The Syndromic versus Laboratory Diagnosis of Sexually Transmitted Infections in Resource-Limited Settings

Sexually transmitted infections (STIs) are highly prevalent in sub-Saharan Africa, where there is a severe HIV epidemic. Thus, accurate recognition and diagnosis of STIs are essential for successful HIV prevention programs in the region. Due to lack of trained personnel and adequate laboratory infrastructure in the region, information regarding the profile of STIs relies essentially on self-reported or physician-diagnosed symptoms. The main objective of the study was to assess the effectiveness of the syndromic diagnosis of STIs, which is often used as a proxy for laboratory diagnosis of STIs in sub-Saharan Africa and other resource-limited settings. The study builds on previously collected data from a community-based survey in Northern Tanzania. We found no significant agreements between patient-reported STIs symptoms and laboratory-confirmed STIs tests. The reported STIs symptoms had high specificity (range = 85–99%) and poor sensitivity (range = 2–17%). Knowledge gained from our study will have significant public health implications, and can help improve the syndromic diagnosis of STIs

Gaze patterns of anatomy students through classroom learning and familiarization

This study aims to identify the gaze patterns of medical students as they correlate with learning and familiarization through the length of a course. The gaze patterns of medical gross anatomy students (n=31) were documented as they identified anatomical structures on a computer screen. Each student took the test before the start of the Human Gross Anatomy course, and was randomly assigned to a group (A, B, or C) that would take it after one of three course section exams, Back and Limbs, Thorax Abdomen Pelvis, and Head and Neck, respectively. Their gaze patterns were expected to change as they become more familiar with the course material, particularly with respect to cognitively salient Areas of Interest (cAOIs) that are relevant to identifying the tagged structure. We predict that unfamiliar students will demonstrate more saccadic movements, shorter fixation times on cognitively salient AOIs, and longer fixation times on visually salient AOIs when compared to experienced students. Predictions that saccade frequency would decrease with familiarity and that fixation time in visually salient AOIs would decrease were not upheld. There appears to be a decrease in fixation time on the area surrounding the AOIs (White Space) for groups of subjects familiar with the material. This is found to be a statistically significant decrease in Group B's Back and Limbs (p = 0.038) and Thorax Abdomen Pelvis (p = 0.000) sections as well as Group C's Back and Limbs section (p = 0.013). This decrease in fixation time on the White Space is due to an increase in fixation time on cognitively salient AOIs with the only statistically significant increase occurring in Group C's Thorax Abdomen Pelvis section

Natural resources for appropriate water treatment

The high cost of water treatment has rendered provision of good quality water in the developing world difficult. The search for low-cost treatment options is essential in order to provide safe drinking water. This paper presents a study on the use of Moringa oleifera and pumice as low cost natural materials for improving water treatment systems. Moringa oleifera was found to be very effective for coagulating raw turbid water. The coagulant component was isolated from the seed and purified using a single-step ion exchange purification method. The process was standardized and it can be readily scaled up. The use of pumice for dual media filtration was compared against a mono-medium sand filtration system. In a pilot scale study pumice/sand dual media increased the filter run length two-fold and reduced the volume of backwash water by half

Financial Performance of Rural Saving and Credit Cooperatives in Tigray, Ethiopia

Saving and Credit Co-operatives are financial institutions that are owned, controlled and capitalized by their members. The overall objective of this study was to examine development and financial performance of Rural Saving and Credit cooperative Societies (RUSACOs) in Tigray, Ethiopia using PEARLS model. In this study both primary and secondary data was collected. Primary data was collected from the purposively selected 13 saving and credit cooperatives using structured questionnaire. The writer analyzed the data using ratios and tables in light of the PEARLS monitoring tool. The cooperatives were found successful in maintaining 100 percent protection against loan losses. Regardless of their weakness in terms of financial structure and profitability indicators, taking 2005 as base year, the RUSACCOs covered in this study registered substantial growth rates in terms of amounts of loan disbursement and saving deposits, members’ share capital, number of membership, total assets, and profitability. However, they are weak in terms of their financial structure and profit generating capacity.  They invested much of their financial resources in less productive/profitable asses (E1), and financed their asses using much capital from members’ share capital (E7) which cannot be used for loan disbursement, instead of saving deposits (E5). The capacity of the RUSACCOs to generate adequate amount of profit was also found substantially below the standard (10 percent). Thus, as RUSCCOS in Tigray are not generating enough amounts of income to cover their operating and financial costs, their sustainability is in question. Keywords: Financial Performance,  PEARLS , Rural Saving and Credit Cooperatives (RUSACOs), Tigray-Ethiopia

Smallholder Farmers’ Innovation and Its Determinants The Case of Hirity Mekan Seed Producers’ Cooperative, Tigray, Ethiopia

Purpose: Based on the Memorandum of understanding signed between the researcher and ISSD –MU, the main purpose of this study was to find out the extent to which farmers in the specified study area demonstrate entrepreneurial orientation (degree of innovativeness) and examine the determinants of farmers’ innovativeness. Methodology: The units of analysis of this study are members Hryti Mekan seed producers’ cooperative in Enda-Mekoni Woreda, southern zone of Tigay. In this study, farmers’ innovativeness was treated as continuous dependent variables. Five point Likert scale was used to capture the innovativeness. Twelve variables, categorized under four major groups: demographic and personal variables, socio cultural variables, wealth related variables and infrastructure; were considered as variables to explain the dependent variable. Primary data was collected from 49 (83 percent of the sample frame) members of the Mekan Seed Producers using structured questionnaire, and interview as well as discussions with key informants. In order to analyze the quantitative data, the researcher applied such descriptive statistics as percentages, ratios, mean standard deviations, tables as well as statistical difference tests. It also used correlation and regression analysis for the purpose of substantiating the descriptive data analysis and examined the factors that influence the innovativeness of the members.Results: The results of econometric analysis show that positive attitude towards agriculture, engagement in production of improved seed, extension services provided by DAs, experts from ISSD, research institutions, and Woreda level agricultural offices have significant positive effect to enhance the innovativeness of farmers. On the other hand while mass-media exposure, total years of experience in traditional farming, inadequacy and cost of inputs are negatively associated with innovativeness of farmers. On the other hand, participation in capacity building events (e.g. trainings, visits to demonstration sites, experience sharing visits, workshops), participation in non-farm activities, level of formal education, financial position and access to credit have no any significant effect on innovation. Keywords: Entrepreneurial Orientation, farmers’ Improved Seed Producers’ Cooperatives, Innovativeness

Material degradation in mooring chains for floating structures in deep waters

There is a dire need for an efficient, trustworthy, and financially feasible positioning technique for offshore large floating structures. Of all the methods of positioning the offshore structures, the mooring chains play a significant role. There is a need for explicit knowledge of the properties of mooring systems so that the design, operation, and analysis of large floating structures, particularly in deep water, should be reliable. Experts from the oil and gas industry have experienced actual corrosion loss rates data for mooring systems that they get are different from those allowed for in traditional design guidance and have long been a recognized challenge. The corrosion allowances from the codes are sometimes very conservative leading to an over design (thicker); this could be the other way round, in some cases. Recently, as long as corrosion has been tolerated with an 'allowance', thicker and heavier chains have been the only way to extend the life of these mooring chains. On the other hand, Corrosion rates can be unpredictable and vary greatly around the world due to the diverse marine environments. As a worst-case scenario, this results in significantly shortened chain lifespans and, at the very least, increased failure rates and integrity issues in the mooring systems. The findings of this study will result in a practical equation function from previous studies that can be used to estimate corrosion loss in deep water based on parameters that have a significant impact on the corrosion, such as temperature, and dissolved inorganic nitrogen (nitrates, nitrites, and ammonia) usually measured together as DIN concentration levels. Data may be unavailable in some regions, or finding them may be difficult, and using the allowances during design from the standards without considering the parameters may lead to inappropriate allowances, and as a result failure may occur. Thereafter, estimating the rest life of inservice degraded mooring chains is another issue and how can this be done through FEM analysis. Finally, although Cathodic Protection has long been a part of corrosion prevention strategies for offshore steel structures, the mooring lines have never been successfully protected in deep waters. Finding a method of protection to extend the lifetime of these degraded chains is another challenge. Following extensive research, a new sacrificial anode cathodic protection system technology has been found in recent years. Considering this method has guaranteed efficiency and a cathodic protection calculation has been made using these anode types

Smooth Risk Functions for Self-Controlled Case Series Models

The self-controlled case series (SCCS) method is commonly used to investigate associations between vaccine exposures and adverse events (side effects). It is an alternative to cohort and case control study designs. It requires information only on cases, individuals who have experienced the adverse event at least once, and automatically controls all fixed confounders that could modify the true association between exposure and adverse event. However, time-varying confounders (age, season) are not automatically controlled. The SCCS method has parametric and semi-parametric versions in terms of controlling the age effect. The parametric method uses piecewise constant functions with a priori chosen age groups and the semi-parametric method leaves the age effect unspecified. Mis-specification of age groups in the parametric version may lead to biased estimates of the exposure effect, and the semi-parametric approach runs into computational problems when the sample size is moderately large. Moreover, both versions of SCCS represent the time-varying exposures using step functions with pre-determined cut-points. A less prescriptive approach may be beneficial when the shape of the relative risk function associated with exposure is not known a priori, especially when exposure effects can be long-lasting. This thesis focuses on extending the SCCS method to avoid the aforementioned limitations by modelling the age and exposure effects using flexible smooth functions. Specifically, we used penalised regression splines based on cubic M-splines, which are piecewise polynomials of degree 3. We developed three new extensions: a method that represents only the age effect with splines, a method that uses splines to model only the exposure effect and a non-parametric SCCS method that represents both effects by splines. Simulation studies showed that these new methods outperformed the parametric and semi-parametric methods. The new methods are illustrated using large data sets. Review of SCCS vaccine studies and directions on how to use the method are also given

