Complementary techniques of percutaneous closure of ductus arteriosus using detachable cook coils and amplatzer devices

Background: Patent Ductus Arteriosus (PDA) is a common cardiac malformation whose treatment locally has been surgical ligation via a lateral thoracotomy. Device closure of the ductus was first performed at the Mater hospital in 1999 in a ten year old male using a five millilitre detachable cook coil. In 2000 the Amplatzer device was introduced to close larger ducts. Subsequently these devices have been used interchangeably to close both small and large ducts. We report this single centre experience of percutaneous PDA closure in a resource-limited setting; utilising the two techniques.Objective: To describe our experience of trans-catheter closure of small and large ducts using either the detachable Cook coils or the Amplatzer occluders at the Mater Hospital Nairobi.Design: A descriptive retrospective cohort study.Setting: The Mater Hospital, Nairobi, Kenya.Subjects: Patients with clinical and echo-cardiographic features of patent ductus arteriosus who underwent cardiac catheterisation and angiography followed by device embolisation of the ductus.Results: From April 1999 to October 2009 a total of ninety eight subjects were recruited into the study. Sixty nine (70%) of these subjects had the ducts closed using the Amplatzer devices, while twenty nine (30%) were embolised using the cook detachable coils. Three of the subjects in the coil group had the ducts embolised using the double technique while the rest were embolised using single coils. Various coil sizes four to eight millimetres were used in patients with small to medium ducts (two to seven millimetres) whereas the Amplatzer duct occluder was successfully used in all the duct sizes. The Amplatzer atrial septal occluder device was used to close very large ducts in two of the patients. The overall success rate was 93.1%, but the coil group had higher failure rate of 6.9% compared to the  Amplatzer group of 3%. One patient in the Amplatzer group had a late embolisation requiring surgical retrieval at one month post occlusion. There were no mortalities.Conclusion: Transcatheter device occlusion of PDA is a safe and alternative to surgery associated with minimal morbidity and no mortalit

Raising awareness for potential sustainability effects in Uganda: A survey-based empirical study

Copyright © 2019 for this paper by its authors. In July 2019, we ran the 3rd International BRIGHT summer school for Software Engineering and Information Systems at the Makerere University in Kampala, Uganda. The participants developed a group project over the course of the week, which included the application of the Sustainability Awareness Framework. The framework promotes discussion on the impact of software systems on sustainability based on a set of questions. In this paper, we present the educational evaluation of the Sustainability Awareness Framework in a country in Sub-Saharan Africa. The results indicate that the framework can provide supportive guidance of the societal and environmental challenges in the given context

Improved methods to capture the total societal benefits of zoonotic disease control : demonstrating the cost-effectiveness of an integrated control programme for Taenia solium, soil transmitted helminths and classical swine fever in northern Lao PDR

Background : Control and elimination of zoonotic diseases requires robust information about their effect on both human and livestock health in order to enable policy formulation and the allocation of resources. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People's Democratic Republic. Method : A cross-sectional study was carried out in 49 households, focusing on the prevalence of T. solium taenias/cysticercosis and soil transmitted helminths before and after a twelve month intervention. The village data was collected using a semi-structured questionnaire through a door-to-door survey. The village data was then projected to the wider northern Lao PDR population using stochastic modelling and cost-effectiveness ratio (after aggregating the net cost to capture both human and animal health parameters) and GDP per capita as a threshold, to determine the cost-effectiveness of the integrated control of T. sollumtaeniasis/ cysticercosis and STH, assuming linear scaling out of the intervention. The zoonotic DALY (zDALY) approach was also used as an alternative method of estimating the cost-effectiveness ratio of controlling T. solium taeniasis/cysticercosis in humans and pigs. Findings : Using cost-effectiveness analysis after aggregating the net cost and control of T. solium taeniasis/cysticercosis alone as the base case, the study found that simultaneous control of T. solium taeniasis/cysticercosis in humans and pigs, STH in humans and Classical Swine Fever (CSF) in pigs was USD 14 per DALY averted and USD 234 per zDALY averted using zDALY method hence considered highly cost-effective whereas controlling T. solium taeniasis/cysticercosis without incorporating STH and CSF was the least cost-effective (USD 3,672 per DALY averted). Additionally, the cost-effectiveness of controlling T. solium taeniasis/cysticercosis in people and pigs using zDALY as an alternative method was USD 3,662 per zDALY averted which was quite close to our findings using the aggregate net cost method. Conclusion : The study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of STH is. Consequently, integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and CSF markedly improved the cost-effectiveness of the intervention. This is especially important in low resource countries where control of zoonotic neglected tropical diseases could be integrated with the human and animal health sectors to optimize use of the limited resources

Impact of early initiation versus national standard of care of antiretroviral therapy in Swaziland's public sector health system : study protocol for a stepped-wedge randomized trial

