Analysis of clustered competing risks with application to a multicentre clinical trial

The usefulness of time-to-event (survival) analysis has made it gain a wide applicability in statistically modelling research. The methodological developments of time-to-event analysis that have been widely adopted are: (i) The Kaplan-Meier method, for estimating the survival function; (ii) The log-rank test, for comparing the equality of two or more survival distributions; (m) The Cox proportional hazards model, for examining the covariate effects on the hazard function; and (iv) The accelerated failure time model, for examining the covariate effects on the survival function. Nonetheless, in time-to-event endpoints assessment, if subjects can fail from multiple mutually-exclusive causes, data are said to have competing risks. For competing risks data, the Fine and Gray proportional hazards model for sub-distributions has gained popularity due to its convenience in directly assessing the effect of covariates on the cumulative incidence function. Furthermore, sometimes competing risks data cannot be considered as independent because of a clustered design; for instance, in registry cohorts or multi-centre clinical trials. The Fine and Gray model has been extended to the analysis of clustered time-to-event data, by including random-centre effects or frailties in the sub-distribution hazard. This research focuses on the analysis of clustered competing risks with an application to the investigation of the management of pericarditis clinical trial (IMPI) dataset. IMPI is a multi- centre clinical trial that was carried out from 19 centres in 8 African countries with the principal objective of assessing the effectiveness and safety of adjunctive prednisolone and Mycobacterium indicus pranii immunotherapy, in reducing the composite outcome of death, constriction or cardiac tamponade, requiring pericardial drainage in patients with probable or definite tuberculous pericarditis. The clinical objective in this thesis is therefore to analyse time to these outcomes. In addition, the risk factors associated with these outcomes were determined, and the effect of the prednisolone and M. indcus pranii was examined, while adjusting for these risk factors and considering centres as a random effect. Using Cox proportional hazards model, it was found that age, weight, New York Heart Association (NYHA) class, hypotension, creatinine, and peripheral oedema show a statistically significant association with the composite outcome. Furthermore, weight, NYHA class, hypotension, creatinine and peripherial oedema show a statistically significant association with death. In addition, NYHA class and hypotension show a statistically significant association with cardiac tamponade. Lastly, prednisolone, gender, NYHA class, tachycardia, haemoglobin level, peripheral oedema, pulmonary infiltrate and HIV status show a statistically significant association with constriction. A value of 0.1 significance level was used to identify variables as significant in the univariate model using forward stepwise regression method. The random effect was found to be significant in the incidence of composite outcomes of death, cardiac tamponade and constriction, and in the individual outcome of constriction, but this only slightly changed the estimated effect of the covariates as compared to when the random effect was not considered. Accounting for death as a competing event to the outcomes of cardiac tamponade or constriction, does not affect the effect of the covariates on these outcomes. In addition, in the multivariate models that adjust for other risk factors, there was no significant difference in the primary outcome between patients who received prednisolone, and those who received placebo, or between those who received M. indicus pranii immunotherapy, and those who received placebo

Till Circumstances Do Us Part: A Socio-Ethical Analysis of Divorce among Christians in Nigeria

The rate of divorce among Christian couples in the 21st Century has reached an alarming proportion with attendant negative effects on the church and the society Given this much has been done to address the trend but obviously success has been minimal Also researches abound on the subject matter in various fields of study This paper discussed the incidence of divorce as a recurring problem among Christians in Nigeria with reference to its social and ethical implications It interrogated contemporary justification for divorce as against biblical injunctions and recommended ways of stemming its tide in order to have a church and society that are free from the clutch of broken homes resulting in juvenile delinquency and other social vices Data were garnered through oral interviews with some clerics married couples and identified divorcees A content analysis of relevant academic materials was also done to complement the primary dat

