A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

Background: Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective: To develop a reliable clinical algorithm for primary care settings to triage cases ofnon-specific, tuberculous and malignant lymphadenopathies. Methods: Calculation of the odd ratios (OR) of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (ReceiverOperator Characteristic) curve. Results: Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR),nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area underthe ROC curve was 0.964 (95% CI, 0.949 – 0.980) and -0.856 (95% CI, 0.787 ‑ 0.925) for scores Aand B respectively, indicating good performance. Conclusion: The developed algorithm can efficiently triage cases with tuberculous andmalignant lymphadenopathies for treatment or referral to specialised centres for furtherwork-up

Immunogenicity and immune modulatory effects of in silico predictedL. donovanicandidate peptide vaccines

The purpose of this action research study was twofold: 1) to investigate the role the Socratic Method of teaching had (if any) on the leadership skills of Junior Reserve Officer Training Cadet (JROTC) leaders at a military boarding school in the Midwest, United States, and 2) to determine if there was any change in the researcher’s teaching while implementing the Socratic Method to his JROTC Cadet leaders in his Western Intellectual History class. The researcher defined leadership based on the Five Leadership Practices derived from the Student Leadership Practices Inventory. These practices consisted of Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart. Through the collection of data via a pretest and posttest on the leadership skills of the cadet participants, student weekly journal entries, the researcher’s weekly journal entries, classroom observations, an end of the year questionnaire concerning the cadet participants’ self-perceptions of their leadership development, and video-recordings of Socratic discussions, the researcher was able to ascertain the development of leadership skills and his own pedagogical development. The data supported that the cadet participants perceived an improvement in their leadership skills after engaging in the Socratic Method in Western Intellectual History class. Moreover, themes that emerged from the journal entries and answers to the end of the year questionnaire aligned with the leadership characteristics in the Five Leadership Practices. Furthermore, the data revealed that the researcher’s pedagogical experience, specifically in lesson delivery, changed during the time he used the Socratic Method of instruction in his Western Intellectual History class