Implementation of a structured paediatric admission record for district hospitals in Kenya – results of a pilot study

BACKGROUND: The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission record (PAR) for district hospitals as a means of improving documentation of illness. METHODS: The PAR was primarily based on symptoms and signs included in the Integrated Management of Childhood Illness (IMCI) diagnostic algorithms. It was introduced with a three-hour training session, repeated subsequently for those absent, aiming for complete coverage of admitting clinical staff. Data from consecutive records before (n = 163) and from a 60% random sample of dates after intervention (n = 705) were then collected to evaluate record quality. The post-intervention period was further divided into four 2-month blocks by open, feedback meetings for hospital staff on the uptake and completeness of the PAR. RESULTS: The frequency of use of the PAR increased from 50% in the first 2 months to 84% in the final 2 months, although there was significant variation in use among clinicians. The quality of documentation also improved considerably over time. For example documentation of skin turgor in cases of diarrhoea improved from 2% pre-intervention to 83% in the final 2 months of observation. Even in the area of preventive care documentation of immunization status improved from 1% of children before intervention to 21% in the final 2 months. CONCLUSION: The PAR was well accepted by most clinicians and greatly improved documentation of features recommended by IMCI for identifying and classifying severity of common diseases. The PAR could provide a useful platform for implementing standard referral care treatment guidelines

Management of incidental findings during imaging research in "healthy" volunteers: current UK practice

OBJECTIVES: Incidental findings (IF) are becoming increasingly common due to the proliferation of imaging research. IFs can be life-changing for “healthy” volunteers. This study examined variation in IF management in UK research studies of healthy volunteers, including comparison with ethical and legal guidelines, thus providing baseline data and informing future practice. METHODS: Questionnaire of participant background [medical/non-medical; radiologist/non-radiologist; years as principal investigator (PI)], type of research (involving children or not), institutional policy, volunteer information, radiologist involvement in reporting scans and IF disclosure mechanisms. Investigator's current and perceived “ideal” practice was examined. Participants were PIs performing imaging research of healthy volunteers approved by UK ethics committees (2006–2009). RESULTS: 63/146 (43%) surveys completed. 54/61 (88.5%) had site-specific guidelines. Information commonly provided to volunteers should IF be found: personal data (51/62; 82%), contingency plans (54/62; 87%) and disclosure to general practitioner (GP)/treating physician (47/62; 76%). PIs used different strategies for image review. Commonest: radiologist reports research scans only when researcher suspicious of IF [15/57 (26%) compared with 5/28 (16%) in ideal practice]. Commonest ideal reporting strategy: routine reporting by specialist radiologists [9/28 (29%) compared with 8/57 (14%) in current practice]. 49/56 (87.5%) have a standardised disclosure contingency plan, usually involving GP. PIs most commonly disclosed IFs to volunteers when judged relevant (27/58; 47%), most commonly face to face (22/54; 41%), by volunteer's GP (26/60; 43%). Background of PI influenced consent, reporting and disclosure practice. CONCLUSION: There is wide variation in handling IFs in UK imaging research. Much of the current practice contravenes the vague existing legal and ethical guidelines, and is unlikely to be in the best interests of volunteers or researchers

The illusion of competency versus the desirability of expertise: Seeking a common standard for support professions in sport

In this paper we examine and challenge the competency-based models which currently dominate accreditation and development systems in sport support disciplines, largely the sciences and coaching. Through consideration of exemplar shortcomings, the limitations of competency-based systems are presented as failing to cater for the complexity of decision making and the need for proactive experimentation essential to effective practice. To provide a better fit with the challenges of the various disciplines in their work with performers, an alternative approach is presented which focuses on the promotion, evaluation and elaboration of expertise. Such an approach resonates with important characteristics of professions, whilst also providing for the essential ‘shades of grey’ inherent in work with human participants. Key differences between the approaches are considered through exemplars of evaluation processes. The expertise-focused method, although inherently more complex, is seen as offering a less ambiguous and more positive route, both through more accurate representation of essential professional competence and through facilitation of future growth in proficiency and evolution of expertise in practice. Examples from the literature are also presented, offering further support for the practicalities of this approach

Hierarchical Structure Formation and Modes of Star Formation in Hickson Compact Group 31

