What is the secondary patency of thrombosed bypasses of the lower limbs cleared by fibrinolysis in situ?

OBJECTIVES: In case of acute thrombosis, lower limbs bypasses can, in certain cases, be cleared by local intra-arterial fibrinolysis (LIF). The aim of this study was to evaluate the secondary patency of thrombosed bypasses after fibrinolysis. METHODS: This retrospective study includes all patients hospitalized for thrombosed bypasses of the lower limbs that were treated with in situ fibrinolysis using urokinase, between 2004 and 2013, in two French university hospital centers. Fibrinolysis was indicated in case of recent thrombosis (< 3 weeks) provoking acute limb ischemia without sensory-motor deficit and in the absence of general contraindications. The secondary patency of the grafts was defined as the time after fibrinolysis without a new thrombotic event. RESULTS: There were 207 patients, hospitalized for recent thrombosis of 244 bypasses. The LIF was efficient in 74% of the cases (n=180). Secondary patency of these bypasses, was 54.2% and 32.4% overall, 68.3% and 50.3% for the supra-inguinal bypasses and 48.3% and 21.5% for the infra-inguinal bypasses, at 1 year and 5 years respectively. There is a significant difference (p = 0.002) regarding the permeability of the supra-inguinal and infra-inguinal bypasses. The survival rate was 75% (± 6.4%) at 5 years and the limb salvage rate was 89% (± 3.3%), 78.2% (±5.1%) and 75% (±5.8%) at 1 year, 3 years et 5 years respectively. The only independent factor influencing the secondary patency of infra-inguinal bypasses that was significant in a multivariate analysis was the infragenicular localization of the distal anastomosis (p=0.023). CONCLUSIONS: LIF is an effective approach that often allows the identification of the underlying cause, permitting elective adjunctive treatment of the underlying cause. Although LIF is at least as effective as its therapeutic alternatives described in the literature, the secondary patency of the bypasses remains modest and encourages close monitoring, particularly in patients with an infragenicular bypass

Brand equity and willingness to pay for condoms in zimbabwe

<p>Abstract</p> <p>Background</p> <p>Zimbabwe suffers from one of the greatest burdens of HIV/AIDS in the world that has been compounded by social and economic instability in the past decade. However, from 2001 to 2009 HIV prevalence among 15-49 year olds declined from 26% to approximately 14%. Behavior change and condom use may in part explain this decline.</p> <p>PSI-Zimbabwe socially markets the Protector Plus (P+) branded line of condoms. When Zimbabwe converted to a dollar-based economy in 2009, the price of condoms was greatly increased and new marketing efforts were undertaken. This paper evaluates the role of condom marketing, a multi-dimensional scale of brand peceptions (brand equity), and price in condom use behavior.</p> <p>Methods</p> <p>We randomly sampled sexually active men age 15-49 from 3 groups - current P+ users, former users, and free condom users. We compared their brand equity and willingness to pay based on survey results. We estimated multivariable logistic regression models to compare the 3 groups.</p> <p>Results</p> <p>We found that the brand equity scale was positive correlated with willingness to pay and with condom use. Former users also indicated a high willingness to pay for condoms. We found differences in brand equity between the 3 groups, with current P+ users having the highest P+ brand equity. As observed in previous studies, higher brand equity was associated with more of the targeted health behavior, in this case and more consistent condom use.</p> <p>Conclusions</p> <p>Zimbabwe men have highly positive brand perceptions of P+. There is an opportunity to grow the total condom market in Zimbabwe by increasing brand equity across user groups. Some former users may resume using condoms through more effective marketing. Some free users may be willing to pay for condoms. Achieving these objectives will expand the total condom market and reduce HIV risk behaviors.</p

Evaluation of a social marketing intervention promoting oral rehydration salts in Burundi

<p>Abstract</p> <p>Background</p> <p>Diarrhea is the second leading cause of death for children under five in Burundi; however, use of oral rehydration salts (ORS), the recommended first-line treatment, remains low. In 2004, PSI/Burundi launched a social marketing intervention to promote ORASEL among caregivers of children under five; the product was relaunched in 2006 with a new flavor. This study evaluates the intervention after the ORASEL relaunch, which included mass media and interpersonal communication activities. The study looks at trends in ORASEL use in Burundi and in behavioral determinants that may be related to its use.</p> <p>Methods</p> <p>In 2006 and 2007, PSI conducted household surveys among Burundian females of reproductive age (15-49). Both surveys used a two-stage sampling process to select 30 households in each of 115 rural and urban collines throughout the nation. Survey respondents were asked about diarrhea treatment-related behavior; key behavioral determinants; and exposure to the ORASEL intervention. Data were analyzed to identify trends over time, characteristics of ORASEL users, and associations between exposure to the intervention and changes in ORASEL use and related behavioral determinants.</p> <p>Results</p> <p>ORASEL use among caregivers at their children's last diarrheal episode increased significantly from 20% in 2006 to 30% in 2007, and there were also desirable changes in several behavioral determinants associated with ORASEL use. Evaluation analysis showed that a higher level of exposure to the social marketing campaign was associated with greater use of ORASEL and with significant improvements in perceived availability, knowledge of the signs of diarrhea and dehydration, social support, and self-efficacy.</p> <p>Conclusions</p> <p>ORS use can be improved through social marketing and educational campaigns that make the public aware of the availability of the product, encourage dialogue about its use, and increase skills and confidence relating to correct product preparation and administration. Further interventions in Burundi and elsewhere should promote ORS through a variety of mass media and interpersonal communication channels, and should be rigorously evaluated in the context of the total market for diarrhea treatment products.</p

Towards a global One Health index: a potential assessment tool for One Health performance

BACKGROUND: A One Health approach has been increasingly mainstreamed by the international community, as it provides for holistic thinking in recognizing the close links and inter-dependence of the health of humans, animals and the environment. However, the dearth of real-world evidence has hampered application of a One Health approach in shaping policies and practice. This study proposes the development of a potential evaluation tool for One Health performance, in order to contribute to the scientific measurement of One Health approach and the identification of gaps where One Health capacity building is most urgently needed. METHODS: We describe five steps towards a global One Health index (GOHI), including (i) framework formulation; (ii) indicator selection; (iii) database building; (iv) weight determination; and (v) GOHI scores calculation. A cell-like framework for GOHI is proposed, which comprises an external drivers index (EDI), an intrinsic drivers index (IDI) and a core drivers index (CDI). We construct the indicator scheme for GOHI based on this framework after multiple rounds of panel discussions with our expert advisory committee. A fuzzy analytical hierarchy process is adopted to determine the weights for each of the indicators. RESULTS: The weighted indicator scheme of GOHI comprises three first-level indicators, 13 second-level indicators, and 57 third-level indicators. According to the pilot analysis based on the data from more than 200 countries/territories the GOHI scores overall are far from ideal (the highest score of 65.0 out of a maximum score of 100), and we found considerable variations among different countries/territories (31.8-65.0). The results from the pilot analysis are consistent with the results from a literature review, which suggests that a GOHI as a potential tool for the assessment of One Health performance might be feasible. CONCLUSIONS: GOHI-subject to rigorous validation-would represent the world's first evaluation tool that constructs the conceptual framework from a holistic perspective of One Health. Future application of GOHI might promote a common understanding of a strong One Health approach and provide reference for promoting effective measures to strengthen One Health capacity building. With further adaptations under various scenarios, GOHI, along with its technical protocols and databases, will be updated regularly to address current technical limitations, and capture new knowledge

Highly Stable Glassy Carbon Interfaces for Long-Term Neural Stimulation and Low-Noise Recording of Brain Activity

We report on the superior electrochemical properties, in-vivo performance and long term stability under electrical stimulation of a new electrode material fabricated from lithographically patterned glassy carbon. For a direct comparison with conventional metal electrodes, similar ultra-flexible, micro-electrocorticography (μ-ECoG) arrays with platinum (Pt) or glassy carbon (GC) electrodes were manufactured. The GC microelectrodes have more than 70% wider electrochemical window and 70% higher CTC (charge transfer capacity) than Pt microelectrodes of similar geometry. Moreover, we demonstrate that the GC microelectrodes can withstand at least 5 million pulses at 0.45 mC/cm2 charge density with less than 7.5% impedance change, while the Pt microelectrodes delaminated after 1 million pulses. Additionally, poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT-PSS) was selectively electrodeposited on both sets of devices to specifically reduce their impedances for smaller diameters (<60 μm). We observed that PEDOT-PSS adhered significantly better to GC than Pt, and allowed drastic reduction of electrode size while maintaining same amount of delivered current. The electrode arrays biocompatibility was demonstrated through in-vitro cell viability experiments, while acute in vivo characterization was performed in rats and showed that GC microelectrode arrays recorded somatosensory evoked potentials (SEP) with an almost twice SNR (signal-to-noise ratio) when compared to the Pt ones

Prise en charge des hernies etranglees de l’aine en milieu chirurgical rural : a propos de 329 cas colliges a l’hopital saint joseph de datcha (Togo)

But : le but de ce travail est de décrire les aspects épidémiologiques et anatomocliniques des hernies étranglées de l’aine et de rapporter les modalités et les résultats de leur traitement en milieu rural chirurgical.Matériels et méthodes : cette étude rétrospective sur 10 ans (2001-2010) a consisté en l’analyse des dossiers de 329 patients opérés pour une hernie étranglée de l’aine de janvier 2001 à décembre 2012 à l’Hôpital Saint Joseph de Datcha (Togo).Résultats : durant la période d’étude, sur les 646 hernies de l’aine recensées, 329 étaient étranglées, soit 50,93 % des hernies de l’aine. Ces 329 hernies étranglées de l’aine se répartissaient en 319 hernies inguinales et 10 hernies crurales et concernaient 314 hommes (95,44 %) et 15 femmes (4,56 %). L’âge médian des patients était de 39 ans. Le délai moyen de consultation était de 2,5 jours et la nécrose intestinale était notée dans 39 cas. Un pincement latéral était observé dans 8 cas et un étranglement rétrograde en «W» dans 1 cas. La résection intestinale a été pratiquée chez les 39 patients qui avaient une nécrose. Les hernies inguinales ont été traitées par la méthode de Bassini, de Shouldice, de Mac Vay et la méthode prothétique (plaque) qui a été motivé par des hernies opérées en moins de 6 heures après la survenue de l’étranglement, une absence d’intestin dans le sac herniaire, et s’il y en avait l’absence de tout signe d’effraction au niveau de la paroi digestive étranglée. Les hernies crurales ont été toutes traitées par la méthode de Mac Vay. Dans les 3 cas de phlegmon herniaire, l’incision et le drainage ont été fait par voie inguinale et la cure herniaire a été faite à distance du processus infectieux (3 mois) par la méthode de Bassini. 20 patients sont décédés (6,07 %) et les facteurs de risques de décès étaient dominés par l’existence d’une nécrose, un délai de consultation ≥ à 48 h, la résection intestinale et l’existence d’une complication. Des complications postopératoires ont été notées chez 12 patients (3,65 %) et étaient dominées par la suppuration pariétale postopératoire (N = 6), un hématome des bourses (N = 3), une péritonite par chute d’escarres (N = 3) ; une réintervention a été nécessaire dans 3 cas.Conclusion : les hernies étranglées de l’aine sont des urgences encore fréquentes et par ce fait elles constituent encore une urgence chirurgicale toujours d’actualité en milieu tropical et surtout rural.Mots clés : hernie, aine, étranglement, complication, mortalit

A Comprehensive Review of Supervised Learning Algorithms for the Diagnosis of Photovoltaic Systems, Proposing a New Approach Using an Ensemble Learning Algorithm

Photovoltaic systems are prone to breaking down due to harsh conditions. To improve the reliability of these systems, diagnostic methods using Machine Learning (ML) have been developed. However, many publications only focus on specific AI models without disclosing the type of learning used. In this article, we propose a supervised learning algorithm that can detect and classify PV system defects. We delve into the world of supervised learning-based machine learning and its application in detecting and classifying defects in photovoltaic (PV) systems. We explore the various types of faults that can occur in a PV system and provide a concise overview of the most commonly used machine learning and supervised learning techniques in diagnosing such systems. Additionally, we introduce a novel classifier known as Extra Trees or Extremely Randomized Trees as a speedy diagnostic approach for PV systems. Although this algorithm has not yet been explored in the realm of fault detection and classification for photovoltaic installations, it is highly recommended due to its remarkable precision, minimal variance, and efficient processing. The purpose of this article is to assist technicians, engineers, and researchers in identifying typical faults that are responsible for PV system failures, as well as creating effective control and supervision techniques that can minimize breakdowns and ensure the longevity of installed systems

Improved long-term stability of thin-film glassy carbon electrodes through the use of silicon carbide and amorphous carbon

Long-term stability of neural interfaces is a challenge that has still to be overcome. In this study, we manufactured a highly stable multi-layer thin-film class of carbon-based devices for electrocorticography (ECoG) incorporating silicon carbide (SiC) and amorphous carbon (DLC) as adhesion promoters between glassy carbon (GC) electrodes and polyimide (PI) substrate and between PI and platinum (Pt) traces. We aged the thin-film electrodes in 30 mM H2O2at 39 °C for one week - to mimic the effects of post-surgery inflammatory reaction - and subsequently stressed them with 2500 CV cycles. We additionally performed stability tests stimulating the electrodes with 15 million biphasic pulses. Finally, we implanted the electrodes for 6 weeks into rat models and optically characterized the explanted devices. Results show that the fabricated ECoG devices were able to withstand the in vitro and in vivo tests without significant change in impedance and morphology