Mortality predictor score in hospitalised patients HIV-associated TB in Africa dataset

This dataset contains details of hospital patients with HIV-associated tuberculosis in sub-Saharan Africa from the STAMP clinical trial. It was generated to derive predictor score for mortality including urine lipoarabinomannan detection. Variables include: age, sex, weight, living status, number of day in follow-up, ART treatment, WHO danger sign, Haemoglobin level, ability to walk, and urine LAM positivity

Tuberculosis diagnostics to reduce HIV-associated mortality: Barnett Christie Lecture 2020

Tuberculosis (TB) was declared a global emergency in 1993 by the World health Organization (WHO), with global and African regional TB incidence rates driven by the HIV epidemic. Much of this burden lay in health facilities in sub-Saharan Africa, with post-mortem studies showing almost half of fatal TB goes undiagnosed, reflecting a failure in the approach to TB diagnostics. HIV-associated TB is often under the clinical radar, and this paper describes strategies to improve TB diagnostics to expedite treatment, reduce the amount of undiagnosed disease and ultimately reduce mortality. Through studies assessing the diagnostic accuracy and yield of new, rapid TB diagnostics, including the Xpert MTB/RIF nucleic acid amplification and urinary lipoarabinomannan (LAM) lateral flow assays, and clinical trials to measure impact on mortality and clinically relevant outcomes, this paper describes how TB diagnostics can reduce HIV-associated morbidity and mortality. With improved TB diagnostics in the pipeline, the future of urine-LAM assays for TB are also discussed

Detection of lipoarabinomannan (LAM) in urine is indicative of disseminated TB with renal involvement in patients living with HIV and advanced immunodeficiency: evidence and implications.

TB is the leading cause of HIV/AIDS-related deaths globally. New diagnostic tools are urgently needed to avert deaths from undiagnosed HIV-associated TB. Although simple assays that detect lipoarabinomannan (LAM) in urine have been commercially available for years, their specific role and utility were initially misunderstood, such that they have been slower to emerge from the diagnostics pipeline than otherwise might have been expected. In this article, we review and explain how urine-LAM assays should be understood as diagnostics for disseminated TB in HIV-positive patients with advanced immunodeficiency, in whom haematogenous TB dissemination to the kidneys serves as the primary mechanism by which LAM enters the urine. These insights are critical for the appropriate design of studies to evaluate these assays and to understand how they might be most usefully implemented. This understanding also supports the 2015 WHO recommendations on the restricted use of these assays in sick HIV-positive patients with advanced immunodeficiency

The 'Brain Drain' of physicians: historical antecedents to an ethical debate, c. 1960–79

Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics

Corporate branding and value creation for initiating and managing relationships in B2B markets

Purpose This study aims to fill a gap in branding literature concerning the effect of corporate brand relationships on brand value through the case study method in a business-to-business (B2B) context. The objectives of this study can be framed in three questions: (1) what are the main constituents of a corporate brand; (2) how does a corporate brand generate tangible and intangible brand value for their business customers; and (3) how do tangible and intangible brand benefits influence relationship initiation and management practices of the case companies? Design/methodology/approach The study adopts a qualitative multiple case study design by using archival data, and both in-depth telephone and online interviews with senior representatives of the case study companies to investigate corporate branding and associated issues in a B2B context. Findings From a managerial perspective, this study reveals that corporate business culture, brand relationships, products, and corporate identity and personality as the main constituents of a corporate brand in a B2B context. The results show that a corporate brand can generate intangible and tangible brand value benefits for business customers. The findings also note the importance of the brand value in enhancing relationship initiation. Originality/value The study contributes to the branding literature by developing a conceptual model that explains the development and role of the corporate brand in a B2B context with its associated value creation and brand management outcomes. The findings advance brand management literature on business relationships, which addresses a gap in B2B contexts rather than mainly about product brand management and value creation in B2C contexts

Xpert MTB/RIF - why the lack of morbidity and mortality impact in intervention trials?

: Compared with smear microscopy, the Xpert MTB/RIF assay (Xpert), with superior accuracy and capacity to diagnose rifampicin resistance, has advanced TB diagnostic capability. However, recent trials of Xpert impact have not demonstrated reductions in patient morbidity and mortality. We conducted a narrative review of Xpert impact trials to summarize which patient-relevant outcomes Xpert has improved and explore reasons for no observed morbidity or mortality reductions. We searched PubMed, Google Scholar, Cochrane Library and Embase and identified eight trials meeting inclusion criteria: three individually randomized, three cluster-randomized, and two pre-post trials. In six trials Xpert increased diagnostic yield of bacteriologically-confirmed TB from sputa and in four trials Xpert shortened time to TB treatment. However, all-cause mortality was similar between arms in all six trials reporting this outcome, and the only trial to assess Xpert impact on morbidity reported no impact. Trial characteristics that might explain lack of observed impact on morbidity and mortality include: higher rates of empiric TB treatment in microscopy compared with Xpert arms, enrollment of study populations not comprised exclusively of populations most likely to benefit from Xpert, and health system weaknesses. So far as equipoise exists, future trials that address past limitations are needed to inform Xpert use in resource-limited settings.<br/

Numerical Solutions of 2-D Steady Incompressible Driven Cavity Flow at High Reynolds Numbers

Numerical calculations of the 2-D steady incompressible driven cavity flow are presented. The Navier-Stokes equations in streamfunction and vorticity formulation are solved numerically using a fine uniform grid mesh of 601x601. The steady driven cavity solutions are computed for Re<21,000 with a maximum absolute residuals of the governing equations that were less than 10-10. A new quaternary vortex at the bottom left corner and a new tertiary vortex at the top left corner of the cavity are observed in the flow field as the Reynolds number increases. Detailed results are presented and comparisons are made with benchmark solutions found in the literature

Using Beatboxing for Creative Rehabilitation After Laryngectomy:Experiences From a Public Engagement Project

Laryngectomy is the surgical removal of the larynx (voice box), usually performed in patients with advanced stages of throat cancer. The psychosocial impact of losing the voice is significant, affecting a person’s professional and social life in a devastating way, and a proportion of this patient group subsequently must overcome depression (22–30%) and social isolation (40%). The profound changes to anatomical structures involved in voicing and articulation, as a result of surgery, radiotherapy or chemotherapy (separately or in combination with one another), introduce challenges faced in speech rehabilitation and voice production that complicate social reintegration and quality of life. After laryngectomy, breathing, voicing, articulation and tongue movement are major components in restoring communication. Regular exercise of the chest, neck and oropharyngeal muscles, in particular, is important in controlling these components and keeping the involved structures supple. It is, however, a difficult task for a speech therapist to keep the patient engaged and motivated to practice these exercises. We have adopted a multidisciplinary approach to explore the use of basic beatboxing techniques to create a wide variety of exercises that are seen as fun and interactive and that maximize the use of the structures important in alaryngeal phonation. We herein report on our empirical work in developing patients’ skills, particularly relating to voiced and unvoiced consonants to improve intelligibility. In collaboration with a professional beatboxing performer, we produced instructional online video materials to support patients working on their own and/or with support from speech therapists. Although the present paper is focused predominantly on introducing the structure of the conducted workshops, the rationale for their design and the final public engagement performance, we also include feedback from participants to commence the critical discourse about whether this type of activity could lead to systematic underlying research and robustly assessed interventions in the future. Based on this exploratory work, we conclude that the innovative approach that we employed was found to be engaging, useful, informative and motivating. We conclude by offering our views regarding the limitations of our work and the implications for future empirical research