Microeconomics of managing Diabetic Ketoacidosis in a rural Nigerian child of low socioeconomic class: a case report

Health care delivery is a concurrent responsibility of the various levels of government in Nigeria where most of the populace earn less than one dollar a day. The total expenditure on Nigerian health care as a percentage of gross domestic product, and the percentage of federal government expenditure on health care is far below the World Health Organization recommended standard. Thus, caregivers pay out of their pockets to settle health care expenses of their children thereby creating a negative microeconomic impact on parents, households and health workers. Herein, we report the case management of newly diagnosed Diabetic Ketoacidosis (DKA) in an eight-year-old boy from a low socioeconomic class (SEC), and the costs implication of the child’s hospital care. After forgoing indirect costs like opportunity cost which is difficult to determine, the direct total cost involved in patient’s hospital care for DKA was forty eight thousand eight hundred naira only (N48, 800.00) equivalent to three hundred and ten United States Dollars and eighty three cents (310.83 USD). Based on the high cost of managing DKA observed in the study case, there is a need to convince health system administrators and policy makers to strengthen health insurance so as to enable patients, especially those from low SEC, to pay their hospital bills promptly.Keywords: Diabetic ketoacidosis; Microeconomics; Costs; Low socioeconomic class; Child; Yola; Nigeri

Clouds over the summertime Sahara: an evaluation of Met Office retrievals from Meteosat Second Generation using airborne remote sensing

Novel methods of cloud detection are applied to airborne remote sensing observations from the unique Fennec aircraft dataset, to evaluate the Met Office-derived products on cloud properties over the Sahara based on the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) on-board the Meteosat Second Generation (MSG) satellite. Two cloud mask configurations are considered, as well as the retrievals of cloud-top height (CTH), and these products are compared to airborne cloud remote sensing products acquired during the Fennec campaign in June 2011 and June 2012. Most detected clouds (67 % of the total) have a horizontal extent that is smaller than a SEVIRI pixel (3 km  ×  3 km). We show that, when partially cloud-contaminated pixels are included, a match between the SEVIRI and aircraft datasets is found in 80 ± 8 % of the pixels. Moreover, under clear skies the datasets are shown to agree for more than 90 % of the pixels. The mean cloud field, derived from the satellite cloud mask acquired during the Fennec flights, shows that areas of high surface albedo and orography are preferred sites for Saharan cloud cover, consistent with published theories. Cloud-top height retrievals however show large discrepancies over the region, which are ascribed to limiting factors such as the cloud horizontal extent, the derived effective cloud amount, and the absorption by mineral dust. The results of the CTH analysis presented here may also have further-reaching implications for the techniques employed by other satellite applications facilities across the world

A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases

BACKGROUND: Trusted literate, or semi-literate, community drug distributors (CDDs) are the primary implementers in integrated preventive chemotherapy (IPC) programmes for Neglected Tropical Disease (NTD) control. The CDDs are responsible for safely distributing drugs and for galvanising communities to repeatedly, often over many years, receive annual treatment, create and update treatment registers, monitor for side-effects and compile treatment coverage reports. These individuals are 'volunteers' for the programmes and do not receive remuneration for their annual work commitment. METHODS: A mixed methods approach, which included pictorial diaries to prospectively record CDD use of time, structured interviews and focus group discussions, was used to triangulate data on how 58 CDDs allocated their time towards their routine family activities and to NTD Programme activities in Uganda. The opportunity costs of CDD time were valued, performance assessed by determining the relationship between time and programme coverage, and CDD motivation for participating in the programme was explored. RESULTS: Key findings showed approximately 2.5 working weeks (range 0.6-11.4 working weeks) were spent on NTD Programme activities per year. The amount of time on NTD control activities significantly increased between the one and three deliveries that were required within an IPC campaign. CDD time spent on NTD Programme activities significantly reduced time available for subsistence and income generating engagements. As CDDs took more time to complete NTD Programme activities, their treatment performance, in terms of validated coverage, significantly decreased. Motivation for the programme was reported as low and CDDs felt undervalued. CONCLUSIONS: CDDs contribute a considerable amount of opportunity cost to the overall economic cost of the NTD Programme in Uganda due to the commitment of their time. Nevertheless, programme coverage of at least 75 %, as required by the World Health Organisation, is not being achieved and vulnerable individuals may not have access to treatment as a consequence of sub-optimal performance by the CDDs due to workload and programmatic factors

Irritable bowel syndrome and risk of glaucoma: An analysis of two independent population-based cohort studies

Objective: Irritable bowel syndrome (IBS) is a chronic disorder associated with an abnormal gastrointestinal microbiome. Microbiome–host interactions are known to influence organ function including in the central nervous system; thus, we sought to identify whether IBS may be a risk factor for the development of glaucoma. Design: Two prospective cohort studies. Subjects: The 1958 United Kingdom Birth Cohort (UKBC; 9091 individuals) and the Danish National Registry of Patients (DNRP; 62,541 individuals with IBS and 625,410 matched general population cohort members). Methods: In the UKBC, participants were surveyed throughout life (including at ages 42 and 50). The DNRP contains records of hospital-based contacts and prescription data from the national prescription database. Main Outcome Measure: The main outcome measure was incidence of glaucoma. In the UKBC, incident glaucoma at age 50 (n = 48) was determined through comparison of survey responses at ages 42 and 50 years. In the DNRP, glaucoma was assessed by hospital diagnosis (n = 1510), glaucoma surgery (n = 582) and initiation of glaucoma medications (n = 1674). Results: In the UKBC, the odds ratio (OR) of developing glaucoma between ages 42 and 50 in persons with a chronic IBS diagnosis was increased [OR: 5.84, 95% confidence interval (CI): 2.26–15.13]. People with an IBS diagnosis in the DNRP had a hazard ratio (HR) of 1.35 for developing physician-diagnosed glaucoma (95% CI: 1.16–1.56), an HR of 1.35 for undergoing glaucoma surgery (95% CI: 1.06–1.70) and an HR of 1.19 for initiating glaucoma medication (95% CI: 1.03–1.38). Conclusions: In two large European cohort studies, IBS is a risk factor for glaucoma

Delayed gastric emptying and reduced postprandial small bowel water content of equicaloric whole meal bread versus rice meals in healthy subjects: novel MRI insights

BACKGROUND/OBJECTIVES: Postprandial bloating is a common symptom in patients with functional gastrointestinal (GI) diseases. Whole meal bread (WMB) often aggravates such symptoms though the mechanisms are unclear. We used magnetic resonance imaging (MRI) to monitor the intragastric fate of a WMB meal (11% bran) compared to a rice pudding (RP) meal. SUBJECTS/METHODS: 12 healthy volunteers completed this randomised crossover study. They fasted overnight and after an initial MRI scan consumed a glass of orange juice with a 2267 kJ WMB or an equicaloric RP meal. Subjects underwent serial MRI scans every 45 min up to 270 min to assess gastric volumes and small bowel water content and completed a GI symptom questionnaire. RESULTS: The MRI intragastric appearance of the two meals was markedly different. The WMB meal formed a homogeneous dark bolus with brighter liquid signal surrounding it. The RP meal separated into an upper, liquid layer and a lower particulate layer allowing more rapid emptying of the liquid compared to solid phase (sieving). The WMB meal had longer gastric half emptying times (132±8 min) compared to the RP meal (104±7 min), P<0.008. The WMB meal was associated with markedly reduced MRI-visible small bowel free mobile water content compared to the RP meal, P<0.0001. CONCLUSIONS: WMB bread forms a homogeneous bolus in the stomach which inhibits gastric sieving and hence empties slower than the equicaloric rice meal. These properties may explain why wheat causes postprandial bloating and could be exploited to design foods which prolong satiation

Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care

Peer reviewedPublisher PD

Adherence to self-administered tuberculosis treatment in a high HIV-prevalence setting: a cross-sectional survey in Homa Bay, Kenya.

Good adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools

Clouds over the summertime Sahara: An evaluation of Met Office Meteosat retrievals using airborne remote sensing

Novel methods of cloud detection are applied to the unique Fennec aircraft dataset, to evaluate the Met Office derived products on cloud properties over the Sahara based on the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) on-board Meteosat. Two cloud mask configurations are considered, as well as the retrievals of cloud-top height, and these products are compared to airborne cloud remote sensing products acquired during the Fennec campaign in June 2011 and June 2012. Most detected clouds (67 % of the total) have a horizontal extent which is smaller than a SEVIRI pixel (3 km x 3 km). We show that, when partially cloud-contaminated pixels are included, a match between the SEVIRI and aircraft datasets is found in 80 ± 8 % of the pixels. Moreover, under clear skies the datasets are shown to agree for more than 90 % of the pixels. Cloud-top height retrievals however show large discrepancies over the region, which are ascribed to limiting factors such as the cloud horizontal extent, the derived effective cloud amount, and the absorption by mineral dust

Isoform‐specific upregulation of FynT kinase expression is associated with tauopathy and glial activation in Alzheimer’s disease and Lewy body dementias

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record Cumulative data suggest the involvement of Fyn tyrosine kinase in progression of Alzheimer's disease (AD). Previously, our group has shown increased immunoreactivities of the FynT isoform in AD neocortex (with no change in the alternatively spliced FynB isoform) which associated with neurofibrillary degeneration and reactive astrogliosis. Since both the aforementioned neuropathological features are also frequently found in Lewy Body dementias (LBD), we investigated potential perturbations of Fyn expression in the postmortem neocortex of patients with AD, as well as those having one of the two main subgroups of LBD: Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB). We found selective upregulation of FynT expression in AD, PDD and DLB which also correlated with cognitive impairment. Furthermore, increased FynT expression correlated with hallmark neuropathological lesions, soluble β-amyloid and phosphorylated tau, as well as markers of microglia and astrocyte activation. In line with the human postmortem studies, cortical FynT expression in aged mice transgenic for human P301S tau was upregulated and correlated with accumulation of aggregated phosphorylated tau as well as with microglial and astrocytic markers. Our findings point to FynT being an important mediator of disease progression in neurodegenerative dementias, likely via effects on tauopathy and neuroinflammation.National Medical Research Council, Singapor