Website design: Technical, social and medical issues for self-reporting by elderly patients

There is growing interest in the use of the Internet for interacting with patients, both in terms of healthcare information provision and information gathering. In this paper we examine the issues in designing healthcare websites for elderly users. In particular this paper uses a year-long case study of the development of a web-based system for self-reporting of symptoms and quality of life with a view to examine the issues relating to website design for elderly users. The issues identified included the technical, social and medical aspects of website design for elderly users. The web-based system developed was based upon the EQ5D health-status questionnaire, a commonly used tool for patient self-reporting of quality of life, and the more specific CROQ (coronary revascularisation outcome questionnaire) questionnaire. Currently self-reporting is generally administered in the form of paper-based questionnaires to be completed in the out-patient clinic, or at home. There are a variety of issues relating to elderly users that imply that websites for elderly patients may involve different design considerations to other types of websites

The fate of nitrogen during agricultural intensification in East Africa: nitrogen budgets in contrasting agroecosystems

Open Access ArticleThe intensification of agricultural systems in sub-Saharan Africa (SSA) is necessary to reduce poverty and improve food security, but increased nutrient applications in smallholder systems could have negative consequences for water quality, greenhouse gas emissions, and air quality. We tracked nitrogen (N) inputs and measured maize (Zea mays) biomass, grain yields, N leaching, and nitric oxide (NO) and nitrous oxide fluxes from a clayey soil in Yala, Kenya and a sandy soil in Tumbi, Tanzania, with application rates of 0, 50, 75, 100, 150, and 200 kg N ha−1 yr−1 over two cropping seasons. Maize yields were 4.5 times higher in Yala than Tumbi, but yields plateaued at both sites with fertilizer applications at or above 100 kg N ha−1 yr−1. Partial N budgets in Yala were typically negative, meaning more N was exported in maize biomass plus grain or lost from the system than was added in fertilizer. In Tumbi, N budgets were negative at lower fertilizer levels but positive at higher fertilizer levels. At both sites most (96%) of the N was lost through maize biomass/grain removal and N leaching. Fertilizer additions at or less than 50 kg N ha−1 yr−1 on these two contrasting sites resulted in minor gaseous N losses, and fertilizer additions less than 200 kg N ha−1 yr−1 caused relatively little change to N leaching losses. This indicates that the modest increases in fertilizer use required to improve maize yields will not greatly increase cropland N losses. Plain Language Summary Crop yields in smallholder agriculture across sub-Saharan Africa are low but could be increased by greater applications of nitrogen fertilizer. However, greater use of nitrogen fertilizer creates potential for higher emissions of nitrogen trace gases and nitrogen leaching losses. This study added nitrogen fertilizer doses (0, 50, 75, 100, 150, and 200 kg of nitrogen per hectare) to maize cropland in two smallholder farming sites, one on clay-rich soils in Kenya and one on sandy soils in Tanzania. It tracked removal of nitrogen fertilizer via harvested maize and losses as nitrous oxide (a greenhouse gas), NO (an air pollutant), and leaching of soil solution. Yields were 4.5 times higher on the clayey soil; yields plateaued at nitrogen application above 100 kg per hectare. Leaching losses far exceeded gaseous losses at both sites: 96% of nitrogen was removed in harvested crops and soil solution. Nitrogen additions at or below 50 kg of nitrogen per hectare led to minor increases in gaseous nitrogen losses and additions less than 200 kg of nitrogen per hectare did not increase soil solution losses. This indicates that the modest increases in fertilizer use required to improve maize yields will not greatly increase cropland nitrogen losses

Impact of a community-based cardiovascular disease service intervention in a highly deprived area

Objective: To examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived area in the North West of England. Methods: A longitudinal matched controlled study using difference-in-differences analysis compared the change in outcomes in the intervention population, to the change in outcomes in a matched comparison population that had not received the intervention, five years before and after implementation. The outcomes were emergency hospitalisations, length of inpatient stay, and re-admission rates for cardiovascular disease (CVD). Results: Findings show that the intervention was associated with 66 fewer emergency CVD admissions per 100,000 population per year [95% CI 22.13 to 108.98] in the post-intervention period, relative to the control group. No significant measurable effects on length of stay or emergency re-admission rates were observed. Conclusion: This consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, was associated with a lower rate of emergency hospital admissions in a highly disadvantaged population. Similar approaches could be an effective component of strategies to reduce unplanned hospital admissions

Thymosin Beta 4 Prevents Oxidative Stress by Targeting Antioxidant and Anti-Apoptotic Genes in Cardiac Fibroblasts

Thymosin beta-4 (Tβ4) is a ubiquitous protein with diverse functions relating to cell proliferation and differentiation that promotes wound healing and modulates inflammatory responses. The effecter molecules targeted by Tβ4 for cardiac protection remains unknown. The purpose of this study is to determine the molecules targeted by Tβ4 that mediate cardio-protection under oxidative stress.Rat neonatal fibroblasts cells were exposed to hydrogen peroxide (H(2)O(2)) in presence and absence of Tβ4 and expression of antioxidant, apoptotic and pro-fibrotic genes was evaluated by quantitative real-time PCR and western blotting. Reactive oxygen species (ROS) levels were estimated by DCF-DA using fluorescent microscopy and fluorimetry. Selected antioxidant and antiapoptotic genes were silenced by siRNA transfections in cardiac fibroblasts and the effect of Tβ4 on H(2)O(2)-induced profibrotic events was evaluated.Pre-treatment with Tβ4 resulted in reduction of the intracellular ROS levels induced by H(2)O(2) in the cardiac fibroblasts. This was associated with an increased expression of antioxidant enzymes Cu/Zn superoxide dismutase (SOD) and catalase and reduction of Bax/Bcl(2) ratio. Tβ4 treatment reduced the expression of pro-fibrotic genes [connective tissue growth factor (CTGF), collagen type-1 (Col-I) and collagen type-3 (Col-III)] in the cardiac fibroblasts. Silencing of Cu/Zn-SOD and catalase gene triggered apoptotic cell death in the cardiac fibroblasts, which was prevented by treatment with Tβ4.This is the first report that exhibits the targeted molecules modulated by Tβ4 under oxidative stress utilizing the cardiac fibroblasts. Tβ4 treatment prevented the profibrotic gene expression in the in vitro settings. Our findings indicate that Tβ4 selectively targets and upregulates catalase, Cu/Zn-SOD and Bcl(2), thereby, preventing H(2)O(2)-induced profibrotic changes in the myocardium. Further studies are warranted to elucidate the signaling pathways involved in the cardio-protection afforded by Tβ4

Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths

<p>Abstract</p> <p>Background</p> <p>The most common method for determining cause of death is certification by physicians based either on available medical records, or where such data are not available, through verbal autopsy (VA). The physician-certification approach is costly and inconvenient; however, recent work shows the potential of a computer-based probabilistic model (InterVA) to interpret verbal autopsy data in a more convenient, consistent, and rapid way. In this study we validate separately both physician-certified verbal autopsy (PCVA) and the InterVA probabilistic model against hospital cause of death (HCOD) in adults dying in a district hospital on the coast of Kenya.</p> <p>Methods</p> <p>Between March 2007 and June 2010, VA interviews were conducted for 145 adult deaths that occurred at Kilifi District Hospital. The VA data were reviewed by a physician and the cause of death established. A range of indicators (including age, gender, physical signs and symptoms, pregnancy status, medical history, and the circumstances of death) from the VA forms were included in the InterVA for interpretation. Cause-specific mortality fractions (CSMF), Cohen's kappa (κ) statistic, receiver operating characteristic (ROC) curves, sensitivity, specificity, and positive predictive values were applied to compare agreement between PCVA, InterVA, and HCOD.</p> <p>Results</p> <p>HCOD, InterVA, and PCVA yielded the same top five underlying causes of adult deaths. The InterVA overestimated tuberculosis as a cause of death compared to the HCOD. On the other hand, PCVA overestimated diabetes. Overall, CSMF for the five major cause groups by the InterVA, PCVA, and HCOD were 70%, 65%, and 60%, respectively. PCVA versus HCOD yielded a higher kappa value (κ = 0.52, 95% confidence interval [CI]: 0.48, 0.54) than the InterVA versus HCOD which yielded a kappa (κ) value of 0.32 (95% CI: 0.30, 0.38). Overall, (κ) agreement across the three methods was 0.41 (95% CI: 0.37, 0.48). The areas under the ROC curves were 0.82 for InterVA and 0.88 for PCVA. The observed sensitivities and specificities across the five major causes of death varied from 43% to 100% and 87% to 99%, respectively, for the InterVA/PCVA against the HCOD.</p> <p>Conclusion</p> <p>Both the InterVA and PCVA compared well with the HCOD at a population level and determined the top five underlying causes of death in the rural community of Kilifi. We hope that our study, albeit small, provides new and useful data that will stimulate further definitive work on methods of interpreting VA data.</p

