Holistic Approach: paradigm shift in the research agenda for digitalisation of healthcare in Sub-Saharan Africa

Despite significant resources employed in the digitalisation agenda in the healthcare sector in Sub-Saharan Africa, the transformative impact of information and communication technologies has not been realised. This article makes two contributions towards developing an understanding of this failure. First, it provides a review of a rich body of academic literature and practitioner accounts regarding barriers to digitalisation and organises them using an established framework. Second, recognising the continuing struggle that digitalisation presents, it proposes a paradigmatic shift in thinking about barriers to digitalisation and suggests the existence of a more fundamental barrier related to inappropriate incentives within the international community. Ultimately, it argues that unpacking the complex contextual reality of healthcare delivery systems is a fundamental but still unaddressed antecedent to any successful digitalisation endeavour. Thus, both the academia and the practitioners should direct their efforts to developing new approaches, which could remove this underlying obstacle

Local recurrence and distant metastases 18 years after resection of the greater omentum hemangiopericytoma

<p>Abstract</p> <p>Background</p> <p>Hemangiopericytoma occurs with increasing frequency in 5^thdecade of life and has prediction for retroperitoneum and extremities. A case of a local recurrence and metastases of hemangiopericytoma is described.</p> <p>Case presentation</p> <p>Recurrence of hemangiopericytoma in the greater omentum and the jejunal mesentery as well as metastases in the retroperitoneal space were diagnosed in a 61-year-old patient who had a hemangiopericytoma of the greater omentum excised 18 years before.</p> <p>Conclusion</p> <p>Because of the rarity of this disease and its typical clinical course associated with late recurrence and metastases, the authors decided to present this case emphasizing the necessity of systematic oncological follow-up after the end of treatment.</p

Effects of TLR Agonists on the Hypoxia-Regulated Transcription Factor HIF-1α and Dendritic Cell Maturation under Normoxic Conditions

Dendritic cells (DC) are professional antigen presenting cells that represent an important link between innate and adaptive immunity. Danger signals such as toll-like receptor (TLR) agonists induce maturation of DC leading to a T-cell mediated adaptive immune response. In this study, we show that exogenous as well as endogenous inflammatory stimuli for TLR4 and TLR2 induce the expression of HIF-1α in human monocyte-derived DC under normoxic conditions. On the functional level, inhibition of HIF-1α using chetomin (CTM), YC-1 and digoxin lead to no consistent effect on MoDC maturation, or cytokine secretion despite having the common effect of blocking HIF-1α stabilization or activity through different mechanisms. Stabilization of HIF-1α protein by hypoxia or CoCl2 did not result in maturation of human DC. In addition, we could show that TLR stimulation resulted in an increase of HIF-1α controlled VEGF secretion. These results show that stimulation of human MoDC with exogenous as well as endogenous TLR agonists induces the expression of HIF-1α in a time-dependent manner. Hypoxia alone does not induce maturation of DC, but is able to augment maturation after TLR ligation. Current evidence suggests that different target genes may be affected by HIF-1α under normoxic conditions with physiological roles that differ from those induced by hypoxia

Management of colorectal cancer presenting with synchronous liver metastases

Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care

Effect of processing and cooking on total and soluble oxalate content in frozen root vegetables prepared for consumption

The oxalate content of beetroot, carrot, celeriac and parsnip after freezing by traditional and modified methods (the latter resulting in a convenience food product), and after the preparation of frozen products for consumption was evaluated. The highest content of total and soluble oxalates (105 and 82 mg 100 g-1 fresh matter) was found in beetroot. The lowest proportion (55%) of soluble oxalates was noted in celeriac; this proportion was higher in the remaining vegetables, being broadly similar for each of them. Blanching brought about a significant decrease in total and soluble oxalates in fresh vegetables. Cooking resulted in a higher loss of oxalates. The level of oxalates in products prepared for consumption directly after freezing approximated that before freezing. Compared with the content before freezing, vegetables prepared for consumption by cooking after frozen storage contained less oxalates, except for total oxalates in parsnip and soluble oxalates in beetroot and celeriac. The highest ratio of oxalates to calcium was found in raw beetroot; it was two times lower in raw carrot; five times lower in raw celeriac; and eight times lower in raw parsnip. These ratios were lower after technological and culinary processing. The percentage of oxalate bound calcium depended on the species; this parameter was not significantly affected by the procedures applied. The true retention of oxalates according to Judprasong et al. (2006) was lower than retention calculated taking its content in 100 g fresh matter into account.

Former melt inclusions in garnet from UHP gneisses of the Seve Nappe Complex, Scandinavian Caledonides

Il metamorfismo ad altissima pressione (UHP) è stato recentemente riportato negli gneiss del complesso Seve Nappe (SNC) dei Caledonidi scandinavi. Questo studio è incentrato sulle inclusioni fuse cristallizzate - noti come nanogranitoidi - e sulle informazioni che esse conservano sui processi anatettici che si verificano durante la subduzione ultraprofonda. I nanogranitoidi (NG) sono piccole gocce (< 20 μm) completamente cristallizzate di fusione anatettica intrappolate in fasi peritettiche. I paragneiss del Monte Åreskutan che rappresentano il SNC fanno parte del margine più esterno del Baltica, che è stato subdotto, metamorfosato e fuso durante la chiusura dell'Oceano Iapeto, che ha causato la collisione tra la Baltica e la Laurentia nel periodo del primo Devoniano. L'insieme dei minerali del paragneiss è costituito da K-feldspato, granato, quarzo, plagioclasio, biotite, mica bianca, cianite, sillimanite e rutilo. Gli ammassi di inclusioni sono composti da piccole (< 5 μm) inclusioni multifase (MPI). Le MPI rappresentano precedenti inclusioni fluide e sono costituite da carbonati, micas, pirofillite, caolinite ± quarzo, grafite, rutilo e da un residuo liquido composto da CO2, CH4 e N2. Nei cluster MPI sono presenti inclusioni NG più grandi (5 - 20 μm) e più rare, composte da quarzo, biotite, K-feldspato, plagioclasio e raramente da carbonati. Sono stati condotti sette esperimenti di riomogenizzazione a diverse condizioni di P-T attraverso un apparato multi-anvil per rifondere i nanogranitoidi e determinare la composizione del fuso anatettico. L'omogeneizzazione migliore è stata acquisita a 850 - 900˚C e 4 - 4,5 GPa. La composizione del fuso intrappolato è prevalentemente riolitica, con un elevato contenuto di alcali (∼10 wt% N2O+K2O). I contenuti di H2O e CO2 dei nanogranitoidi rifusi, analizzati mediante NanoSIMS, sono rispettivamente ~ 4,6 wt% (3,3 - 6,6 wt%) e ∼0,88 wt% (0,12 - 2,11 wt%). La composizione chimica della fusione anatettica proveniente dai paragneiss della SNC è coerente con gli studi sperimentali sui fusi UHP. Sono stati riconosciuti due eventi di fusione parziale nel Monte Åreskutan, SNC, uno in condizioni di eclogite-facies e il secondo in condizioni di granulite-facies (441 Ma)

Efterfrågeflex vid kapacitetsbrist i elnätet

The power grid must expand rapidly to meet future capacity needs. Society's electrification and transition to transient energy sources, as well as the advent of micro-production means that the electricity grid must change. Since there is a shortage of capacity in the electricity networks already, it is necessary to look at alternatives that could reduce the need for capacity. One such alternative is “demand side flexibility”. That means that the user adjusts his electricity consumption according to production. The adjustment means that consumption is reduced or increased as needed, but also that consumption can be moved to an earlier or later occasion.   The local electricity network of Umeå Energi that is powered by distribution station S is a rural network with 1018 subscribers supplied by 49 substations, this electricity network is examined using network analyzes at the medium-voltage level for two different cases. In each case, both network expansion and demand side flexibility are studied as a solution to the capacity shortage. The first case deals with the emergence of electric car charging in the electricity grid, while the second case deals with expansion of micro-production in the electricity grid. The study of these two cases showed that demand side flexibility can solve the lack of capacity effectively, but in the long term, network expansion is a better and more economically profitable alternative. The first case declares that the cost of network expansion corresponds to the cost of 3.26 years with demand flexibility while the second case says that a period of 0.84 years with demand flexibility will reach the cost of a network expansion. The biggest found economic difference is that the network expansion has only non-recurring costs, while the cost of demand flexibility consists of both non-recurring costs and recurring costs.  Elnätet måste byggas ut snarast för att klara av framtida kapacitetsbehov. Samhällets elektrifiering och övergång till transienta energikällor samt tillkomst av mikroproduktion gör att elnätet måste utvecklas. Eftersom det råder kapacitetsbrist i elnäten redan nu så måste det beaktas alternativ som kan hantera kapacitetsbehovet, ett sådant alternativ är efterfrågeflexibilitet. När användaren justerar sin elkonsumtion vid behov kallas detta för efterfrågeflexibilitet. Justeringen innebär att konsumtionen minskas eller ökas vid behov, men även att den flyttas till ett tidigare eller senare tillfälle.   Umeå Energis lokalnät som matas ifrån fördelningsstation S är ett typiskt landsbygdnät med 1018 abonnenter som försörjs av 49 nätstationer, detta elnät undersöks med hjälp av nätanalyser på mellanspänningsnivån för två olika fall. I vartdera fall undersöks både nätutbyggnad och efterfrågeflexibilitet som lösning på kapacitetsbristen. Första fallet behandlar tillkomst av elbilsladdning i elnätet, medan det andra fallet behandlar expansion utav mikroproduktion i elnätet. Studien av dessa två fall visade att efterfrågeflexibilitet kan lösa kapacitetsbristen effektivt, men långsiktigt är nätutbyggnaden ett bättre och mer ekonomiskt lönsamt alternativ. Det första fallet konstaterar att kostanden för nätutbyggnad motsvarar kostnaden för 3,26 år med efterfrågeflexibilitet, andra fallet fastställer att det räcker med en tidsperiod på 0,84 år med efterfrågeflexibilitet för att nå kostanden för en nätutbyggnad. Den största ekonomiska skillnaden är att nätutbyggnaden har engångskostnader medan kostnaden för efterfrågeflexibiliteten består utav både engångskostnader och rörliga kostnader.