The prevalence of primary headache disorders in Ethiopia

BACKGROUND: Knowledge of the epidemiology of primary headache disorders in sub-Saharan Africa (SSA) remains very limited. We performed a population-based survey in rural and urban areas of Ethiopia, using methods similar to those of an earlier study in Zambia and tested in multiple other countries by Lifting The Burden. METHODS: In a cross-sectional survey we visited households unannounced in four regions of Ethiopia: the mostly urban populations in Addis Ababa and its environs and rural populations of selected districts in Oromia, Amhara and South Nations Nationalities and People's Regions States (SNNPRS). We used cluster-randomized sampling: within clusters we randomly selected households, and one adult member (18-65 years old) of each household. The HARDSHIP structured questionnaire, translated into the local languages, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-II criteria. RESULTS: From 2,528 households approached, 2,385 of 2,391 eligible members (1,064 [44.7%] male, 596 [25.0%] urban) consented to interview (participating proportion 99.8%). Headache in the preceding year was reported by 1,071 participants (44.9% [95% CI: 42.4-46.3]; males 37.7%, females 49.9%), and headache yesterday by 170 (7.1% [6.2-8.2]; males 45 [4.1%], females 125 [9.2%]). Adjusted for gender, age and habitation (urban/rural), 1-year prevalence of migraine was 17.7%, of tension-type headache (TTH) 20.6%, of all headache on ≥15 days/month 3.2%, and of probable medication-overuse headache (pMOH) 0.7%. The adjusted prevalence of headache yesterday was 6.4%. Very few cases (1.6%) were unclassifiable. All headache disorders were more common in females. TTH was less common in urban areas (OR: 0.3; p < 0.0001), but pMOH was very strongly associated (OR: 6.1; p < 0.0001) with urban dwelling. Education was negatively associated with migraine (OR: 0.5-0.7; p < 0.05) but (at university level) positively with pMOH (OR: 2.9; p = 0.067). Income above ETB 500/month showed similar associations: negatively with migraine (OR: 0.8; p = 0.035), positively with pMOH (OR: 2.1; p = 0.164). CONCLUSIONS: Findings for migraine and TTH in Ethiopia were quite similar to those from Zambia, another SSA country; pMOH was much less prevalent but, as in Zambia, essentially an urban problem. Primary headache disorders are at least as prevalent in SSA as in high-income western countries

Reflection of Ultrasonic Waves by an Imperfect Diffusion Bond

The analytical treatment of the reflection of ultrasonic wave motion by a planar distribution of cracks is of interest for the nondestructive evaluation of imperfect diffusion bonds. Preliminary results for an experimental approach have been given by Hosten et al.1, for two bonded stainless steel cylinders. In practice, new high strength steel tubing has complicated the pinch welding process and placed emphasis on the integrity of the resulting weld, see Rehbein et al2, Thomas et al3. Two ultrasonic nondestructive evaluation techniques to find defects in the pinch weld and to determine weld strength have been discussed by Thomas et al.4

Ultrasonic Evaluation and Imaging of Tube Closure Welds

Tube closure welds, commonly called pinch welds, are made by solid state upset welding, where quality assurance consists of process control and geometric feature verification. Ultrasonic nondestructive evaluation demonstrated the feasibility for sorting oxide contaminated pinch welds from clean welds. Until now contaminated pinch welds could only be detected by destructive testing. Two approaches are presented in this paper. First, a study was conducted to detect the variation in the ultrasonic signal caused by interaction with the pinch weld. Correlations between the good and bad welds were accomplished with feature extraction and pattern recognition techniques. The second approach involved high resolution scanning of the pinch weld with an acoustic microscope. The acoustic microscope produced excellent color images of the weld which clearly distinguished the pre-weld cleanliness.</p

A climate for contemporary evolution

A new study of divergence in freshwater fish provides strong evidence of rapid, temperature-mediated adaptation. This study is particularly important in the ongoing debate over the extent and significance of evolutionary response to climate change because divergence has occurred in relatively few generations in spite of ongoing gene flow and in the aftermath of a significant genetic bottleneck, factors that have previously been considered obstacles to evolution. Climate change may thus be more likely to foster contemporary evolutionary responses than has been anticipated, and I argue here for the importance of investigating their possible occurrence

Ultrasonic Model for Solid State Weld Evaluation

Ultrasonic techniques have classified good and poor solid state welds in several studies [1,2,3]. A number of different types of solid state welds such as pinch welds, inertia welds, and diffusion bonds, have been evaluated with various ultrasonic feature extraction and pattern recognition techniques. The results of these studies have presented trends in the features needed to determine bond quality, but there is no physical explanation as to why certain features of the ultrasonic wave forms are influenced by the bond quality. An appropriate physical model that complements the experimental results would help explain the acoustic interactions measured. One model for the solid state weld is that the acoustic interaction with the bond line is controlled by the effective compliance of the interface. We have designed an experiment to examine this model. In our experiment, two blocks made from a high glass transition temperature (Tg) epoxy are joined together with a thin, lower Tg epoxy interlayer. If the temperature of the specimen is held below the Tg of the low temperature epoxy, then the interlayer compliance ratio across the interface can be changed by varying the temperature. Ultrasonic data are acquired at each temperature and, thus, each compliance ratio. This ultrasonic data can be compared with theoretical predictions from the compliance model.</p

Functional characteristics of lymphocytes propagated from a human multivisceral allograft.

We investigated the characteristics of lymphocytes propagated from biopsies of the mesenteric lymph nodes, liver, and ileum of a human multivisceral allograft in order to provide functional evidence for the presence or absence of rejection and graft-versus-host disease (GVHD). The recipient was a 39-month-old girl with secretory diarrhea due to microvillus inclusion disease and end-stage liver disease secondary to prolonged parenteral nutrition. She developed a multifocal posttransplant lymphoproliferative disorder (PTLD) and died 37 days after transplantation. Four pairs of sequential mesenteric lymph node and liver biopsies (13, 17, 24, and 33 d posttransplant) and a single ileal biopsy (31 d posttransplant) were placed in culture with recombinant interleukin-2 (rIL-2) and phytohemagglutinin (PHA). T-cell phenotyping of cultured cells showed that CD8+ cells became dominant in all three tissues. The alloreactivity of biopsy-grown cells was determined using the primed lymphocyte test (PLT) and cell-mediated lympholysis test (CML). The proliferative and/or cytolytic responses of biopsy-grown cells to donor but not recipient or third party cells provided evidence for rejection and absence of GVHD. This donor-specific alloreactivity was detected before there was histologic evidence of rejection and during the period of active lymphoproliferation. This study suggests that the functional characterization of graft-infiltrating lymphocytes is useful in defining the immunologic events following multivisceral transplantation

“Empathize with me, Doctor!” Medical Undergraduates Training Project: Development, Application, Six-months Follow-up

The aim of the study was to assess the effectiveness of specially designed, empathy training for medical undergraduates, based on the principles of Person-Centered Approach.Within the context of the humanistic person-centered patient care, the experiential, 60-hour “Empathize with me, Doctor!” training program contains theory, personal development and skills development. Role plays, experiential exercises, self-awareness exercises, active listening practice and conduction of a person-centered interview constituted the training.Forty-two medical undergraduates (66% females; 29% fourth year of study, 40% fifth, 31% sixth) from the University of Ioannina in Greece applied and all of them completed the empathy training. Forty-five medical students comprised a similar according to age and year of studies control group.The Jefferson Scale of Physician Empathy (JSPE) was used to assess the empathic performance, and Cohen’s d to assess the practical importance of any statistical difference.The JSPE mean score (and standard deviation) before, after and six months follow-up was 109.3(12.7), 121.1(9.0), 121.1(9.5), respectively. The before–after and before–follow-up difference was highly significant (CI95%, p<0.001 in both cases), and of great practical importance (d=1.072, d=1.052, respectively), while no decrease was observed six-months later (CI 95%, p=0.999, d<0.001). Control group reached a JSPE 108.7(10.5), similar to intervention group before training (CI95%, p=0.832), and highly different and important compared to after (CI 95%p<0.001; d=1.268) and follow-up (CI 95%, p<0.001; d=1.238) intervention scores.The “Empathize with me, Doctor!” improved significantly and importantly medical undergraduates’ empathic performance, which was maintained intact for at least six months

Premenopausal endogenous oestrogen levels and breast cancer risk: a meta-analysis.

BACKGROUND: Many of the established risk factors for breast cancer implicate circulating hormone levels in the aetiology of the disease. Increased levels of postmenopausal endogenous oestradiol (E2) have been found to increase the risk of breast cancer, but no such association has been confirmed in premenopausal women. We carried out a meta-analysis to summarise the available evidence in women before the menopause. METHODS: We identified seven prospective studies of premenopausal endogenous E2 and breast cancer risk, including 693 breast cancer cases. From each study we extracted odds ratios of breast cancer between quantiles of endogenous E2, or for unit or s.d. increases in (log transformed) E2, or (where odds ratios were unavailable) summary statistics for the distributions of E2 in breast cancer cases and unaffected controls. Estimates for a doubling of endogenous E2 were obtained from these extracted estimates, and random-effect meta-analysis was used to obtain a pooled estimate across the studies. RESULTS: Overall, we found weak evidence of a positive association between circulating E2 levels and the risk of breast cancer, with a doubling of E2 associated with an odds ratio of 1.10 (95% CI: 0.96, 1.27). CONCLUSION: Our findings are consistent with the hypothesis of a positive association between premenopausal endogenous E2 and breast cancer risk

Acute rejection is associated with antibodies to non-Gal antigens in baboons using Gal-knockout pig kidneys

We transplanted kidneys from α1,3-galactosyltransferase knockout (GalT-KO) pigs into six baboons using two different immunosuppressive regimens, but most of the baboons died from severe acute humoral xenograft rejection. Circulating induced antibodies to non-Gal antigens were markedly elevated at rejection, which mediated strong complement-dependent cytotoxicity against GalT-KO porcine target cells. These data suggest that antibodies to non-Gal antigens will present an additional barrier to transplantation of organs from GalT-KO pigs to humans. © 2005 Nature Publishing Group

How does reviewing the evidence change veterinary surgeons' beliefs regarding the treatment of ovine footrot? A quantitative and qualitative study

Footrot is a widespread, infectious cause of lameness in sheep, with major economic and welfare costs. The aims of this research were: (i) to quantify how veterinary surgeons’ beliefs regarding the efficacy of two treatments for footrot changed following a review of the evidence (ii) to obtain a consensus opinion following group discussions (iii) to capture complementary qualitative data to place their beliefs within a broader clinical context. Grounded in a Bayesian statistical framework, probabilistic elicitation (roulette method) was used to quantify the beliefs of eleven veterinary surgeons during two one-day workshops. There was considerable heterogeneity in veterinary surgeons’ beliefs before they listened to a review of the evidence. After hearing the evidence, seven participants quantifiably changed their beliefs. In particular, two participants who initially believed that foot trimming with topical oxytetracycline was the better treatment, changed to entirely favour systemic and topical oxytetracycline instead. The results suggest that a substantial amount of the variation in beliefs related to differences in veterinary surgeons’ knowledge of the evidence. Although considerable differences in opinion still remained after the evidence review, with several participants having non-overlapping 95% credible intervals, both groups did achieve a consensus opinion. Two key findings from the qualitative data were: (i) veterinary surgeons believed that farmers are unlikely to actively seek advice on lameness, suggesting a proactive veterinary approach is required (ii) more attention could be given to improving the way in which veterinary advice is delivered to farmers. In summary this study has: (i) demonstrated a practical method for probabilistically quantifying how veterinary surgeons’ beliefs change (ii) revealed that the evidence that currently exists is capable of changing veterinary opinion (iii) suggested that improved transfer of research knowledge into veterinary practice is needed (iv) identified some potential obstacles to the implementation of veterinary advice by farmers