HIV-Associated Burkitt Lymphoma: More than a starry sky appearance

Introduction: •People with HIV infection are at least 50 times more likely to get lymphoma as compared to the general population. •25-40% of these lymphomas will be Burkitt Lymphoma (BL) – an aggressive B cell malignancy with a high proliferative rate and potentially fatal within months if not diagnosed and treated in a timely manner. •This translates to a 10-20% individual life-time risk of BL for an HIV infected person. •The incidence of BL declined after the introduction of highly active antiretroviral therapy (HAART), but to a lesser extent than other HIV-associated malignancies. •Epidemiologic studies suggest the incidence of BL will increase as the HIV-infected population ages Case Presentation: A 24 yo woman with known HIV presented with 1 month of intermittent fevers, chills, nausea and diffuse abdominal pain most notable in the epigastric region. Her symptoms acutely worsened in the last week, prompting her visit to the Emergency Department. Past Medical History: •HIV- diagnosed in 2014. Last on ART Feb-May 2019 while in jail. CD4 count 596 (low at 26%) and HIV RNA viral count 26,400 prior to ART initiation. CD4 count improved to 33% with an undetectable viral load in April. •Chronic hepatitis C •Active IVDU – heroin, methamphetamines •Tobacco dependence Exam: •Vitals: HR 135, RR 22, Temp 102.8 F, normotensive,SpO2\u3e95% on room air •Profuse sweating, notably uncomfortable •New 2/6 holosystolic heart murmur in LUSB with no radiation •Left lower quadrant and epigastric tenderness, negative Murphy’s sign Labs on admission: •Hgb 9 (baseline: 11) •Normal complete metabolic panel •HIV RNA viral load 55,800 •CD4 count 596, 32% Hospital Course: •Started on broad spectrum antibiotics for presumed endocarditis in the setting of active IVDU •TTE revealed no vegetations, blood cultures negative •CT abdomen pelvis obtained the night of admission demonstrated diffuse gastric thickening with evidence of omental seeding with nodularity and splenomegaly •Endoscopy completed the following day found a large nonbleeding gastric ulcer and diffuse gastric inflammation. •Pathology of endoscopic biopsies of the gastric antrum identified Diffuse Large B-cell Lymphoma (DLBCL) and H.pylori. •Immunohistochemistry test positive for Epstein Barr Virus. •The patient was started on Biktarvy (last use 1-3 months prior) •PET scan was done for staging revealed advanced disease with a diffuse tumor burden •MYC rearrangement detected on FISH analysis, consistent with high grade Burkitt lymphoma •She completed 1 cycle of Short Course EPOCH-RR with a guarded prognosis. There was high concern for TLS and gastric perforation due to the extensive abdominal tumor burden. Fortunately, neither happened. •Thus far, she has tolerated 3 of the anticipated 6 chemo cycles with relatively minor complications by comparison including bradycardia, frequent NSVT and neutropenia necessitating adjustments to her chemotherapy regimen and schedule delays. •Her pain control has remained a challenge in light of her ongoing IV substance use. Discussion: •Lymphoma in the leading cause of cancer-related deaths among HIV-infected patients in the anti-retroviral therapy era. •Burkitt lymphoma (BL) is a highly proliferative NHL deriving from B cells and with characteristic oncogenic pathways, including translocation in the MYC gene-- a gene that normally plays a role in controlling cell proliferation, differentiation and apoptosis. •The WHO classifies 3 different clinical variants of BL: endemic, sporadic and immunodeficiency-associated. •Unlike other HIV-associated lymphomas, BL is frequently noted in patients with CD4 cell counts \u3e200 and viral loads suppressed by ART •HIV-associated BL typically presents with extra-nodal disease, mostly commonly the stomach •Intra-abdominal BL may present with abdominal pain, nausea, vomiting, GI bleeding, bowel obstruction; fever, night sweats, weight loss (B symptoms), fatigue and malaise are also common. •Approximately 70% will present with wide spread disease (stage III or IV), in addition to elevated LDH and uric acid levels •The classic “starry sky appearance” is not often seen in the histological examination of HIV-associated BL. Most are positive for Epstein Barr Virus (EBV). •Recent studies suggest the pathobiology of HIV-associated lymphomas is distinct from non-HIV lymphomas. HIV may directly induce B-cell activation. Further oncogenic viruses, as EBV, are more prevalent in HIV-associated lymphomas. •Survival with HIV-associated BL is approaching that of HIV-negative BL thanks to the development of short duration, dose intensive combination chemotherapy with aggressive CNS prophylaxis, the availability of rituximab and the implementation of effective ART •Rare cases of IRIS- associated Burkitt Lymphoma have been reported, typically within 6 months after the initiation of HAART. It is unclear if that was the case with our patient.https://digitalcommons.psjhealth.org/ppmc_internal/1016/thumbnail.jp