian Tremor Detection from Subthalamic Nucleus Local Field Potentials for Closed-Loop Deep Brain Stimulation
Deep Brain Stimulation (DBS) is a widely used therapy to ameliorate symptoms experienced by patients with Parkinson's Disease (PD). Conventional DBS is continuously ON even though PD symptoms fluctuate over time leading to undesirable side-effects and high energy requirements. This study investigates the use of a Iogistic regression-based classifier to identify periods when PD patients have rest tremor exploiting Local Field Potentials (LFPs) recorded with DBS electrodes implanted in the Subthalamic Nucleus in 7 PD patients (8 hemispheres). Analyzing 36.1 minutes of data with a 512 milliseconds non-overlapping window, the classification accuracy was well above chance-level for all patients, with Area Under the Curve (AUC) ranging from 0.67 to 0.93. The features with the most discriminative ability were, in descending order, power in the 31-45 Hz, 5-7 Hz, 21-30 Hz, 46-55 Hz, and 56-95 Hz frequency bands. These results suggest that using a machine learning-based classifier, such as the one proposed in this study, can form the basis for on-demand DBS therapy for PD tremor, with the potential to reduce side-effects and lower battery consumption
International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) - the propagation of knowledge in ultrasound for the improvement of OB/GYN care worldwide: experience of basic ultrasound training in Oman.
BACKGROUND: The aim of this study is to evaluate effectiveness of a new ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) Outreach Teaching and Training Program delivered in Muscat, Oman. METHODS: Quantitative assessments to evaluate knowledge and practical skills were administered before and after an ultrasound course for sonologists attending the ISUOG Outreach Course, which took place in November, 2017, in Oman. Trainees were selected from each region of the country following a national vetting process conducted by the Oman Ministry of Health. Twenty-eight of the participants were included in the analysis. Pre- and post-training practical and theoretical scores were evaluated and compared. RESULTS: Participants achieved statistically significant improvements, on average by 47% (p <â0.001), in both theoretical knowledge and practical skills. Specifically, the mean score in the theoretical knowledge test significantly increased from 55.6% (± 14.0%) to 81.6% (± 8.2%), while in the practical test, the mean score increased from 44.6% (± 19.5%) to 65.7% (± 23.0%) (p <â0.001). Performance was improved post-course among 27/28 participants (96.4%) in the theoretical test (range: 14 to 200%) and among 24/28 (85.7%) trainees in the practical skills test (range: 5 to 217%). CONCLUSION: Application of the ISUOG Basic Training Curriculum and Outreach Teaching and Training Course improved the theoretical knowledge and practical skills of local health personnel. Long-term re-evaluation is, however, considered imperative to ascertain and ensure knowledge retention
Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion
There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4â12% of
patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease
(ESRD). Renal transplantation offers the best outcomes for these patients with but their
access to transplantation is often limited. Regular automated exchange blood transfusions
(EBT) reduce the complications of SCD and may improve outcomes. However, concerns
over alloimmunisation limit its widespread implementation. In this retrospective multicenter
study, data were collected on 34 SCD patients who received a kidney transplant across 6
London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or
post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at
all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on
EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT
developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as
compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably
small sample size and differences in the date of transplantation, do suggest that long-term
automated EBT post renal transplant is effective and safe, with improvement in graft and
patient outcomes and no increase in antibody formation or graft rejection
Bayesian approach to probabilistic design space characterization: a nested sampling strategy
Quality by design in pharmaceutical manufacturing hinges on computational methods and tools that are capable of accurate quantitative prediction of the design space. This paper investigates Bayesian approaches to design space characterization, which determine a feasibility probability that can be used as a measure of reliability and risk by the practitioner. An adaptation of nested samplingâa Monte Carlo technique introduced to compute Bayesian evidenceâis presented. The nested sampling algorithm maintains a given set of live points through regions with increasing probability feasibility until reaching a desired reliability level. It furthermore leverages efficient strategies from Bayesian statistics for generating replacement proposals during the search. Features and advantages of this algorithm are demonstrated by means of a simple numerical example and two industrial case studies. It is shown that nested sampling can outperform conventional Monte Carlo sampling and be competitive with flexibility-based optimization techniques in low-dimensional design space problems. Practical aspects of exploiting the sampled design space to reconstruct a feasibility probability map using machine learning techniques are also discussed and illustrated. Finally, the effectiveness of nested sampling is demonstrated on a higher-dimensional problem, in the presence of a complex dynamic model and significant model uncertainty
The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study.
BACKGROUND: Tuberculosis (TB) continues to be a major cause of death across sub-Saharan Africa (SSA). In parallel, non-communicable disease and especially cardiovascular disease (CVD) burden has increased substantially in the region. Cardiac manifestations of TB are well-recognised but the extent to which they co-exist with pulmonary TB (PTB) has not been systematically evaluated. The aim of this study is to improve understanding of the burden of cardiac pathology in PTB in those living with and without HIV in a high-burden setting. METHODS: This is a cross-sectional and natural history study to evaluate the burden and natural history of cardiac pathology in participants with PTB in Lusaka, Zambia, a high burden setting for TB and HIV. Participants with PTB, with and without HIV will be consecutively recruited alongside age- and sex-matched TB-uninfected comparators on a 2:1 basis. Participants will undergo baseline assessments to collect clinical, socio-demographic, functional, laboratory and TB disease impact data followed by point-of-care and standard echocardiography. Participants with PTB will undergo further repeat clinical and functional examination at two- and six months follow-up. Those with cardiac pathology at baseline will undergo repeat echocardiography at six months. DISCUSSION: The outcomes of the study are to a) determine the burden of cardiac pathology at TB diagnosis, b) describe its association with patient-defining risk factors and biochemical markers of cardiac injury and stretch and c) describe the natural history of cardiac pathology during the course of TB treatment
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