A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test.

peer-reviewedObjectives. Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test –with these conventional tests in hospitalised elderly patients. Methods. The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA. Results. The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range = 1–29). There was a strong, positive correlation between the LSD and both the CDT (r = 0.56) and IPT (r = 0.71). The correlation between the LSD and MoCA (r = 0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r = 0.86), attention (0.81) and visuospatial function (r = 0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%). Conclusion. The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.PUBLISHEDpeer-reviewe

Permeable pavements for storm water control incorporating nano clay

Stormwater affects the economic situation of the environment, changes the land use, which also affects the ecosystem. Consequently, this affects the pavement condition of the road and lead to both structural and functional pavement defects. In a bid to proffer solution to the harmful effects of stormwater and reduce the cost of pavement construction in track with sustainability, this research utilized nano clay in the development of permeable concrete. The nano clay was used as a partial replacement for cement. It was dehydroxylated at 720°C; the characterization and particle geometry was done using the XRF equipment. The de-hydroxylated nano clay was used as a partial replacement for cement at 5, 10, 15, 20 and 25%. Correspondingly, six samples of concrete were developed. The mechanical properties (compressive and flexural strength) of the permeable concrete was assessed at 3, 7, 14, 21 and 28 days. Additionally, the porosity of the concrete was determined using Archimedes principle. The result of the research showed that using nano clay replacement at 15% gave a flexural strength of 4.01MPa. This is lower than the required specification of 4.27Mpa—4.5MPa for pavement construction at 28 days and 4.5Mpa and above for airfield pavement. The porosity test using Archimedes principle showed a satisfactory result. This proves the efficiency of the concrete for stormwater control. Therefore, this concrete is recommended for use in the design and construction of low axle or low trafficked road for stormwater control and aquifer recharge based on the flexural strength

Intermittent preventive treatment with sulphadoxine-pyrimethamine is effective in preventing maternal and placental malaria in Ibadan, south-western Nigeria

<p>Abstract</p> <p>Background</p> <p>Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) is currently the recommended regimen for prevention of malaria in pregnancy in endemic areas. This study sets out to evaluate the effectiveness of IPT-SP in the prevention of maternal and placental malaria in parturient mothers in Ibadan, Nigeria, where the risk of malaria is present all year round.</p> <p>Method</p> <p>During a larger study evaluating the epidemiology of congenital malaria, the effect of malaria prophylaxis was examined in 983 parturient mothers. Five hundred and ninety eight mothers (60.8%) received IPT-SP, 214 (21.8%) received pyrimethamine (PYR) and 171 (17.4%) did not take any chemoprophylactic agent (NC).</p> <p>Results</p> <p>The prevalence of maternal parasitaemia in the IPT-SP, PYR and NC groups was 10.4%, 15.9% and 17% respectively (p = 0.021). The prevalence of placental parasitaemia was 10.5% in the IPT-SP, 16.8% PYR and 17% NC groups, respectively (p = 0.015). The prevalence of maternal anaemia (haematocrit <30%) was 5.7% vs. 8.9% vs. 13.4% among the IPT-SP, PYR and NC groups respectively (p < 0.0001) while that of pre-term delivery (GA <37 weeks) was 10.5%, 19.2% and 25.3% among IPT-SP, PYR and NC groups respectively (p < 0.0001). Babies born to mothers in the IPT-SP, PYR and NC groups had mean birth weights of 3204 ± 487.16, 3075 ± 513.24 and 3074 ± 505.92 respectively (ρ < 0.0001). There was a trend towards a lower proportion of low birth weight babies in the IPT-SP group (p = 0.095).</p> <p>Conclusion</p> <p>IPT-SP is effective in preventing maternal and placental malaria as well as improving pregnancy outcomes among parturient women in Ibadan, Nigeria. The implementation of the recently adopted IPT-SP strategy should be pursued with vigour as it holds great promise for reducing the burden of malaria in pregnancy in Nigeria.</p

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Fine Needle aspiration of superficial Lymph node enlargement seen in Lagos, Nigeria: our experience over a six-year period

Background: Lymphadenopathy is one of the common palpable superficial tumours in the body. The diagnosis of these masses can be challenging to physicians. Fine needle aspiration cytology (FNAC) is a cost effective investigation for the diagnosis especially in resource limited settings like ours.Objectives: The aim of this study is to present the use of FNAC of lymph nodes, highlighting the benefits of this investigation.Methods: This is a six year retrospective study of all lymph nodes FNAC performed in two laboratories in Ikeja, Lagos between January 2008 and December 2013. All cytological slides were retrieved and re-evaluated. Clinical details including age, gender, site of aspirations were retrieved from the request forms.Results: A total of 128 cases were seen during the study period with an age range of 1 to 84 years and male to female ratio of 1:1.1. Cervical lymph node (90/128) was the commonest aspirated site. Tuberculous lymphadenitis accounted for 32.3% of cases. Diagnosis of malignancy accounted for 25% of cases comprising metastatic carcinoma (71.9%) and lymphoma (28.1%). All cases of lymphoma diagnosed were from cervical lymph node which also accounted for 60.9% metastatic carcinoma diagnosis.Conclusion: Chronic granulomatous lymphadenitis is a very common cause of lymphadenopathy in our environment. Metastatic carcinoma is the most common cause of malignant lymphadenopathy. FNAC is a veritable tool for the diagnosis of lymphadenopathy and it can be performed on all age groups. Introduction of special technique such as immunohistochemistry and flow cytometry is advocated for definitive diagnosis of lymphomas.Keywords: Lymphadenopathy, FNAC, tuberculous lymphadenitis, metastatic carcinoma, lymphoma

Motivation to move fast, motivation to wait and see: The association of prevention and promotion focus with clinicians’ implementation of the JNC‐7 hypertension treatment guidelines

Abstract Roughly half of the adults in the United States are diagnosed with hypertension (HTN). Unfortunately, less than one‐third have their condition under control. Clinicians generally have positive regard for the use of HTN guidelines to achieve HTN treatment goals; however, actual uptake remains low. Factors underpinning clinician variation in practice are poorly understood. To understand the relationship between clinicians’ personal motivation to complete goals and their uptake of the Joint National Commission's HTN guidelines. The authors used Regulatory Focus Theory (RFT, ie, prevention and promotion focus), an empirically supported motivational theory, as a guiding framework to examine the relationship. The authors hypothesized that clinicians with high prevention focus would report following guidelines more often and have shorter follow‐up visit intervals for patients with uncontrolled blood pressure. Clinicians (n  = 27) caring for adult patients diagnosed with HTN (n = 8605) in Federally Qualified Health Centers (n = 8). Clinicians’ prevention and promotion focus scores and the number of days between visits for their patients with uncontrolled systolic blood pressure (SBP) (≥ 140 mm Hg). Consistent with RFT, 60% of prevention focused clinicians reported they always followed the monthly visit guideline for the patients with uncontrolled blood pressure, compared with 38% of promotion focused clinicians (p = .254). The unadjusted probability of returning for a follow‐up visit within 30 days was greater among patients whose clinician was higher in prevention focus (p = .009), but there was no evidence at the 0.05 significance level in our adjusted model. These findings provide some limited evidence that RFT is a useful framework to understand clinician adherence to HTN treatment guidelines

Towards resolving the co-existing impacts of multiple dynamic factors on the performance of EMG-pattern recognition based prostheses

Background and Objective: Mobility of subject (MoS) and muscle contraction force variation (MCFV) have been shown to individually degrade the performance of multiple degrees of freedom electromyogram (EMG) pattern recognition (PR) based prostheses control systems. Though these factors (MoS-MCFV) co-exist simultaneously in the practical use of the prosthesis, their combined impact on PR-based system has rarely been studied especially in the context of amputees who are the target users of the device. Methods: To address this problem, this study systematically investigated the co-existing impact of MoS-MCFV on the performance of PR-based movement intent classifier, using EMG recordings acquired from eight participants who performed multiple classes of targeted limb movements across static and non-static scenarios with three distinct muscle contraction force levels. Then, a robust feature extraction method that is invariant to the combined effect of MoS-MCFV, namely, invariant time-domain descriptor (invTDD), was proposed to optimally characterize the multi-class EMG signal patterns in the presence of both factors. Results: Experimental results consistently showed that the proposed invTDD method could significantly mitigate the co-existing impact of MoS-MCFV on PR-based movement-intent classifier with error reduction in the range of 7.50%~17.97% (p<0.05), compared to the commonly applied methods. Further evaluation using 2-dimentional principal component analysis (PCA) technique, revealed that the proposed invTDD method has obvious class-separability in the PCA feature space, with a significantly lower standard error (0.91%) compared to the existing methods. Conclusion: This study offers compelling insight on how to develop accurately robust multiple degrees of freedom control scheme for multifunctional prostheses that would be clinically viable. Also, the study may spur positive advancement in other application areas of medical robotics that adopts myoelectric control schemes such as the electric wheelchair and human-computer-interaction systems

A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test.

Objectives. Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test –with these conventional tests in hospitalised elderly patients. Methods. The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA. Results. The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range = 1–29). There was a strong, positive correlation between the LSD and both the CDT (r = 0.56) and IPT (r = 0.71). The correlation between the LSD and MoCA (r = 0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r = 0.86), attention (0.81) and visuospatial function (r = 0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%). Conclusion. The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition