The Relationship between Exports and Growth in Select African Nations

The relationship between exports and growth is an important one in economics, particularly for developing nations that seek to improve the livelihoods of their citizens through economic reform. This paper analyzes the theories behind the role that exports play in growth, and seeks to use regression analysis for four African nations’ economic data from 1981-2003, namely the Democratic Republic of the Congo, Guinea Bissau, Malawi, and Nigeria. The data show a mostly positive relationship between exports and growth and mixed results for the other independent variables, investment and population

The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Post Stroke Depression

Depression is the most common neuropsychiatric disorder affecting over one third of all stroke patients. The presence of depression after a stroke greatly affects the ability of patients to participate in rehabilitation and can even affect their long-term mortality. Poststroke depression is a well-documented and studied aspect of stroke management because of the implications it has on morbidity, mortality and recovery. Despite post stroke depression being a well-studied phenomenon, it remains underdiagnosed. The development of poststroke depression is multifactorial and has been evaluated from the cellular, genetic, and environmental perspective. Using numerous studies this chapter will review facets of post stroke depression such as epidemiology, etiology and treatment, while evaluating how this phenomena effects patient recovery and rehabilitation

When should patients with stroke receive thrombolytics?

Thrombolytic therapy should be limited to patients with acute ischemic stroke who meet strict inclusion and exclusion criteria and who can adhere to strict treatment protocol. Patients treated under these conditions have improved combined mortality and disability outcomes at 1 year when treated with recombinant tissue plasminogen activator (rtPA) (number needed to treat [NNT]=18; 95% confidence interval [CI], 11-56) (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials with significant heterogeneity)

Study - Mucosal and peri-orificial involvement in Post-Kala-Azar dermal leishmaniasis

BACKGROUND AND AIMS: Lesions of post-kala-azar dermal leishmaniasis (PKDL) usually affect the skin. Uncommonly, the involvement of oral and genital mucosae has been reported. METHODS: Twenty five patients clinically diagnosed as post-kala-azar dermal leishmaniasis were studied for periorificial and mucosal lesions. Clinical examination, skin smears and biopsy were done for the patients with periorificial or mucosal lesions. RESULTS: Out of 25 patients of PKDL, seven patients had lesions on the oral and/or genital mucosa. Three cases had oral lesions; two had only genital lesions and three patients had both sites involved. All the patients were having skin lesions elsewhere too either as nodules and/or plaque or macules. Conclusion: While examining a case of PKDL, mucosal involvement must also be examined carefully

Therapeutic trial of sodium antimony gluconate alone and in combination with ketoconazole in post-kala-azar dermal leishmaniasis

BACKGROUND: Drugs used in PKDL include parenteral sodium antimony gluconate (SAG), amphotericin-B, pentamidine, and ketoconazole (KTZ). SAG is the most effective one. Given alone, SAG has to be given for a long duration, leading to poor patient compliance and treatment failure. This study was carried out to compare the effectiness of SAG alone and a combination of SAG and KTZ for sixty days. METHODS: Ten patients of PKDL were included in the study. Five patients (Group A) were given SAG intravenously, in the dose of 20 mg/kg per day and five (Group B) were given SAG (intravenously 20 mg/kg per day) and KTZ (200 mg twice daily orally). Both treatment regimens were given for sixty days. RESULTS: In Group A, the nodules and/or plaques showed approximate 80-85% clinical improvement, and macules showed 25-30% improvement. In group B (SAG + KTZ), there was 90-95% clinical improvement in the nodules and/or plaques and 25-30% in macules. CONCLUSION: This study suggests the therapeutic superiority of the combination treatment regimen in a shorter duration but is not conclusive as the number of patients was low. Further trials are recommended

Randomized double-blind study comparing the efficacy and safety of lamotrigine and amitriptyline in painful diabetic neuropathy

WSTĘP. Celem niniejszej pracy było porównanie skuteczności oraz bezpieczeństwa stosowania lamotryginy i amitryptyliny w opanowywaniu przewlekłego bólu spowodowanego obwodową neuropatią u chorych na cukrzycę. MATERIAŁ I METODY. Badanie kliniczne z randomizacją przeprowadzono w układzie naprzemiennym metodą podwójnie ślepej próby, z grupą kontrolną otrzymującą terapię standardową. W badaniu wzięły udział 53 osoby. Zastosowano różne dawki leków. Amitryptylinę stosowano w 3 dawkach doustnie: 10, 25 lub 50 mg, jednorazowo na noc przez 2 tygodnie, a lamotryginę - doustnie, 2 × na dobę, w 3 dawkach: 25, 50 lub 100 mg; każdą z dawek stosowano przez 2 tygodnie. Między zamianą leków zastosowano 2-tygodniową przerwę, podczas której chorzy otrzymywali placebo. Oceniano wpływ terapii na zmniejszenie bólu, ogólne polepszenie stanu zdrowia oraz wystąpienie działań niepożądanych. WYNIKI. W ogólnej ocenie pacjentów zniesienie bólu w dużym, umiarkowanym i małym stopniu zanotowano odpowiednio u 19 (41%), 6 (13%) i 7 (15%) osób przyjmujących lamotryginę oraz u 13 (28%), 5 (11%) i 15 (33%) osób stosujących amitryptylinę. Ogólna ocena przeprowadzona przez pacjentów i lekarzy, kwestionariusz McGilla i skala bólu Likerta nie wykazały różnic istotnych statystycznie. Poprawę obserwowano już po 2 tygodniach stosowania obu leków. Odnotowano 44 przypadki działań niepożądanych, 33 (75%) dotyczyły amitryptyliny, z czego najczęściej stwierdzano działanie nasenne (19 pacjentów, 43%); 11 przypadków (25%) dotyczyło lamotryginy, najczęściej była to wysypka (3 chorych, 7%) i podwyższenie stężenia kreatyniny (4 osoby, 9%). Preferowana dawka lamotryginy to 25 mg 2 × na dobę. WNIOSKI. Mimo że wykazano niewiele różnic w skuteczności obu leków, wybór lamotryginy w dawce 25 mg 2 × na dobę wydaje się lepszy, ze względu na mniejszą liczbę działań niepożądanych wywołanych w badanej populacji.AIMS. To compare the efficacy and safety of lamotrigine and amitriptyline in controlling chronic painful peripheral neuropathy in diabetic patients. METHODS. A randomized, double-blind, crossover, active-control, clinical trial with variable dose titration was carried out (n = 53). Amitriptyline orally, at doses of 10, 25 and 50 mg at night-time, each dose for 2 weeks, and lamotrigine orally, at doses of 25, 50 and 100 mg twice daily, each dose for 2 weeks, by optional titration were used. There was a placebo washout period for 2 weeks between the two drugs. Assessment for pain relief, overall improvement and adverse events were carried out. RESULTS. Good, moderate and mild pain relief were noted in 19 (41%), six (13%) and seven (15%) patients on lamotrigine and 13 (28%), five (11%) and 15 (33%) patients on amitriptyline, respectively, by patient’s global assessment of efficacy and safety. Patient and physicians global assessment, McGill pain questionnaire and Likert pain scale showed no significant difference between the treatments, although improvement with both treatments was seen from 2 weeks. Of the 44 adverse events reported, 33 (75%) were with amitriptyline, sedation being the commonest [in 19 (43%) patients]. Lamotrigine caused adverse events in 11 (25%), of which rash in three (7%) and elevations of creatinine in four (9%) were the most common. The preferred lamotrigine dose was 25 mg twice daily. CONCLUSIONS. As there are few differences between the two treatments in efficacy, lamotrigine 25 mg twice daily might be the first choice as it is associated with fewer adverse effects in our population

Supporting Academic Primary Care Teams Serving Refugees: A Qualitative Study

Introduction: Primary care providers continue to experience significant challenges when caring for refugee patients, yet they are often refugees’ initial point of contact with the U.S. health care system. The purpose of this qualitative study is to expand our understanding of the experiences of academic primary care team members during clinical encounters with refugee patients. Methods: This multi-perspective, qualitative study included physicians (faculty and residents), nurse practitioners, pharmacists, nurses, and medical assistants (n=10), who have been working with refugee patients for at least one year at two family medicine residency clinics and/or a community health center. Semi-structured in-person interviews were conducted and audio-recorded, transcribed, and openly coded to identify emergent themes. Through an immersion/crystallization and consensus approach, data was categorized into domains and subthemes. Results: Major domains and subthemes emerged: Building relationships (over time, earning trust, cultural humility); Markers of success in clinical encounters (improving communication, adaptation); Knowledge of or lack of clinical resources (focused trainings, formal debriefs, access to resources, unwritten languages). Conclusion: Perceptions of success in clinical encounters with refugee patients were primarily associated with communication as opposed to achievement in numeric metrics (e.g. hypertension control). The development of any formalized trainings, tools, and resources to support primary care providers working with refugee patient populations should take these goals into consideration. Lastly, potential solutions were identified to address existing barriers for primary care providers in clinical encounters with refugee patients, but further research and development is necessary to assess their efficacy and utility

Qualification of 3D-Printed Titanium Volume-Optimized Propulsion Tanks for Small Satellites

The current state of the art for small satellite chemical propellant tanks is limited in design customization, is expensive, and is volumetrically inefficient within the cuboid volumes of small satellite buses. Space Dynamics Laboratory and Velo3D Inc. partnered to develop propulsion tank technology that solves these challenges using metal additive manufacturing (AM). We designed, analyzed, built, heat-treated, post-machined, precision cleaned, and qualification tested a titanium 6A14V volume-optimized 3D-printed propulsion tank with an integral printed propellant management device (PMD). They are rated for a maximum expected operating pressure of 400 psi. These tanks are 3D-printed in the desired cuboid mission geometries with significantly faster lead times, yielding a much lower cost while improving delta-V per size envelope. This project focused on half ESPA satellite sized tanks, compatible with hydrazine or green propellant, with a scalable methodology to execute any size from 1U to full ESPA. The qualification testing results, processes developed, lessons learned, and key takeaways for the industry are presented. Additionally, this paper outlines a roadmap for the industry showing the pre- and post-printing processing steps needed for success in metal AM for propulsion tanks, referencing the applicable industry standards. We performed a thorough specimen testing campaign and share the results. Finally, we also designed, analyzed, 3D-printed, and heat treated a full ESPA sized propulsion tank with integral printed PMD. This work demonstrates the viability of metal volume-optimized AM tanks for small satellite propulsion and the processes required to be successful in future projects

Differential Expression of Heat Shock Protein (HSP) 70-2 Gene Polymorphism in Benign and Malignant Pancreatic Disorders and Its Relationship with Disease Severity and Complications

Context The role of heat shock protein (HSP) 70-2 gene polymorphism (at position 1267, A to G transition) in patients with pancreatic disorders is not clear. Objective To evaluate HSP 70-2 gene polymorphism (at position 1267, A to G transition) in patients with acute and chronic pancreatitis as well as pancreatic carcinoma, and to find any association of this polymorphism with disease complications and severity. Methods One-hundred and fifty patients (50 each of acute, chronic pancreatitis, and pancreatic carcinoma) and 50 healthy blood donors as controls were prospectively studied. Three alleles (AA, AG and GG) of HSP 70-2 gene determined by PstI restriction fragment length polymorphism. Results There was a statistically significant difference in the distribution pattern of HSP 70-2 gene polymorphism in patients with acute pancreatitis (P=0.001) and pancreatic carcinoma (P<0.001) as compared to controls. The frequency of mutant allele (G allele) was significantly higher in diseased group as compared to control group (19% in control group, 40% in acute pancreatitis, 33% in chronic pancreatitis and 45% in pancreatic carcinoma). No association of this polymorphism was found with disease severity in patients with acute and chronic pancreatitis or pancreatic carcinoma. Conclusions In our patient sample the frequency of mutant allele (G allele) of HSP 70-2 gene is significantly higher in patients with acute pancreatitis and pancreatic carcinoma compared to controls (50 healthy blood donors). However, this polymorphism was not associated with disease severity and complications.Image: Allelic distribution in the study population