Injection-induced sciatic nerve injury in Nigerian children

A CAJM journal article.Objectives: A retrospective study of all children with a diagnosis of sciatic nerve injury managed at the University College Hospital, Ibadan, Nigeria over a 12 year period was carried out in order to determine predisposing factors to the nerve injury and highlighting practical preventive measures. Design: The necessary data was collected from the case files of children seen at the hospital with a diagnosis of sciatic nerve injury, from 1988 to 1999. Results: There were 27 children aged five months to 12 years with a diagnosis of sciatic nerve injury. Twenty (74%) of the children were aged five years or less. While seven patients (26%) presented within two weeks of development of foot drop consequent on intramuscular (IM) injection given on the buttock, 20 patients (74%) presented much later. Fever was the most common complaint for which the injection had been given. The identity of the drugs given was not known in 10 patients. In the remaining 17 patients drugs administered were specified and included Chloroquine,Novalgin, Paraldehyde, Procaine penicillin, and Sulfadoxine- Pyrimethamine. Most of the patients had received the injections in privately owned medical facilities where staff with minimal training are often allowed to administer IM injections. Conclusion: It is suggested that the IM route for injection be strongly discouraged when a drug can be given by other routes. Only trained staff should be allowed to administer IM injections. Giving IM injections at sites other than the buttock maybe advantageous in children particularly those aged five years and below

Christian Ethical Values and the Quest for Sustainable National Development in Nigeria

The quest for development and its sustainability has been a top priority for governments societies international political organisations the academia and nongovernmental organisations across the globe The aim of this paper is to examine the imperative of Christian ethical values towards attaining sustainable development in Nigeria Data for the study were collected via exiting literature on the subject matter statistical information on development issues as well as personal experience of the researcher The findings revealed that there has been no meaningful development in modern day Nigeria or a sustainable development as apparent in the level of poverty infrastructure decay falling standard of education poor health care delivery system low life expectancy and unemployment in the country This development is largely attributable to the neglect of Christian ethical values by both the leaders and followers who profess Christianity Thus the paper recommended moral transformation on the part of all Christians in order to achieve sustainable development which has been obscure in the countr

Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK : a register linkage study

Peer reviewedPublisher PD

THE IMPACT OF ACCREDITATION ON THE GROWTH OF ACADEMIC LIBRARIES IN NIGERIA.

The library being the most essential pillar of any academic institution needs utmost attention to avoid total collapse of the entire university community. The process of programmes accreditation in Nigerian universities is to ensure a uniform Maximum Academic Standards (MAS). To ensure that the process is meeting its set goals and objectives, this study examines the impact of accreditation on the growth of academic libraries in Nigeria. The research adopts a descriptive survey design. A total enumeration technique was used to select 125 respondents as the sampled population. Questionnaire was used for data collection and analyzed using simple percentage. The finding revealed that there is paucity of funds affecting the optimum performance of academic libraries in Nigeria; fund is not released until accreditation is approaching. Findings further revealed that accreditation exercise has been beneficial to the library in terms of increased library information resources and library face lift. The finding also revealed some of the challenges facing academic libraries in Nigeria. When there is no accreditation, the library faces poor attention and lack of fund from the university management which results to poor library services and no acquisition. Therefore, the study recommends that academic libraries in Nigeria should device a means of self-funding through Internally Generated Revenue (IGR) in form of bindery, internet access provision, reprographic services etc. Also, the university managements should continue to fund its library and release to time the statutory 10% total budget of the institution’s recurrent expenditure

Indigenous knowledge development as a way-out of unemployment in Nigeria: A case study of Ondo, Ekiti and Osun states

