Using digital pens to expedite the marking procedure

This is the Post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2010 Inderscience PublishersDigital pens have been introduced over the last six years and have demonstrated that they can be used effectively for collecting, processing and storing data. These properties make them ideal for use in education, particularly in the marking procedure of multiple-choice questions (MCQ). In this report, we present a system that was designed to expedite the marking procedure of MCQ, for use at any educational level. The main element of the system is a digital pen, i.e. given to the students prior to the examination. On return of the pen, the system immediately recognises the students' answers and produces their results. In this specific research, four groups of students were studied and a variety of data were collected, concerning issues, such as accuracy, time gained by the use of the system and the impressions of the students. The pedagogic value of the use of the system is also presented

Multiplexed nanoparticle-based immunoassays

Multiplexed immunoassays have been explored using the fluorescent and luminescent properties of fluorophores and nanoparticles. Epi-fluorescence microscopy, confocal laser scanning microscopy and programmable array microscopy were used to detect signals from mixtures of conventional organic fluorophores, quantum dots and silica nanoparticles doped with europium, samarium and terbium in single-welled multiplexed immunosorbent assays. Spectral unmixing was investigated using mixtures of fluorophores and cadmium selenide quantum dots. Mixtures of up to four dyes were separated quantitatively using least squares minimisation, with relative standard error ranging from 0.5 to 13 %. Silica nanoparticles doped with luminescent lanthanides were synthesised and used in a model immunoassay system for simultaneous, single-welled detection of human and mouse IgGs. The results indicated the lanthanides are well suited to multiplexed assays, mainly because of their atomic line emission bands. Analytes in a mixture could be quantified with < 5 % error. The multiplexed assay developed was applied to the detection of anti-dengue IgM and IgG in mouse sera, to differentiate primary and secondary dengue infection. The assay traced the kinetics of antibody production for both IgM and IgG with an IgM/IgG ratio of 1

Drought-related cholera outbreaks in Africa and the implications for climate change: a narrative review

Africa has historically seen several periods of prolonged and extreme droughts across the continent, causing food insecurity, exacerbating social inequity and frequent mortality. A known consequence of droughts and their associated risk factors are infectious disease outbreaks, which are worsened by malnutrition, poor access to water, sanitation and hygiene and population displacement. Cholera is a potential causative agent of such outbreaks. Africa has the highest global cholera burden, several drought-prone regions and high levels of inequity. Despite this, research on cholera and drought in Africa is lacking. Here, we review available research on drought-related cholera outbreaks in Africa and identify a variety of potential mechanisms through which these outbreaks occurred, including poor access to water, marginalization of refugees and nomadic populations, expansion of informal urban settlements and demographic risks. Future climate change may alter precipitation, temperature and drought patterns, resulting in more extremes, although these changes are likely to be spatially heterogeneous. Despite high uncertainty in future drought projections, increases in drought frequency and/or durations have the potential to alter these related outbreaks into the future, potentially increasing cholera burden in the absence of countermeasures (e.g. improved sanitation infrastructure). To enable effective planning for a potentially more drought-prone Africa, inequity must be addressed, research on the health implications of drought should be enhanced, and better drought diplomacy is required to improve drought resilience under climate change

The effect of resource limitation on the temperature-dependence of mosquito population fitness

Laboratory-derived temperature dependencies of life history traits are increasingly being used to make mechanistic predictions for how climatic warming will affect vector-borne disease dynamics, partially by affecting abundance dynamics of the vector population. These temperature-trait relationships are typically estimated from juvenile populations reared on optimal resource supply, even though natural populations of vectors are expected to experience variation in resource supply, including intermittent resource limitation. Using laboratory experiments on the mosquito Aedes aegypti, a principal arbovirus vector, combined with stage-structured population modelling, we show that low-resource supply in the juvenile life stages significantly depresses the vector’s maximal population growth rate across the entire temperature range (22–32°C) and causes it to peak at a lower temperature than at high-resource supply. This effect is primarily driven by an increase in juvenile mortality and development time, combined with a decrease in adult size with temperature at low-resource supply. Our study suggests that most projections of temperature-dependent vector abundance and disease transmission are likely to be biased because they are based on traits measured under optimal resource supply. Our results provide compelling evidence for future studies to consider resource supply when predicting the effects of climate and habitat change on vector-borne disease transmission, disease vectors and other arthropods

Accessing sub-national cholera epidemiological data for Nigeria and the Democratic Republic of Congo during the seventh pandemic

Background: Vibrio cholerae is a water-borne pathogen with a global burden estimate at 1.4 to 4.0 million annual cases. Over 94% of these cases are reported in Africa and more research is needed to understand cholera dynamics in the region. Cholera data are lacking, mainly due to reporting issues, creating barriers for widespread research on cholera epidemiology and management in Africa. Main body: Here, we present datasets that were created to help address this gap, collating freely available sub-national cholera data for Nigeria and the Democratic Republic of Congo. The data were collated from a variety of English and French publicly available sources, including the World Health Organization, PubMed, UNICEF, EM-DAT, the Nigerian CDC and peer-reviewed literature. These data include information on cases, deaths, age, gender, oral cholera vaccination, risk factors and interventions. Conclusion: These datasets can facilitate qualitative, quantitative and mixed methods research in these two high burden countries to assist in public health planning. The data can be used in collaboration with organisations in the two countries, which have also collected data or undertaking research. By making the data and methods available, we aim to encourage their use and further data collection and compilation to help improve the data gaps for cholera in Africa

Understanding the risks for post-disaster infectious disease outbreaks: a systematic review protocol

Introduction: Disasters have many forms, including those related to natural hazards and armed conflict. Human-induced global change, such as climate change, may alter hazard parameters of these disasters. These alterations can have serious consequences for vulnerable populations, which often experience post-disaster infectious disease outbreaks, leading to morbidity and mortality. The risks and drivers for these outbreaks and their ability to form cascades are somewhat contested. Despite evidence for post-disaster outbreaks, reviews quantifying them have been on short time scales, specific geographic areas or specific hazards. This review aims to fill this gap and gain a greater understanding of the risk factors involved in these contextual outbreaks on a global level. Methods and analysis: Using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist and Khan’s methodological framework, a systematic search strategy will be created and carried out in August 2020. The strategy will search MEDLINE, Embase and GlobalHealth electronic databases and reference lists of selected literature will also be screened. Eligible studies will include any retrospective cross-sectional, case–control or cohort studies investigating an infectious disease outbreak in a local disaster affected population. Studies will not be excluded based on geographic area or publication date. Excluded papers will include non-English studies, reviews, single case studies and research discussing general risk factors, international refugee camps, public health, mental health and other non-communicable diseases, pathogen genetics or economics. Following selection, data will be extracted into a data charting form, that will be reviewed by other members of the team. The data will then be analysed both numerically and narratively. Ethics and dissemination: Only secondary data will be used and there will be no public or patient involvement; therefore, no ethical approval is needed. Our findings will aim to be disseminated through a peer-reviewed journal. The authors intend to use the results to inform future mathematical modelling studies

Factors affecting communication in emergency departments: doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong

© 2015, Pun et al. Background: This study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Methods: Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. Results: The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. Conclusions: These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety

Traits and risk factors of post-disaster infectious disease outbreaks: a systematic review

Infectious disease outbreaks are increasingly recognised as events that exacerbate impacts or prolong recovery following disasters. Yet, our understanding of the frequency, geography, characteristics and risk factors of post-disaster disease outbreaks globally is lacking. This limits the extent to which disease outbreak risks can be prepared for, monitored and responded to following disasters. Here, we conducted a global systematic review of post-disaster outbreaks and found that outbreaks linked to conficts and hydrological events were most frequently reported, and most often caused by bacterial and water-borne agents. Lack of adequate WASH facilities and poor housing were commonly reported risk factors. Displacement, through infrastructure damage, can lead to risk cascades for disease outbreaks; however, displacement can also be an opportunity to remove people from danger and ultimately protect health. The results shed new light on post-disaster disease outbreaks and their risks. Understanding these risk factors and cascades, could help improve future region-specifc disaster risk reduction

Association between Conflict and Cholera in Nigeria and the Democratic Republic of the Congo

Cholera outbreaks contribute substantially to illness and death in low- and middle-income countries. Cholera outbreaks are associated with several social and environmental risk factors, and extreme conditions can act as catalysts. A social extreme known to be associated with infectious disease outbreaks is conflict, causing disruption to services, loss of income, and displacement. To determine the extent of this association, we used the self-controlled case-series method and found that conflict increased the risk for cholera in Nigeria by 3.6 times and in the Democratic Republic of the Congo by 2.6 times. We also found that 19.7% of cholera outbreaks in Nigeria and 12.3% of outbreaks in the Democratic Republic of the Congo were attributable to conflict. Our results highlight the value of providing rapid and sufficient assistance during conflict-associated cholera outbreaks and working toward conflict resolution and addressing preexisting vulnerabilities, such as poverty and access to healthcare

Exploring relationships between drought and epidemic cholera in Africa using generalised linear models

Background Temperature and precipitation are known to affect Vibrio cholerae outbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought. Methods Here, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO2 emissions, socio-economic development, and population growth. Results The best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous. Conclusions Despite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by the Natural Environmental Research Council [NE/S007415] as part of the Grantham Institute for Climate Change and the Environments (Imperial College London) Science and Solutions for a Changing Planet Doctoral Training Partnership. We also acknowledge joint Centre funding from the UK Medical Research Council and Department for International Development [MR/R0156600/1]