'Like sugar and honey': the embedded ethics of a larval control project in The Gambia.

This paper describes a malaria research project in The Gambia to provoke thinking on the social value of transnational research. The Larval Control Project (LCP) investigated the efficacy of a microbial insecticide to reduce vector density and, ultimately, clinical malaria in Gambian children. The LCP's protocol delineated a clinical surveillance scheme that involved Village Health Workers (VHWs) supported by project nurses. Combining insights from ethnographic fieldwork conducted at the Medical Research Council (MRC) Laboratories in Farafenni from 2005 to 2009, open-ended interviews with project nurses, and eight focus group discussions held with participant mothers in October 2007, we consider the social impact of the LCP's investigative method against the backdrop of several years of research activity. We found that while participants associated the LCP with the clinical care it provided, they also regarded the collaboration between the nurses and VHWs added additional benefits. Organised around the operational functions of the trial, small-scale collaborations provided the platform from which to build local capacity. While ethical guidelines emphasise the considerations that must be added to experimental endeavour in southern countries (e.g. elaborating processes of informed consent, developing strategies of community engagement or providing therapeutic access to participants after the trial concludes), these findings suggest that shifting attention from supplementing ethical protocols to the everyday work of research -embedding ethics through scientific activity - may provide a sounder basis to reinforce the relationship between scientific rigour and social value

Patient Knowledge of their Dispensed Drugs in Rural Gambia

Patient knowledge of dispensed medication as they exit health facilities holds a central place in the overall outcome of treatment, as a lack of knowledge can result in medication errors. A cross-sectional survey collecting quantitative data from patients following dispensation of prescribed drugs from a hospital pharmacy aimed at assessing patient

Use of fibroscan in assessment of hepatic fibrosis in patients with chronic hepatitis B infection

Introduction: Assessment of the stage of liver fibrosis plays a prominent role in the decision process of treatment in chronic viral hepatitis.Objective: To determine the stage of fibrosis in patients with chronic HBV infection using fibroscan.Method: This is a cross sectional descriptive study involving patients with CHB with a valid transient elastography (TE) measurement. Liver function test and platelet count was determined. APRI and FIB-4 were calculated and Spermans rank coefficient was applied for correlation of transient elastography (TE) with either serum biomarkers.Results: 190 patients were enrolled, mean age 36.3years, 64.2% males and 89.9% were asymptomatic. TE correlated significantly with APRI and FIB-4 (r = 0.58; P < 0.001 and r = 0.42; P < 0.001, respectively). Most of the patients 131(68.9%) had no significant fibrosis (F0,F1) while those with significant fibrosis and cirrhosis were 59 (31.1%) and 23(12.1%) respectively.Conclusion: The prevalence of significant fibrosis and cirrhosis is high in this population.Keywords: Fibroscan, Hepatic fibrosis, APRI, FIB-

The Effect of Foreign Direct Investment on the Nigerian Manufacturing Sector

This study examined the effect of Foreign Direct Investment (FDI) on the Nigerian manufacturing sector spanning 1975 – 2008. Nigeria has embarked on several policy measures aimed at enhancing the manufacturing sector’s productivity coupled with the inflow of FDI to the country. The controversy is that the policy makers are not convinced that the potential benefits of FDI could be fully realized. The methodology adopted for the study is the Vector Auto Regression (VAR), co-integration and error correction techniques to establish the relationship between FDI and the growth of manufacturing sector. The findings from the study show that FDI has a negative effect on the manufacturing productivity and is statistically significant. Arising from the findings, it is recommended that government should create an enabling environment for foreign investment and the monitoring of FDI benefits, with particular focus of NEPAD and NEEDS through the instrumentality of the MDGs; thereby mustering the capacity for sustainable growth in the manufacturing sector.Key words: FDI; Manufacturing sector; Productivity; Growth, Polic

Awareness and Benefits of Self-Curing Concrete in Construction Projects: Builders and Civil Engineers Perceptions

Self-cured concrete is a type of concrete with a special ability to reduce autogenous shrinkage responsible for early-stage cracking. It is useful generally for the construction of high rise buildings and bridges. The application and use of this technique of curing concrete, however, depends on the level of awareness among stakeholders regarding the application of the technique and its benefits among other factors. This study, therefore, sets out to investigate the level of awareness of selected construction professionals regarding the self-curing concrete technique in addition to the benefits. A cross-sectional survey design method was embraced by giving out 115 questionnaires to builders and engineers in Lagos who were purposely selected. The data was subjected to descriptive statistics. The results indicate that about 21% of selected builders and civil engineers practicing in Lagos are not aware and familiar with the concept of self-curing technology while about 43.1% of the professionals who have the knowledge of SCT have never used it in their professional practice. In addition, lower permeability, reduced coefficients of thermal expansion, and improved microstructures of cementitious paste were perceived as the dominant benefits of the self-curing concrete method. The implication of this study to construction professionals in Nigeria is in developing capacities on innovation practices in high-strength concrete technologies that will make them strike a balance with international counterparts

An IoT-Based Multimodal Real-Time Home Control System for the Physically Challenged: Design and Implementation

Physical impairments affect a significant proportion of the global populace, emphasizing the need for assistive technologies to increase the ability of these individuals to perform daily activities autonomously. This study discusses the development and implementation of a multimodal home control system, designed to afford physically challenged individuals greater control over their home environments. This system utilizes the Internet of Things (IoT) for its functionality. The system is primarily based on the utilization of the Amazon Alexa Echo Dot, which facilitates speech-based control, and a sequential clap recognition system, both made possible through an internet connection. These methods are further supplemented by an additional manual switching option, thereby ensuring a diverse range of control methods. The processing core of this system consists of an Arduino Uno and an ESP32 Devkit module. In conjunction with these, a sound detector is employed to discern and process a variety of clap patterns, which is set to function at a predefined threshold. The Amazon Alexa Echo Dot serves as the primary interface for voice commands and real-time information retrieval. Furthermore, an Android smartphone, equipped with the Alexa application, provides alternate interfaces for appliance control, through both soft buttons and voice commands. Based on an analysis of this system, it is suggested that it is not only viable but also effective. Key attributes of the system include rapid response times, aesthetic appeal, secure operation, low energy consumption, and most importantly, increased accessibility for physically disabled individuals

Exploiting Pan Influenza A and Pan Influenza B Pseudotype Libraries for Efficient Vaccine Antigen Selection.

We developed an influenza hemagglutinin (HA) pseudotype library encompassing Influenza A subtypes HA1-18 and Influenza B subtypes (both lineages) to be employed in influenza pseudotype microneutralization (pMN) assays. The pMN is highly sensitive and specific for detecting virus-specific neutralizing antibodies against influenza viruses and can be used to assess antibody functionality in vitro. Here we show the production of these viral HA pseudotypes and their employment as substitutes for wildtype viruses in influenza neutralization assays. We demonstrate their utility in detecting serum responses to vaccination with the ability to evaluate cross-subtype neutralizing responses elicited by specific vaccinating antigens. Our findings may inform further preclinical studies involving immunization dosing regimens in mice and may help in the creation and selection of better antigens for vaccine design. These HA pseudotypes can be harnessed to meet strategic objectives that contribute to the strengthening of global influenza surveillance, expansion of seasonal influenza prevention and control policies, and strengthening pandemic preparedness and response

Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) are used in many low-income countries but their impact on the incidence of pneumonia is unclear. The Gambia introduced PCV7 in August, 2009, and PCV13 in May, 2011. We aimed to measure the impact of the introduction of these vaccines on pneumonia incidence. METHODS: We did population-based surveillance and case-control studies. The primary endpoint was WHO-defined radiological pneumonia with pulmonary consolidation. Population-based surveillance was for suspected pneumonia in children aged 2-59 months (minimum age 3 months in the case-control study) between May 12, 2008, and Dec 31, 2015. Surveillance for the impact study was limited to the Basse Health and Demographic Surveillance System (BHDSS), whereas surveillance for the case-control study included both the BHDSS and Fuladu West Health and Demographic Surveillance System. Nurses screened all outpatients and inpatients at all health facilities in the surveillance area using standardised criteria for referral to clinicians in Basse and Bansang. These clinicians recorded clinical findings and applied standardised criteria to identify patients with suspected pneumonia. We compared the incidence of pneumonia during the baseline period (May 12, 2008, to May 11, 2010) and the PCV13 period (Jan 1, 2014, to Dec 31, 2015). We also investigated the effectiveness of PCV13 using case-control methods between Sept 12, 2011, and Sept 31, 2014. Controls were aged 90 days or older, and were eligible to have received at least one dose of PCV13; cases had the same eligibility criteria with the addition of having WHO-defined radiological pneumonia. FINDINGS: We investigated 18 833 children with clinical pneumonia and identified 2156 cases of radiological pneumonia. Among children aged 2-11 months, the incidence of radiological pneumonia fell from 21·0 cases per 1000 person-years in the baseline period to 16·2 cases per 1000 person-years (23% decline, 95% CI 7-36) in 2014-15. In the 12-23 month age group, radiological pneumonia decreased from 15·3 to 10·9 cases per 1000 person-years (29% decline, 12-42). In children aged 2-4 years, incidence fell from 5·2 to 4·1 cases per 1000 person-years (22% decline, 1-39). Incidence of all clinical pneumonia increased by 4% (-1 to 8), but hospitalised cases declined by 8% (3-13). Pneumococcal pneumonia declined from 2·9 to 1·2 cases per 1000 person-years (58% decline, 22-77) in children aged 2-11 months and from 2·6 to 0·7 cases per 1000 person-years (75% decline, 47-88) in children aged 12-23 months. Hypoxic pneumonia fell from 13·1 to 5·7 cases per 1000 person-years (57% decline, 42-67) in children aged 2-11 months and from 6·8 to 1·9 cases per 1000 person-years (72% decline, 58-82) in children aged 12-23 months. In the case-control study, the best estimate of the effectiveness of three doses of PCV13 against radiological pneumonia was an adjusted odds ratio of 0·57 (0·30-1·08) in children aged 3-11 months and vaccine effectiveness increased with greater numbers of doses (p=0·026). The analysis in children aged 12 months and older was underpowered because there were few unvaccinated cases and controls. INTERPRETATION: The introduction of PCV in The Gambia was associated with a moderate impact on the incidence of radiological pneumonia, a small reduction in cases of hospitalised pneumonia, and substantial reductions of pneumococcal and hypoxic pneumonia in young children. Low-income countries that introduce PCV13 with reasonable coverage can expect modest reductions in hospitalised cases of pneumonia and a marked impact on the incidence of severe childhood pneumonia. FUNDING: GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan, Bill & Melinda Gates Foundation, and UK Medical Research Council

Emergence of a unique group of necrotizing mycobacterial diseases.

Although most diseases due to pathogenic mycobacteria are caused by Mycobacterium tuberculosis, several other mycobacterial diseases-caused by M. ulcerans (Buruli ulcer), M. marinum, and M. haemophilum-have begun to emerge. We review the emergence of diseases caused by these three pathogens in the United States and around the world in the last decade. We examine the pathophysiologic similarities of the diseases (all three cause necrotizing skin lesions) and common reservoirs of infection (stagnant or slow-flowing water). Examination of the histologic and pathogenic characteristics of these mycobacteria suggests differences in the modes of transmission and pathogenesis, though no singular mechanism for either characteristic has been definitively described for any of these mycobacteria

Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report

Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define—for the first time—the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries—who only made up 21% of the total attendees. Conclusions To track global progress towards timely access to quality SAO care, these indicators—at the basic level—should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.publishedVersio