The handful of low-mass, late-type galaxies that comprise Hickson Compact Group 31 is in the midst of complex, ongoing gravitational interactions, evocative of the process of hierarchical structure formation at higher redshifts. With sensitive, multicolor Hubble Space Telescope imaging, we characterize the large population of <10 Myr old star clusters that suffuse the system. From the colors and luminosities of the young star clusters, we find that the galaxies in HCG 31 follow the same universal scaling relations as actively star-forming galaxies in the local Universe despite the unusual compact group environment. Furthermore, the specific frequency of the globular cluster system is consistent with the low end of galaxies of comparable masses locally. This, combined with the large mass of neutral hydrogen and tight constraints on the amount of intragroup light, indicate that the group is undergoing its first epoch of interaction-induced star formation. In both the main galaxies and the tidal-dwarf candidate, F, stellar complexes, which are sensitive to the magnitude of disk turbulence, have both sizes and masses more characteristic of z=1-2 galaxies. After subtracting the light from compact sources, we find no evidence for an underlying old stellar population in F -- it appears to be a truly new structure. The low velocity dispersion of the system components, available reservoir of HI, and current star formation rate of ~10 solar masses per year, indicate that HCG31 is likely to both exhaust its cold gas supply and merge within ~1 Gyr. We conclude that the end product will be an isolated, X-ray-faint, low-mass elliptical.Comment: 24 pages, 14 figures (including low resolution versions of color images), latex file prepared with emulateapj. Accepted for publication by the Astronomical Journa

The merger history, AGN and dwarf galaxies of Hickson Compact Group 59

Compact group galaxies often appear unaffected by their unusually dense environment. Closer examination can, however, reveal the subtle, cumulative effects of multiple galaxy interactions. Hickson Compact Group (HCG) 59 is an excellent example of this situation. We present a photometric study of this group in the optical (HST), infrared (Spitzer) and X-ray (Chandra) regimes aimed at characterizing the star formation and nuclear activity in its constituent galaxies and intra-group medium. We associate five dwarf galaxies with the group and update the velocity dispersion, leading to an increase in the dynamical mass of the group of up to a factor of 10 (to 2.8e13 Msun), and a subsequent revision of its evolutionary stage. Star formation is proceeding at a level consistent with the morphological types of the four main galaxies, of which two are star-forming and the other two quiescent. Unlike in some other compact groups, star-forming complexes across HCG 59 closely follow mass-radius scaling relations typical of nearby galaxies. In contrast, the ancient globular cluster populations in galaxies HCG 59A and B show intriguing irregularities, and two extragalactic HII regions are found just west of B. We age-date a faint stellar stream in the intra-group medium at ~1 Gyr to examine recent interactions. We detect a likely low-luminosity AGN in HCG 59A by its ~10e40 erg/s X-ray emission; the active nucleus rather than star formation can account for the UV+IR SED. We discuss the implications of our findings in the context of galaxy evolution in dense environments.Comment: 38 pages, 17 figures. Please visit "http://tinyurl.com/isk-hcg59" for a full-resolution PDF. Accepted for publication in the Astrophysical Journa

Исследование изменений твёрдости поверхности при азотировании сталей

Contact allergies are complex diseases, and one of the important challenges for public health and immunology. The German 'Federal Institute for Risk Assessment' hosted an 'International Workshop on Contact Dermatitis'. The scope of the workshop was to discuss new discoveries and developments in the field of contact dermatitis. This included the epidemiology and molecular biology of contact allergy, as well as the development of new in vitro methods. Furthermore, it considered regulatory aspects aiming to reduce exposure to contact sensitisers. An estimated 15-20% of the general population suffers from contact allergy. Workplace exposure, age, sex, use of consumer products and genetic predispositions were identified as the most important risk factors. Research highlights included: advances in understanding of immune responses to contact sensitisers, the importance of autoxidation or enzyme-mediated oxidation for the activation of chemicals, the mechanisms through which hapten-protein conjugates are formed and the development of novel in vitro strategies for the identification of skin-sensitising chemicals. Dendritic cell cultures and structure-activity relationships are being developed to identify potential contact allergens. However, the local lymph node assay (LLNA) presently remains the validated method of choice for hazard identification and characterisation. At the workshop the use of the LLNA for regulatory purposes and for quantitative risk assessment was also discussed

WNT signaling regulates self-renewal and differentiation of prostate cancer cells with stem cell characteristics

Prostate cancer cells with stem cell characteristics were identified in human prostate cancer cell lines by their ability to form from single cells self-renewing prostaspheres in non-adherent cultures. Prostaspheres exhibited heterogeneous expression of proliferation, differentiation and stem cell-associated makers CD44, ABCG2 and CD133. Treatment with WNT inhibitors reduced both prostasphere size and self-renewal. In contrast, addition of Wnt3a caused increased prostasphere size and self-renewal, which was associated with a significant increase in nuclear Β-catenin, keratin 18, CD133 and CD44 expression. As a high proportion of LNCaP and C4-2B cancer cells express androgen receptor we determined the effect of the androgen receptor antagonist bicalutamide. Androgen receptor inhibition reduced prostasphere size and expression of PSA, but did not inhibit prostasphere formation. These effects are consistent with the androgen-independent self-renewal of cells with stem cell characteristics and the androgen-dependent proliferation of transit amplifying cells. As the canonical WNT signaling effector Β-catenin can also associate with the androgen receptor, we propose a model for tumour propagation involving a balance between WNT and androgen receptor activity. That would affect the self-renewal of a cancer cell with stem cell characteristics and drive transit amplifying cell proliferation and differentiation. In conclusion, we provide evidence that WNT activity regulates the self-renewal of prostate cancer cells with stem cell characteristics independently of androgen receptor activity. Inhibition of WNT signaling therefore has the potential to reduce the self-renewal of prostate cancer cells with stem cell characteristics and improve the therapeutic outcome.Peer reviewe