Indigenous knowledge is otherwise known as African science and knowledge. It was conceived, born, processed, disseminated but preserved through natural inheritance from succeeding generations without written document. This study was done to discover the various indigenous knowledge jobs available, the employment status, the challenges they encounter and suggest what government can do to help. Out of four hundred and fifty (450) copies of questionnaire that were distributed, four hundred and eighteen (418) copies (92.9%) were returned with usable responses, while thirty two (32) copies (7.1%) were not returned. Descriptive statistical method was applied for the study, Questionnaire, and observations were the research instruments used for data gathering. Data were analysed using the use of frequency counts and percentages method. Findings revealed that indigenous knowledge is the pivot of Nigerian economy. If indigenous knowledge is better funded by the three tiers of Nigerian government, it is capable of reducing unemployment syndrome that besieged the country. The various levels of government should intensify efforts to improve the adult literacy programme, public orientation and enlightenment, accreditation of indigenous knowledge practitioners, grant interest free loans and establish more indigenous knowledge skill acquisition centres nationwide

A Christian View of Genetic Engineering

There has been an age long conflict between religion and science Thus many scientific breakthroughs have literally faulted some religious claims In spite o f this the symbiotic relationship between the duo cannot be overlooked In o ther words there is a recurring scholarly intercourse and intellectual romance between science and religion as established by scholars This paper examines genetic engineer ing from a Chr istian perspective with emphasis on the prospect and burden of the innovation It is premised on Barbour s model for the study of the interaction between Religion and Science and Artigas Complementary Theory which emphasizes the harmonizing and dialoguing roles between science and religion Using content analysis this work delineates the blessing and woes of genetic engineer ing in the Christian context Christianity for instance balances respect for human life and dignity of the human person on the one hand and the blessings of science in human development on the other hand Whereas Christianity appreciates the fact of human creativity in genetic engineer ing as it leads to improved plant and animal lives increased food production and therapeutic functions it equally considers broad implications of this breakthrough on the human person future and his environment It is recommended that man must not lose his dignity nor should genetic engineers arrogate to themselves the Creator s right that is to determine what kind of human that should live or die Moreover religion as part of her oversight and prophetic function must be more proactive than reactive to current scientific progress in genetic engineering in order to guide and guard science from falling into the mash of conceited and self-destructive breakthrough

Determinants of adoption level of risk management strategies by fish farmers in Degema Local Government Area of Rivers State, Nigeria

The study examined the socio-economic determinants of level of adoption of risk management strategies by fish farmers in Degema Local Government Area of Rivers State. The study specifically described the socioeconomic characteristics of fish farmers, identified the various sources of risk and determined the socioeconomic factors that influence the level of adoption of risk management strategies. A two-stage sampling technique was used to select sixty-seven (67) fish farmers. Structured questionnaire and interview schedule were used for data collection. Data analysis was done using descriptive statistics and multiple regression. The result showed that majority were young male with an average age of 40 years. The most common sources of risk were the fluctuation in prices of fish feed and fish. The age of farmers, household size, and farming experience were some of the factors that influenced the adoption to risk management strategies. However due to the inadequate extension service activities, farmers were not able to fully utilize the different and essential risk management strategies. Hence, the study recommends that young women should be encouraged to invest in fish farming business. Also, extension agents should be encouraged to disseminate useful information to farmers on essential risk management strategies.Keywords: Risk, Risk Management Strategies, Fish farming, Adoptio

Teachers' cultural values and accountability in Nigeria

This study investigates teacher‟s cultural values and accountability in Nigeria. A questionnaire developed by Professor Rosenblatt (University of Haifa, Israel) was used to gather quantitative data from 483 secondary teachers across Oyo, Osun, Ogun, and Lagos States in Southwest Nigeria. Data collected were analyzed using percentages, descriptive statistics, and analysis of variance (ANOVA). The findings show that Nigerian teachers have high dispositions towards both bureaucratic (external) and internal (professional) accountability and their scores for internal accountability (M= 4.4286; SD= 0.5726) were higher than their scores for external accountability (M= 3.9759; SD = 0.5575). Geographical locations made a significant difference in the scores. Teachers from urban and suburban areas demonstrate higher scores than teachers from the rural in both bureaucratic (external) and internal (professional) accountabilit