MedFuse: Multi-modal fusion with clinical time-series data and chest X-ray images

Multi-modal fusion approaches aim to integrate information from different data sources. Unlike natural datasets, such as in audio-visual applications, where samples consist of "paired" modalities, data in healthcare is often collected asynchronously. Hence, requiring the presence of all modalities for a given sample is not realistic for clinical tasks and significantly limits the size of the dataset during training. In this paper, we propose MedFuse, a conceptually simple yet promising LSTM-based fusion module that can accommodate uni-modal as well as multi-modal input. We evaluate the fusion method and introduce new benchmark results for in-hospital mortality prediction and phenotype classification, using clinical time-series data in the MIMIC-IV dataset and corresponding chest X-ray images in MIMIC-CXR. Compared to more complex multi-modal fusion strategies, MedFuse provides a performance improvement by a large margin on the fully paired test set. It also remains robust across the partially paired test set containing samples with missing chest X-ray images. We release our code for reproducibility and to enable the evaluation of competing models in the future

Antitheilerial Activity of Some Medicinal Plants in Sudan

This study investigates the antitheilerial activity (in vitro) of the aqueous extract of four local medicinal plants, Gardenia ternifolia(Abu Gawie), Kigelia africana(Abu shutour), Sonchus cornutus(Moleita) and Tinospora bakis(Irg al-Hagar). Preliminary screening of the aqueousextracts of the four plants for activity against Theileria lestoquardi(ovine theileriosis) was done at concentrations of 250, 500, 5000 and 10000 ppm. The antimalarial drug, Paluther (Artemether 80), was tested for antitheilerial effect. On the other hand, Butalex (buparvaquone) was used as a standard drug. Screening for antitheilerial activity revealed K. africanato be the most potent candidate among the studied plants, followed by Gardenia ternifolia, and Tinospora bakis. However, Sonchus cornutuslacks activity. The highest activity of K. africana, Gardenia ternifolia andT. bakisat 10000 ppm was 80%, 60% and 30%, respectively; Artemether 80 producing 45% activity at 10mg/L. But buparvaquone at 10mg/L produced 100% activity. LC50of K. africana, G. ternifolia andT. bakiswas 2660.28 ppm, 6745.28ppm and 184268.54 ppm, respectively. However, Artemether 80 and buparvaquone having LC50of 21.29 mg/L and 0.000015 mg/L, respectively. Plant extracts plus Artemether80 and buparvaquonecaused changes in the morphology, colour and mean number of macroschizonts. The number of cells with extra cellular macroschizonts increased, but the mean XIV number of divided cells (binucleated and multinucleated) and viable cells decreased. The four plants, Artemether 80 and buparvaquone caused partial cytotoxicity at the highest concentration resulting in changes of the morphology of lymphoblast cells and decreasing the number of viable cells

Impact of Human Resources Management Practices on Turnover, Productivity and Corporate Financial Performance

In developing countries, the human resource availability is quite easy but the most unfortunate part is its effective and efficient management. It is a well established fact that it is human beings behind the machines which can drive or drown the organizations. Human behavior and psychology is driven and motivated by varying degree of factors. The researchers across the globe have evolved and successfully practiced certain HRM techniques in order to achieve best performance and productivity from human capital. Unfortunately this area remained neglected and human resource could not be exploited to its full potential in Pakistan despite the fact that the country possesses  one of the best human capital in the world. This paper is an Endeavour to identify the best Human Resource Management practices applicable to Pakistani environments and analyze their positive effects on labor turnover, productivity and corporate financial performance. In order to achieve this objective, a survey questionnaire was designed and disseminated among respondents. A total of 200 questionnaires were distributed, out of which 145 completed questionnaires were received. The authors analyzed the data by using statpro software. the major conclusions and findings were; Need for articulation of vision, mission and values for organization, lack of performance management system, lack of benefit and compensation program, issue of corporate loyalty, poor workforce alignment, absence of HR development and training programs, lack of Human Resource Information System(HRIS),and non adoption of TQM. Keywords: HRM, Productivity, Pakistan, Turnover

In vitro Activity of the Aqueous Extract of the Plant Kigelia africana Against Theileria lestoquardi

The objective of this study was to test the activity of the aqueous extract of the plant Kigelia africana against Theileria lestoquardi, the causative agent of malignant ovine theileriosis. Aqueous extract of K. africana fruits was screened for its in vitro activity against T. lestoquardi at different concentrations of 250, 500, 5000 and 10000 ppm. Lymphocytes infected with T. lestoquardi were isolated from heparinized blood with Ficoll-paque, grown in minimum essential medium and continuously sub cultured until passage 8 which was used for the test. The parasite was identified, using indirect fluorescent antibody test. The results revealed in vitro activities of 20%, 58% and 80% at concentrations of 500, 5000 and 10000 ppm, respectively. Lethal dose 50% and 99% (LC50 and LC99) were 2660.28 and 29980.34 ppm, respectively. The extract activity caused significantly (P≤0.05) high death of macroschizonts, decrease in the number of macroschizonts per cell, and increase in the number of extra cellular macroschizonts at concentrations of 5000 and 10000 ppm. The number of dividing cells significantly (P≤0.05) decreased at concentrations of 500, 5000 and 10000 ppm. The number of viable cells, also, significantly (P≤0.05) decreased at concentrations of 5000 and 10000 ppm compared with the control which did not significantly (P>0.05) increase. Besides, the activity of the highest concentration (10000 ppm) revealed some lymphoblast cells with degenerated nuclei. The study showed that K. africana has antitheilerial effect on T. lestoquardi and could be an effective candidate for the treatment of malignant ovine theileriosis after in vivo confirmation. Further studies are recommended for phytochemical analysis and mode of action

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation