Diagnostic accuracy of multi-parametric MRI in diagnosis of clinically significant prostate cancer

Background: Traditionally, the diagnosis of prostate cancer has been based on an elevated prostate specific antigen or an abnormal digital rectal examination and confirmed histologically following prostate biopsy. This has led to a number of men without cancer or with clinically insignificant disease undergoing unwarranted prostate biopsies and suffering consequent complications. Pre-biopsy multi-parametric MRI plays a vital role in determining men with clinically significant cancer who need biopsy and those with a negative MRI who can safely avoid an unwarranted biopsy. Whereas studies on the value of multi-parametric MRI have been done elsewhere, there is variation in prevalence of prostate cancer in different populations which affects the predictive value, varying thresholds in defining clinically significant cancer as well as possible differences in tumour biology with our population. Objective: To determine the diagnostic accuracy of multi-parametric MRI in differentiating clinically significant and clinically insignificant prostate cancer using histopathology as the reference standard. Methods: The diagnostic accuracy of multi-parametric MRI using transrectal ultrasound guided biopsy as the reference test was established for 133 men who underwent multi-parametric MRI and biopsy between January 2016 – March 2019. The multi-parametric MRI images were reviewed and reported by two independent consultant radiologists. Clinically significant cancer was defined as PI-RADS score of ≥3 and Gleason score ≥3 + 4 (grade group ≥2). Results: Multi-parametric MRI of the prostate was found to have 92% sensitivity, 47.8% specificity, 86.8% negative predictive value and 62% positive predictive value. Conclusion: Multi-parametric MRI has a high sensitivity and a negative predictive value validating its use in pre-biopsy evaluation of men at risk of prostate cancer to safely avoid unnecessary prostate biopsy and to guide biopsy of suspicious lesions

Not Indian enough? How domestic development actors respond to decentralised INGOs

Francesco Obino uncovers what Indian civil society organisations and bureaucrats think of international NGOs’ decision to become ‘fully Indian’

Book review: revealing Indian philanthropy

On reading “Revealing Indian Philanthropy”, Francesco Obino asks whether domestic philanthropy can support equitable and sustainable development in India

The changing political legitimacy of international NGOs: a look from India

Francesco Obino questions whether the creation of ‘fully national’ offices as part of a broader decentralisation process within international NGOs supports their efforts to enhance political legitimacy and anchor global development agendas in domestic development debates

Stem Cells

Considerando a origem de obtenção, as células-tronco podem ser classificadas como células-tronco embrionárias (ES) ou como células-tronco adultas. Mas, se a plasticidade for considerada, as células-tronco podem ser classificadas como células totipotentes, quando as células-tronco preservam a capacidade de dar origem a um novo indivíduo completo. Quando as células-tronco perdem esta capacidade, passam a ser classificadas como células-tronco pluripotentes, que podem dar origem a praticamente todos os tipos celulares maduros que compõem um organismo. Células-tronco totipotentes e pluripotentes podem ser obtidas de estágios embrionários iniciais. O grupo de células-tronco que apresenta plasticidade restrita é denominado de multipotente. Estas células podem se diferenciar em determinado tipo celular comprometido com um órgão ou tecido específico. Células ES podem ser expandidas in vitro, mantendo sua forma indiferenciada, ou podem ser submetidas a uma série de protocolos, que irão induzir diferenciação in vitro. Por outro lado, as células-tronco adultas multipotentes não podem ser mantidas in vitro na forma indiferenciada, exceto uma subpopulação de células-tronco adultas aderentes, denominadas células-tronco mesenquimais, que podem ser mantidas in vitro na forma indiferenciada. Considerando a capacidade de gerar teratomas, as células ES não foram utilizadas para transplante celular experimental in vivo. Além disso, várias cirurgias de transplantes experimentais com células-tronco adultas têm sido realizadas, porém apresentando resultados controversos.Stem cells can be classified as embryonic stem (ES) cells or adult stem cells considering their origin. If plasticity is considered, stem cells can be classified as totipotent, when stem cells retain the ability to give rise to an entire new organism. When stem cells lose this capacity, cells are named pluripotent stem cells, which can give rise to almost all mature cell types that compound an organism. Totipotent and pluripotent stem cells can be obtained from developing early-stage embryos. Multipotent is the group of adult stem cells with restricted plasticity. These cells can differentiate into a defined cell type related with a specific organ or tissue. ES cells can be propagated in vitro under undifferentiated system or with a series of protocols to induce cell differentiation. On the other hand, multipotent adult stem cells cannot be maintained in vitro in an undifferentiated form, except for a special class of adherent adult stem cells named mesenchimal stem cells, which can be expanded in vitro conserving their undifferentiated characteristics. Considering the ability to gen-erate teratomas, ES cells were not used in experimental in vivo cell transplant. On the other hand, several experimental adult stem cells transplants have been performed with controversial results

Exploring the Challenges and Opportunities in Microfinance Group Lending Model among HIV and AIDS Affected Households

Microfinancing has been taken as the panacea in poverty reduction and disaster mitigation in many third world countries world over. The mode of application of this tool in HIV and AIDS disaster mitigation, however, poses unique challenges and opportunities to Microfinance Institutions (MFIs) and their clients. To find out the nature of these challenges and opportunities experienced by HIV and AIDS MF clients in group lending model, cross-sectional survey design was used to execute the study in Kakamega County, Kenya.  Two hundred and five (205) HIV and AIDS affected households who were clients of Microfinance (MF) were purposively sampled for questionnaire survey. Separately, seven (7) Focus Group Discussions and five (5) in-depth Interviews were conducted among affected household heads and MF managers. The study found that microfinancing can be a major instrument in asset rebuilding to mitigate the impacts of HIV and AIDS disaster. However, MFIs face a number of challenges key to which is lack of government policy to guide MF operations in this essential sub-sector. Consequently, high interest rates, loan defaulting and loan hawking by MF clients abound. The study recommends that the government comes up with a clear policy to regulate and streamline this significant sub-sector. Local communities need to be sensitized on the role of MFIs in poverty alleviation in HIV and AIDS affected households in Kenya. Keywords:  Challenges, Opportunities, Microfinance, Group Lending, HIV and AIDs, Affected Household

FUTURE OF TEACHER PROFESSIONAL DEVELOPMENT IN KENYA: STRATEGIC LEADERSHIP APPROACH

The purpose of this study was to examine the place of strategic leadership in the implementation of teacher professional development (TPD). The study was done through a literature review of two kinds: policy documents and published studies. Published studies were identified using Dimensions and Google search engines and through pearl growing. The search queries targeted studies published between 2013 and 2022 whose titles, abstracts, or keywords contained terms related to teachers’ professional development, strategic implementation and strategic leadership in fields of education, business and management. Studies which lacked these terms were deemed irrelevant and excluded. The findings were based on the review, analysis and synthesis of 33 relevant studies. Consensus across multiple studies was that strategic leadership influences strategy implementation which informed the recommendation of strategic leadership in TPD implementation. Threats to TPD implementation such as potential resistance by teachers, misalignment of goals, cost implications and lack of a clear organization structure were established and areas of further research were recommended.  Article visualizations