MeerKAT uncovers the physics of an odd radio circle

Odd radio circles (ORCs) are recently-discovered faint diffuse circles of radio emission, of unknown cause, surrounding galaxies at moderate redshift (z ∼0.2-0.6). Here, we present detailed new MeerKAT radio images at 1284 MHz of the first ORC, originally discovered with the Australian Square Kilometre Array Pathfinder, with higher resolution (6 arcsec) and sensitivity (∼2.4 μJy/beam). In addition to the new images, which reveal a complex internal structure consisting of multiple arcs, we also present polarization and spectral index maps. Based on these new data, we consider potential mechanisms that may generate the ORCs

The scientific basis of climate-smart agriculture: A systematic review protocol

Background: ‘Climate-smart agriculture’ (CSA)—agriculture and food systems that sustainably increase food production, improve resilience (or adaptive capacity) of farming systems, and mitigate climate change when possible—has quickly been integrated into the global development agenda. However, the empirical evidence base for CSA has not been assembled, complicating the transition from CSA concept to concrete actions, and contributing to ideological disagreement among development practitioners. Thus, there is an urgent need to evaluate current knowledge on the effectiveness of CSA to achieve its intended benefits and inform discourse on food, agriculture, and climate change. This systematic review intends to establish the scientific evidence base of CSA practices to inform the next steps in development of agricultural programming and policy. We will evaluate the impact of 73 promising farm-level management practices across five categories (agronomy, agroforestry, livestock, postharvest management, and energy systems) to assess their contributions to the three CSA pillars: (1) agronomic and economic productivity, (2) resilience and adaptive capacity, and (3) climate change mitigation in the developing world. The resulting data will be compiled into a searchable Web-based database and analytical engine that can be used to assess the relative effectiveness and strength of evidence for CSA, as well as identify best-fit practices for specific farming and development contexts. This represents the largest meta-analysis of agricultural practices to date. Methods/Design: This protocol sets out the approach for investigating the question: How do farm-level CSA management practices and technologies affect food production and/or farmers’ incomes, resilience/adaptive capacity, and climate change mitigation in farming systems of developing countries? The objective of this ongoing systematic review is to provide a first appraisal of the evidence for CSA practices in order to inform subsequent programming. The review is based on data found in English-language peer-reviewed journals with searches using terms relevant to CSA practices and CSA outcomes. Searches were conducted via Web of Science (WoS) and Scopus. Articles located were screened first by abstract and then full text according to predefined eligibility criteria for inclusion in the review. Data capturing the context of the study (e.g., geographic location, environmental context), management practices, and impacts (e.g., indicators of CSA outcomes) will be compiled from those studies that meet the predetermined criteria. Statistical relationships between practices and impacts will be evaluated via meta-analytical approaches including response ratios and effect sizes. Mechanisms to identify bias and maintain consistency continue to be applied throughout the review process. These analyses will be complemented with an analysis of determinants of/barriers to adoption of promising CSA practices covered in the meta-analysis. Results of the review will be incorporated into a publicly available Web-based database. Data will be publicly available under Creative Commons License in 2016

Automated Detection of Malarial Retinopathy in Digital Fundus Images for Improved Diagnosis in Malawian Children with Clinically Defined Cerebral Malaria

Cerebral malaria (CM), a complication of malaria infection, is the cause of the majority of malaria-associated deaths in African children. The standard clinical case definition for CM misclassifies ~25% of patients, but when malarial retinopathy (MR) is added to the clinical case definition, the specificity improves from 61% to 95%. Ocular fundoscopy requires expensive equipment and technical expertise not often available in malaria endemic settings, so we developed an automated software system to analyze retinal color images for MR lesions: retinal whitening, vessel discoloration, and white-centered hemorrhages. The individual lesion detection algorithms were combined using a partial least square classifier to determine the presence or absence of MR. We used a retrospective retinal image dataset of 86 pediatric patients with clinically defined CM (70 with MR and 16 without) to evaluate the algorithm performance. Our goal was to reduce the false positive rate of CM diagnosis, and so the algorithms were tuned at high specificity. This yielded sensitivity/specificity of 95%/100% for the detection of MR overall, and 65%/94% for retinal whitening, 62%/100% for vessel discoloration, and 73%/96% for hemorrhages. This automated system for detecting MR using retinal color images has the potential to improve the accuracy of CM diagnosis