Background: There is robust clinical evidence to support offering early access to antiretroviral treatment (ART) to all HIV-positive individuals, irrespective of disease stage, to both improve patient health outcomes and reduce HIV incidence. However, as the global treatment guidelines shift to meet this evidence, it is still largely unknown if early access to ART for all (also referred to as "treatment as prevention" or " universal test and treat") is a feasible intervention in the resource-limited countries where this approach could have the biggest impact on the course of the HIV epidemics. The MaxART Early Access to ART for All (EAAA) implementation study was designed to determine the feasibility, acceptability, clinical outcomes, affordability, and scalability of offering early antiretroviral treatment to all HIV-positive individuals in Swaziland's public sector health system. Methods: This is a three-year stepped-wedge randomized design with open enrollment for all adults aged 18 years and older across 14 government-managed health facilities in Swaziland's Hhohho Region. Primary endpoints are retention and viral suppression. Secondary endpoints include ART initiation, adherence, drug resistance, tuberculosis, HIV disease progression, patient satisfaction, and cost per patient per year. Sites are grouped to transition two at a time from the control (standard of care) to intervention (EAAA) stage at each four-month step. This design will result in approximately one half of the total observation time to accrue in the intervention arm and the other half in the control arm. Our estimated enrolment number, which is supported by conservative power calculations, is 4501 patients over the course of the 36-month study period. A multidisciplinary, mixed-methods approach will be adopted to supplement the randomized controlled trial and meet the study aims. Additional study components include implementation science, social science, economic evaluation, and predictive HIV incidence modeling. Discussion: A stepped-wedge randomized design is a causally strong and robust approach to determine if providing antiretroviral treatment for all HIV-positive individuals is a feasible intervention in a resource-limited, public sector health system. We expect our study results to contribute to health policy decisions related to the HIV response in Swaziland and other countries in sub-Saharan Africa

Real-time optimal control of river basin networks

River basins are key components of water supply grids. River basin operators must handle a complex set of objectives including runoff storage, flood control, supply for consumptive use, hydroelectric power generation, silting management, and maintenance of river basin ecology. At present, operators rely on a combination of simulation and optimization tools to help them make operational decisions. The complexity associated with this approach makes it suitable for long term planning but not daily or hourly operation. The consequence is that between longerterm optimized operation points, river basins are largely operated in open loop. This leads to operational inefficiencies most notably wasted water and poor ecological outcomes. This paper proposes a systematic approach using optimal control based on simple low order models for the real-time operation of entire river basin networks. © 2011 IFAC

Model predictive control of Murray-darling basin networks

River basins are the most significant component in water supply grids and are under increasing pressure from competing demands for fresh water. However, unlike energy grids which are managed very efficiently using closed-loop operation, water grids, and river basins in particular, are largely open-loop systems. One reason is the difficulty associated with developing suitable models and feedback controllers. This paper proposes a systematic approach using model predictive control based on simple low order models for the real-time operation of entire river basin networks. © 2011 IEEE

Human taeniasis: current insights into prevention and management strategies in endemic countries

Anna L Okello,1 Lian Francesca Thomas2 1Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences College of Medicine and Veterinary Medicine, University of Edinburgh, Scotland; 2Independent Consultant, Lusaka, Zambia Abstract: Human taeniasis is a zoonotic condition resulting from infection with the adult stages of Taenia saginata (“beef tapeworm”), Taenia solium (“pork tapeworm”) or Taenia asiatica (“Asian tapeworm”). Although these parasites have a worldwide distribution, the overwhelming burden is felt by communities in low- and middle-income countries. This is particularly true for T. solium, whereby infection of the central nervous system with the larval stage of the parasite (neurocysticercosis) is a major cause of acquired epilepsy in low-resource settings. With a focus on endemic countries, this review provides an insight into the prevention and management of human taeniasis, concluding with some recent case studies describing their implementation. Discussion of the opportunities and challenges regarding current fecal and serological diagnostic assays for detecting Taenia spp. highlights the importance of accurate and accessible diagnostic options for the field situation. The lack of long-term impact on the parasites’ lifecycle from human anthelmintic treatment, coupled with the propensity for adverse reactions, highlights the importance of a “two-pronged” approach that considers the relevant animal hosts, particularly in the case of T. solium. Aside from the therapeutic options, this review reiterates the importance of adequate assessment and consideration of the associated behavioral and policy aspects around sanitation, hygiene and meat inspection that have been shown to support parasite control, and potential elimination, in endemic regions. Keywords: Taenia solium, Taenia saginata, cysticercosis, zoonotic disease, neglected tropical disease

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers\u27 Knowledge and Treatment of Hypertension

Background: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. Objective: The impact of Healthy Heart Africa on HCPs\u27 knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. Methods: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs\u27 knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. Results: Sixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs\u27 knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. Conclusions: HCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation