GeoGebra Assisted Multiple Representations for Enhancing Students’ Representation Translation Abilities in Calculus

Multiple representations cultivate students’ mathematical mindset. However, research results have reported that students do not benefit from these tools due to lack of representational fluency. This study was designed to determine the impact of GeoGebra assisted multiple representations approach on students’ representation translation performance in calculus. Pretest - posttest quasi experimental design was implemented. Three intact groups of first year first semester of social science students in the 2019/2020 academic year of size 53, 57 and 54 at Jigjiga and Kebri-Dehar Universities in Ethiopia were considered. The groups were taught with GeoGebra supported multiple representations (MRT), multiple representations (MR) and comparison group (CG). Representation translation test was given before and after the treatment. Furthermore, students’ translation errors were categorized as implementation, interpretation and preservation errors and analyzed using frequency and percentage. The ANCOVA result revealed that significant difference was obtained on the adjusted mean of RTF posttest (F (2,160) = 5.29, P = 0.006, Partial η2 =0.062) in favor of the MRT. The interpretation error was the most frequently committed among the groups. Recommendations were forwarded that included the use of GeoGebra and the need to conduct further study with different participants to generalize to the entire population

A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia.

BACKGROUND: Leprosy Type 1 (T1R) reactions are immune-mediated events leading to nerve damage and preventable disability affecting hands, feet and eyes. Type 1 Reactions are treated with oral corticosteroids. There is little evidence on alternative treatments for patients who do not respond to steroids or experience steroid adverse effects. We report the results of a randomized controlled trial testing the efficacy and adverse effect profile of ciclosporin and prednisolone (CnP) in comparison to prednisolone only (P) in patients with new T1R in Ethiopia. Ciclosporin is a potent immunosuppressant. Outcomes were measured using a clinical severity score, recurrence rate, adverse events and quality of life. RESULTS: Seventy three patients with new T1R were randomized to receive CnP or P for 20 weeks. Recovery rates in skin signs was similar in both groups (91% vs 88%). Improvements in nerve function both, new and old, sensory (66% vs 49%) and motor (75% vs 74%) loss were higher (but not significantly so) in the patients on CnP. Recurrences rates of T1R (85%) were high in both groups, and recurrences occurred significantly earlier (8 weeks) in patients CnP, who needed 10% more additional prednisolone. Serious major and minor adverse events rates were similar in patients in the two treatment arms of the study. Both groups had a significant improvement in their quality of life after the study, measured by the SF-36. CONCLUSIONS: This is the first double-blind RCT assessing ciclosporin, in the management of T1R in Africa. Ciclosporin could be a safe alternative second-line drug for patients with T1R who are not improving with prednisolone or are experiencing adverse events related to prednisolone. This study illustrates the difficulty in switching off leprosy inflammation. Better treatment agents for leprosy patients with reactions and nerve damage are needed

Validating an Amharic version of the 36-Item Short Form Health Survey (SF-36) in individuals with leprosy in Ethiopia

Background: Health-related quality of life (HRQoL) has now become an indispensable outcome measure in many randomized clinical trials and other studies. It provides the patient’s voice in measuring health improvement or decline and assessing treatment effectiveness. A validated Amharic version of HRQoL assessment tool was needed for leprosy clinical trials in Ethiopia. The SF-36 was chosen but a validated Amharic version was not available. We describe how this was developed. Methods: The SF-36 was translated from English into Amharic and evaluated for content acceptability in a patient focus group. Back translation was performed. Validity and reliability of the Amharic SF-36 in leprosy affected individuals was tested with 100 patients with leprosy attending the leprosy clinic at ALERT hospital and compared to the Amharic version of the WHOQOL-BREF. Results: Amharic versions of both the WHOQOL-BREF and the SF-36 had good reliability and validity amongst leprosy affected individuals. Internal consistency reliability estimates for each domain/scale exceeded 0.70. The Amharic SF-36 had better convergent and discriminant validity than WHOQOL-BREF in this group of patients. Good known-group validity was seen in both WHOQOL-BREF and SF-36 in leprosy affected patients. The Amharic SF-36 had good inter-rater reliability with seven out of 8 domains scoring above 0.8 in intra-class correlation. Conclusion: This Amharic version of the SF-36 is a valid instrument to measure HRQoL in studies and clinical settings involving leprosy affected individuals in Ethiopia

Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised, Double Blind, Controlled Pilot Studies in Ethiopia.

BACKGROUND: Erythema Nodosum Leprosum (ENL) is a serious complication of leprosy. It is normally treated with high dose steroids, but its recurrent nature leads to prolonged steroid usage and associated side effects. There is little evidence on the efficacy of alternative treatments for ENL, especially for patients who have become steroid resistant or have steroid side effects. These two pilot studies compare the efficacy and side effect profile of ciclosporin plus prednisolone against prednisolone alone in the treatment of patients with either new ENL or chronic and recurrent ENL. METHODS AND RESULTS: Thirteen patients with new ENL and twenty patients with chronic ENL were recruited into two double-blinded randomised controlled trials. Patients were randomised to receive ciclosporin and prednisolone or prednisolone treatment only. Patients with acute ENL had a delay of 16 weeks in the occurrence of ENL flare-up episode, with less severe flare-ups and decreased requirements for additional prednisolone. Patients with chronic ENL on ciclosporin had the first episode of ENL flare-up 4 weeks earlier than those on prednisolone, as well as more severe ENL flare-ups requiring 2.5 times more additional prednisolone. Adverse events attributable to prednisolone were more common that those attributable to ciclosporin. CONCLUSIONS: This is the first clinical trial on ENL management set in the African context, and also the first trial in leprosy to use patients' assessment of outcomes. Patients on ciclosporin showed promising results in the management of acute ENL in this small pilot study. But ciclosporin, did not appear to have a significant steroid-sparing effects in patients with chronic ENL, which may have been due to the prolonged use of steroids in these patients in combination with a too rapid decrease of steroids in patients given ciclosporin. Further research is needed to determine whether the promising results of ciclosporin in acute ENL can be reproduced on a larger scale

Evaluation of Auramine O staining and conventional PCR for leprosy diagnosis: A comparative cross-sectional study from Ethiopia.

BACKGROUND:Diagnosis of leprosy mainly relies on clinical examination due to the inconsistent sensitivity and poor reproducibility of the current laboratory tests. Utilisation of alternative methods to the standard Ziehl Neelsen (ZN), Fite-Faraco (FF) and Haematoxylin and Eosin (H&E) staining procedures may eventually improve leprosy diagnosis. METHODOLOGY/PRINCIPAL FINDINGS:In this comparative study, the performance of the fluorescent Auramine O (AO) staining and polymerase chain reaction (PCR) was assessed with different skin samples using a combination of ZN, FF and H&E staining as the gold standard. AO, ZN, FF, H&E and PCR tests were performed on slit skin smears (SSS) and/or punch biopsies collected from 141 clinically confirmed leprosy cases and 28 non-leprosy skin samples. DNA was extracted from punch biopsies using two different methods with or without mechanical lysis. Sensitivities were 87.6%, 59.3% and 77% for H&E, ZN and FF, respectively, whereas it reached 65.5% and 77.9% for AO in SSS and tissue sections and 91.1% for PCR in tissue samples. Morover, samples with low bacillary index, sensitivity of AO staining (61.8%) was similar to FF (60%, p>0.05) and lower than PCR (86.6%, p<0.05). Sensitivity of PCR also increased (96.8%, p<0.05) when mechanical lysis was used during DNA extraction compared to enzymatic treatment alone (84.6%). CONCLUSIONS/SIGNIFICANCE:Our results showed that for diagnostic purposes, analysis of skin section is more sensitive than SSS, especially for samples with low bacillary load. AO staining on SSS and tissue sections was not significantly better than other routine diagnostic tests but considerably more user friendly. The sensitivity of PCR was higher than current standard methods and increased when combined with more efficient DNA extraction using mechanical and chemical lysis. Therefore, we recommend AO staining for the diagnosis of leprosy in lower health facilities such as health centres and district hospitals and PCR diagnosis at referral level and research centres

Number of patients experiencing minor and major adverse events per study arm (related to ciclosporin and/ or prednisolone).

<p>Number of patients experiencing minor and major adverse events per study arm (related to ciclosporin and/ or prednisolone).</p

Duration and severity of T1R in study participants.

<p>Duration and severity of T1R in study participants.</p

Sensory function change in nerves with new loss of sensation.

<p>Sensory function change in nerves with new loss of sensation.</p

Additional and total prednisolone received in patients.

<p>(Group mean, range and median in mg.)</p

Motor function change in nerves with new weakness.

<p>Motor function change in nerves with new weakness.</p