Combining evidence and values in priority setting: testing the balance sheet method in a low-income country

<p>Abstract</p> <p>Background</p> <p>Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity.</p> <p>Methods</p> <p>Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions.</p> <p>Results</p> <p>The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%.</p> <p>Conclusion</p> <p>Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.</p

Understanding the influence of race/Ethnicity, gender, and class on inequalities in academic and non-academic outcomes among eighth-grade students: findings from an intersectionality approach

Socioeconomic, racial/ethnic, and gender inequalities in academic achievement have been widely reported in the US, but how these three axes of inequality intersect to determine academic and non-academic outcomes among school-aged children is not well understood. Using data from the US Early Childhood Longitudinal Study—Kindergarten (ECLS-K; N = 10,115), we apply an intersectionality approach to examine inequalities across eighth-grade outcomes at the intersection of six racial/ethnic and gender groups (Latino girls and boys, Black girls and boys, and White girls and boys) and four classes of socioeconomic advantage/disadvantage. Results of mixture models show large inequalities in socioemotional outcomes (internalizing behavior, locus of control, and self-concept) across classes of advantage/disadvantage. Within classes of advantage/disadvantage, racial/ethnic and gender inequalities are predominantly found in the most advantaged class, where Black boys and girls, and Latina girls, underperform White boys in academic assessments, but not in socioemotional outcomes. In these latter outcomes, Black boys and girls perform better than White boys. Latino boys show small differences as compared to White boys, mainly in science assessments. The contrasting outcomes between racial/ethnic and gender minorities in self-assessment and socioemotional outcomes, as compared to standardized assessments, highlight the detrimental effect that intersecting racial/ethnic and gender discrimination have in patterning academic outcomes that predict success in adult life. Interventions to eliminate achievement gaps cannot fully succeed as long as social stratification caused by gender and racial discrimination is not addressed

Effect of Surface Dissolution on Dislocation Activation in Stressed FeSi6.5 Steel

The effects of surface dissolution on dislocation activation in FeSi6.5 steel are quantitatively studied by analyzing the stress relaxation data using the thermal activation theory of dislocation. The stressed FeSi6.5 steel sample in acid solutions (H2SO4 or HCl) exhibits a much higher rate of stress reduction with time compared with that in air or deionized water. As the stress relaxation time is prolonged to 20 min, the relaxation rates are 0.055 MPa&middot;min&minus;1 in water and 0.074, 0.1, 0.11 MPa&middot;min&minus;1 in H2SO4 solutions with pH 4, 3, and 2, respectively. In a NaCl solution, a slight increase in the relaxation rate compared with air was found. Higher acidity (lower pH) of the solution inducing higher stress relaxation rate implies the softening is associated with the anodic dissolution of the surface layer and the accelerated (additional) flow of dislocations. The analyses using the thermal activation theory of dislocation during relaxation reveal the mechanism for the accelerated plastic flow induced by the corrosive medium. The variations of these parameters are related to the relaxation of the stress field of dislocations and the weakening of interaction between slip dislocations and short-range obstacles. The chemomechanical effect, including a reduction in apparent activation energy and a decrease in waiting time for dislocation to obtain sufficient thermal activation energy to cross obstacles, causes an increase in the stress relaxation rate (plastic strain rate). The study confirms that surface dissolution accelerates the plastic flow of metals and supports the view that surface dissolution facilitates dislocation slip. It is helpful to improve the formability of brittle metals

Correlation Between Visual Function and Simulated Performance of Daily Living Activities in Glaucomatous Patients

International audiencePURPOSE:To analyze the correlations between functional clinical tests and the performance of glaucoma patients in simulated daily living activities.METHODS:Thirty-two patients with chronic glaucoma, followed at the Quinze-Vingts National Ophthalmology Hospital, were included. All patients had a clinical evaluation of visual function including best-corrected visual acuity (BCVA), contrast sensitivity (CS) and monocular and binocular visual field (VF) tests. Four different simulated activities of daily living were evaluated in standardized artificial platforms (StreetLab® and HomeLab®): "mobility" and an obstacle avoidance task in an artificial street, "reaching and grasping" large and small objects on a kitchen work surface, "localization of people" and "face orientation recognition." Patient performance in the different tasks was correlated with VF evaluation including integrated binocular visual field (IVF), VF mean deviation (MD) of the better and the worse eye, Esterman binocular VF, BCVA and CS.RESULTS:The IVF score was significantly correlated with "localization of people" time (r=0.49; P=0.003), "face orientation recognition" time (r=0.50; P=0.002) and "movement onset" for reaching and grasping small objects (r=0.38; P=0.029). The MD of the better eye appeared significantly correlated with "face orientation recognition" time (r=-0.44; P=0.009) and "localization of people" time (r=-0.46; P=0.005). The Esterman score appeared significantly correlated with "mobility time" (r=-0.40; P=0.018), "localization of people" (r=-0.37; P=0.030), "face orientation recognition" times (r=-0.39; P=0.024), and "movement onset" for reaching and grasping large objects (r=-0.43; P=0.015).CONCLUSIONS:The IVF score and the MD of the better eye appeared to better evaluate "reaching and grasping," "face orientation recognition" and "localization of people" simulated tasks, whereas for the "mobility" task, the Esterman VF seemed more useful. The precise evaluation of the glaucoma patient's ability to perform everyday life tasks is complex and may require both monocular and binocular visual field tests

Acceptability of single screening and treatment policy for the control of malaria in pregnancy: perceptions of providers and pregnant women from selected health facilities in Lindi region, Tanzania

Abstract Background Tanzania started implementing single screening and treatment (SST) for all pregnant women attending their first antenatal care (ANC) visits in 2014, using malaria rapid diagnostic tests (RDTs) and treating those who test positive according to the national guidelines. However, there is a paucity of data to show the acceptability of SST to both pregnant women and health care workers (HCWs), taking into consideration the shortage of workers and the added burden of this policy to the health system. This study assessed the perceptions and opinions of health service users and providers to determine the acceptability of SST policy. Methods Pregnant women and HCWs in eight health facilities in two districts of Lindi region (Kilwa and Lindi) were interviewed using semi-structured questionnaires with open and close-ended questions. Both qualitative and quantitative data were collected, including demographic characteristics, women’s experience, their perception on SST and challenges they face when receiving services for malaria offered at ANC. Experience of HCWs regarding the implementation of SST as part of routine services and the challenges encountered when providing ANC services for malaria in pregnancy (MIP) were also assessed. Results Of the 143 pregnant women interviewed, 97% viewed testing favourably and would wish to be tested for malaria again, while 95% were satisfied with services and reasons for testing during the first ANC visit. Nearly all (99%) would recommend their fellow pregnant women to be tested for malaria and all women recommended that the Ministry of Health should continue the SST strategy. This was despite the fact that 76% of the women experienced pain and 16% had anxiety as a result of finger prick. Sixteen HCWs (mostly nurses) were interviewed; they also viewed SST implementation favourably and reported feeling empowered to use RDTs for malaria screening. The main challenge identified by HCWs was that nurses are not allowed to prescribe anti-malarials to women who test positive and need to refer them to the outpatient department for treatment. Conclusion SST was considered an acceptable approach to control MIP by HCWs and pregnant women, and they recommended the continuation of the policy. In addition, consideration should be given to implementing a task-shifting policy to allow nurses to dispense anti-malarials to pregnant women

Fully automatic GBM segmentation in the TCGA-GBM dataset: Prognosis and correlation with VASARI features

Reproducible definition and quantification of imaging biomarkers is essential. We evaluated a fully automatic MR-based segmentation method by comparing it to manually defined sub-volumes by experienced radiologists in the TCGA-GBM dataset, in terms of sub-volume prognosis and association with VASARI features. MRI sets of 109 GBM patients were downloaded from the Cancer Imaging archive. GBM sub-compartments were defined manually and automatically using the Brain Tumor Image Analysis (BraTumIA). Spearman’s correlation was used to evaluate the agreement with VASARI features. Prognostic significance was assessed using the C-index. Auto-segmented sub-volumes showed moderate to high agreement with manually delineated volumes (range (r): 0.4 – 0.86). Also, the auto and manual volumes showed similar correlation with VASARI features (auto r = 0.35, 0.43 and 0.36; manual r = 0.17, 0.67, 0.41, for contrast-enhancing, necrosis and edema, respectively). The auto-segmented contrast-enhancing volume and post-contrast abnormal volume showed the highest AUC (0.66, CI: 0.55–0.77 and 0.65, CI: 0.54–0.76), comparable to manually defined volumes (0.64, CI: 0.53–0.75 and 0.63, CI: 0.52–0.74, respectively). BraTumIA and manual tumor sub-compartments showed comparable performance in terms of prognosis and correlation with VASARI features. This method can enable more reproducible definition and quantification of imaging based biomarkers and has potential in high-throughput medical imaging research

Phototoxic Action Spectrum on a Retinal Pigment Epithelium Model of Age-Related Macular Degeneration Exposed to Sunlight Normalized Conditions

International audienceAmong the identified risk factors of age-related macular degeneration, sunlight is known to induce cumulative damage to the retina. A photosensitive derivative of the visual pigment, N-retinylidene-N-retinylethanolamine (A2E), may be involved in this phototoxicity. The high energy visible light between 380 nm and 500 nm (blue light) is incriminated. Our aim was to define the most toxic wavelengths in the blue-green range on an in vitro model of the disease. Primary cultures of porcine retinal pigment epithelium cells were incubated for 6 hours with different A2E concentrations and exposed for 18 hours to 10 nm illumination bands centered from 380 to 520 nm in 10 nm increments. Light irradiances were normalized with respect to the natural sunlight reaching the retina. Six hours after light exposure, cell viability, necrosis and apoptosis were assessed using the Apotox-Glo Triplex™ assay. Retinal pigment epithelium cells incubated with A2E displayed fluorescent bodies within the cytoplasm. Their absorption and emission spectra were similar to those of A2E. Exposure to 10 nm illumination bands induced a loss in cell viability with a dose dependence upon A2E concentrations. Irrespective of A2E concentration, the loss of cell viability was maximal for wavelengths from 415 to 455 nm. Cell viability decrease was correlated to an increase in cell apoptosis indicated by caspase-3/7 activities in the same spectral range. No light-elicited necrosis was measured as compared to control cells maintained in darkness. Our results defined the precise spectrum of light retinal toxicity in physiological irradiance conditions on an in vitro model of age-related macular degeneration. Surprisingly, a narrow bandwidth in blue light generated the greatest phototoxic risk to retinal pigment epithelium cells. This phototoxic spectrum may be advantageously valued in designing selective photoprotection ophthalmic filters, without disrupting essential visual and non-visual functions of the eye