Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study.

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications

Lessons learnt in recruiting schoolchildren into a large asthma case-control study in urban Uganda

Schools present an excellent opportunity for research among children and adolescents. We share our experiences and lessons learnt in enrolling schoolchildren into a large asthma case-control study from schools in urban Uganda, and make recommendations for best practices. Our key lessons were as follows: working closely with the school administration and teachers was vital in gaining timely access to parents of the schoolchildren; having a meeting with parents, within their children�s school premises, was a cost-effective way of reaching a wide audience of potential research participants with our message and an opportunity to seek their participation; allowing flexibility within our processes enabled us to fit our research activities within the school schedule, and with minimal disruptions; however, obtaining informed written consent from parents of children in the boarding section of school remained a challenge. In conclusion, conducting research in schools in Uganda is feasible and may be a cost-effective way to make the most of limited resources to remedy the research and data deficiencies among school-age children in sub-Saharan Africa.</ns3:p

Risk factors associated with rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda.

BACKGROUND: The prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established. OBJECTIVES: To investigate the risk factors associated with ARDs among schoolchildren in Uganda. METHODS: We conducted a secondary data analysis of a large asthma case-control study involving 1700 schoolchildren, 5-17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP® . We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios. RESULTS: The lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42-4.99) compared to rural]; father's [2.62 (1.79-3.83)] and mother's history of allergic disease [2.12 (1.48-3.02)]; frequent de-worming in the last 12 months [2.01 (1.30-3.11), ≥2 versus none]; current high frequency of 'trucks passing on the street near home' [2.59 (1.48-4.52), 'almost all the time' versus rarely] and positive SPT [1.54 (1.09-2.18)] but not asIgE [1.38 (0.60-3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. CONCLUSION: We found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema-similar to asthma risk factors-among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda

Setting research priorities to improve global newborn health and prevent stillbirths by 2025.

BACKGROUND: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. METHODS: We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. RESULTS: Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. CONCLUSION: These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed

Setting research priorities to improve global newborn health and prevent stillbirths by 2025

Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed

Cenozoic tectonic history of the South Georgia microcontinent and potential as a barrier to Pacific-Atlantic through flow

Cenozoic opening of the central Scotia Sea involved the tectonic translation of crustal blocks to form the North Scotia Ridge, which today is a major topographic constriction to the flow of the deep Antarctic Circumpolar Current that keeps Antarctica thermally isolated from warmer ocean waters. How this ridge developed and whether it was a topographic barrier in the past are unknown. To address this we investigated the Cenozoic history of the South Georgia microcontinental block, the exposed part of the ridge. Detrital zircon U-Pb geochronology data confirm that the Cretaceous succession of turbidites exposed on South Georgia was stratigraphically connected to the Rocas Verdes backarc basin, part of the South America plate. Apatite thermochronometry results show that South Georgia had remained connected to South America until ca. 45–40 Ma; both record a distinct rapid cooling event at that time. Subsequent separation from South America was accompanied by kilometer-scale reburial until inversion ca. 10 Ma, coeval with the cessation of spreading at the West Scotia Ridge and collision between the South Georgia block and the Northeast Georgia Rise. Our results show that the South Georgia microcontinental block could not have been an emergent feature from ca. 40 Ma until 10 Ma

GUI2WiRe: Rapid wireframing with a mined and large-scale GUI repository using natural language requirements

High-fidelity Graphical User Interface (GUI) prototyping is a well-established and suitable method for enabling fruitful discussions, clarification and refinement of requirements formulated by customers. GUI prototypes can help to reduce misunderstandings between customers and developers, which may occur due to the ambiguity comprised in informal Natural Language (NL). However, a disadvantage of employing high-fidelity GUI prototypes is their time-consuming and expensive development. Common GUI prototyping tools are based on combining individual GUI components or manually crafted templates. In this work, we present GUI2WiRe, a tool that enables users to retrieve GUI prototypes from a semi-automatically created large-scale GUI repository for mobile applications matching user requirements specified in Natural Language (NLR). We extract multiple text segments from the GUI hierarchy data and employ various Information Retrieval (IR) models and Automatic Query Expansion (AQE) techniques to achieve ad-hoc GUI retrieval from NLR. Retrieved GUI prototypes mined from applications can be inserted in the graphical editor of GUI2WiRe to rapidly create wireframes. GUI components are extracted automatically from the GUI screenshots and basic editing functionality is provided to the user. Finally, a preview of the application is created from the wireframe to allow interactive exploration of the current design. We evaluated the applied IR and AQE approaches for their effectiveness in terms of GUI retrieval relevance on a manually annotated collection of NLR and discuss our planned user studies

Drake Passage and Cenozoic climate: An open and shut case?

Drake Passage opening has often been viewed as a single, discrete event, possibly associated with abrupt changes in global circulation and climate at or near the Eocene-Oligocene boundary. A new plate tectonic model, based on recent reinterpretations of the opening history of basins in the Scotia Sea, suggests that an effective ocean gateway may have developed even earlier, during the middle Eocene. This is consistent with a growing body of evidence from sediment core proxy data for Eocene changes in Southern Ocean circulation and biological productivity. The period between earliest opening after ∼50 Ma and the latest Eocene was characterized by the evolution of various current pathways across the subsiding continental shelves and intervening deep basins. This shallow opening may have caused important changes in Southern Ocean circulation, contributing to Eocene cooling and the growth of Antarctic ice sheets