Incorporation of leguminous cover crops in smallholder cassava-based production system in Western Tanzania.

Small-scale crop production in many parts of Tanzania is constrained by many problems among which soil fertility degradation is a major problem. Over 80% of cassava (Manihot esculenta) production in Tanzania is done by the small-scale farmers who continuously cultivate their fields, but use limited inputs to restore depleted plant nutrients. The objective of this study was to examine the best legume species that could be incorporated in cassava (Manihot esculenta) production systems under farmers? conditions and result in increase in soil fertility and crop yields. Mucuna pruriens and Canavalia ensiformis were either incorporated with cassava (Manihot esculenta) or planted as sole crop in rotation with cassava. Mucuna pruriens and Canavalia ensiformis were found to produce almost similar amount of biomass. The two legumes, however, produced higher biomass in rotation than intercropping system. The amount of biomass produced by Mucuna pruriens and Canavalia ensiformis in rotation system was 6.28 t.ha-1 and 5.31 t.ha-1, respectively. The Mucuna use represents an input of nitrogen into the soil which simulates a saving cost of 181.42 and 141.96 US$ ha-1. In the first year, cassava root yields were significantly increased (p < 0.05) over control (continuous sole cassava) (1.44 t.ha-1) by the use of intercropping of cassava (Manihot esculenta) with Mucuna pruriens (2.41 t.ha-1) and or Canavalia ensiformis (2.25 t.ha-1). Intercropping and rotation of cassava with legumes increase cassava yield and represent a sustainable alternative to reduce the farms? dependence on external inputs and to enhance inherent soil fertility.Made available in DSpace on 2018-01-29T23:38:16Z (GMT). No. of bitstreams: 1 Incorporationleguminous.pdf: 1067716 bytes, checksum: 0ca29656ac050122146628eb1cbddc49 (MD5) Previous issue date: 2017-12-27bitstream/item/171782/1/Incorporation-leguminous.pd

A gendered analysis of climate variability and change impacts and adaptations in semi arid area farming systems and natural resources management

Climate change and climate variability is increasingly threatening the livelihoods of many Tanzanians especially those living in semi-arid rural areas. The most affected are those; with low incomes, less food, poor access to health services, unstable energy supplies, and living in fragile natural ecosystems. Generally, women and men contribute differently to climate change; likewise, they are affected differently and react differently to its impact. The overall objective of the study was to assess the impact of climate change on rural livelihoods' and how households in semi-arid areas of Tanzania adapt based on gender. The study was conducted in Iramba and Meatu Districts. The study adopted a Sustainable livelihood Approach (SLA) developed by DFID (1992) in the analysis of climate change impacts and households' adaptation. Data was collected using qualitative methods such as focus group discussions and key informant interviews, informal interviews and observations. Findings from the study show that, climate change impacts affect almost everybody in the studied communities; however, differences by gender exist. These findings thus suggest that adaptation to climate change impacts vary across genders due to differences in roles and responsibilities, power relations and access to and control over resources.Research ReportClimate Change Impacts, Adaptation and Mitigation' (CCIAM) Programme in Tanzani