Feasibility of the modified sequential organ function assessment score in a resource-constrained setting: a prospective observational study.

BackgroundSub-Saharan Africa has a great burden of critical illness with limited health care resources. We evaluated the feasibility and utility of the modified Sequential Organ Function Assessment (mSOFA) score in assessing morbidity and mortality in the National Referral Hospital's intensive care unit (ICU) for one year.MethodsWe conducted a prospective, observational cohort study on patients above 12 years of age admitted to the ICU at Mulago Hospital (Kampala, Uganda). All SOFA scores were determined at admission and at 48 h. We modified the SOFA score by replacing the PaO2/FiO2 ratio with SPO2/FiO2. The primary outcome was ICU mortality.ResultsThis ICU cohort of 118 patients had a mean age of 37 years and an ICU mortality rate of 46.6%. Non-survivors had higher initial (7.7 SD 3.8 vs. 5.5 SD 3.3; p = 0.007), mean (8.1 SD 3.9 vs 4.7 SD 2.6; p < 0.001) and highest mSOFA scores (9.4 SD 4.2 vs. 5.8 SD 3.2; p < 0.001), with an increase of 1.0 (SD 3.1) mSOFA on average after 48 h when compared to survivors (p < 0.001). The area under the receiver operating characteristic curves for each mSOFA category was: initial-0.68, mean-0.76, highest-0.76 and delta mSOFA-0.74. Multivariate logistic regression analysis showed no significant association between mSOFA scores and mortality.ConclusionOur results confirm that calculation of the mSOFA score is feasible for an ICU population in a resource-limited country. More data are needed to test for an association between mSOFA and mortality

Capturing Hiproofs in HOL Light

Hierarchical proof trees (hiproofs for short) add structure to ordinary proof trees, by allowing portions of trees to be hierarchically nested. The additional structure can be used to abstract away from details, or to label particular portions to explain their purpose. In this paper we present two complementary methods for capturing hiproofs in HOL Light, along with a tool to produce web-based visualisations. The first method uses tactic recording, by modifying tactics to record their arguments and construct a hierarchical tree; this allows a tactic proof script to be modified. The second method uses proof recording, which extends the HOL Light kernel to record hierachical proof trees alongside theorems. This method is less invasive, but requires care to manage the size of the recorded objects. We have implemented both methods, resulting in two systems: Tactician and HipCam

A Vernacular for Coherent Logic

We propose a simple, yet expressive proof representation from which proofs for different proof assistants can easily be generated. The representation uses only a few inference rules and is based on a frag- ment of first-order logic called coherent logic. Coherent logic has been recognized by a number of researchers as a suitable logic for many ev- eryday mathematical developments. The proposed proof representation is accompanied by a corresponding XML format and by a suite of XSL transformations for generating formal proofs for Isabelle/Isar and Coq, as well as proofs expressed in a natural language form (formatted in LATEX or in HTML). Also, our automated theorem prover for coherent logic exports proofs in the proposed XML format. All tools are publicly available, along with a set of sample theorems.Comment: CICM 2014 - Conferences on Intelligent Computer Mathematics (2014

Sharing HOL4 and HOL Light proof knowledge

New proof assistant developments often involve concepts similar to already formalized ones. When proving their properties, a human can often take inspiration from the existing formalized proofs available in other provers or libraries. In this paper we propose and evaluate a number of methods, which strengthen proof automation by learning from proof libraries of different provers. Certain conjectures can be proved directly from the dependencies induced by similar proofs in the other library. Even if exact correspondences are not found, learning-reasoning systems can make use of the association between proved theorems and their characteristics to predict the relevant premises. Such external help can be further combined with internal advice. We evaluate the proposed knowledge-sharing methods by reproving the HOL Light and HOL4 standard libraries. The learning-reasoning system HOL(y)Hammer, whose single best strategy could automatically find proofs for 30% of the HOL Light problems, can prove 40% with the knowledge from HOL4

Patterns and predictors of self-medication in northern Uganda.

Self-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult (≥18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method. One respondent who reported having an illness within three months in each household was recruited. In each household, information was obtained from only one adult individual. Data was analyzed using STATA at 95% level of significance. The study found that a high proportion (75.7%) of the respondents practiced antimicrobial self-medication. Fever, headache, lack of appetite and body weakness were the disease symptoms most treated through self-medication (30.3%). The commonly self-medicated antimicrobials were coartem (27.3%), amoxicillin (21.7%), metronidazole (12.3%), and cotrimoxazole (11.6%). Drug use among respondents was mainly initiated by self-prescription (46.5%) and drug shop attendants (57.6%). On average, participants obtained 13.9±8.8 (95%CI: 12.6-13.8) tablets/capsules of antimicrobial drugs from drug shops and drugs were used for an average of 3.7±2.8 days (95%CI: 3.3-3.5). Over half (68.2%) of the respondents would recommend self-medication to another sick person. A high proportion (76%) of respondents reported that antimicrobial self-medication had associated risks such as wastage of money (42.1%), drug resistance (33.2%), and masking symptoms of underlying disease (15.5%). Predictors of self-medication with antimicrobial agents included gender, drug knowledge, drug leaflets, advice from friends, previous experience, long waiting time, and distance to the health facility. Despite knowledge of associated risks, use of self-medication with antimicrobial drugs in management of disease symptoms is a common practice in post-conflict northern Uganda

Blood biochemistry and haematology of weaner rabbits fed sun-dried, ensiled, and fermented cassava peel-based diets

Twenty-four New Zealand white × Chinchilla weaner bucks, aged between 7 and 8 weeks and averaging 0.9 kg in weight, were divided into four groups of six each and used in a 12-week feeding trial to evaluate the blood biochemistry and haematology of rabbits fed sun-dried, ensiled, and fermented cassava peel-based diets. The test diets designated A, B, C and D were completely randomised. Diet A, the control, was a 16.18 per cent CP (crude protein) weaner ration formulated from maize, maize offals, soya bean meal, blood meal, oyster shell, bone meal, vitamin premix, and common salt. Diets B, C and D were also weaner rations of, respectively, 16.10, 16.20 and 16.08 per cent CP in which 10 per cent maize of the control diet was replaced, respectively, with sun-dried, ensiled and fermented cassava peels. The diets were roughly iso-caloric. The haematological components of the study included packed cell volume (PCV), white blood cells (WBC), neutrophil (N), and lymphocytes (L). The biochemical parameters were serum creatinine, urea, bilirubin (total and conjugated), serum glutamic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), eosinophil, and blood sugar. Liver and kidney weights were also monitored. The results showed that PCV, WBC, N and L were affected (P0.05) among rabbits fed different dietary treatments. Vingt-quatre lapins mâles en sevrage de l\'espèce de Nouvelle - Zélande blanc × Chinchilla agé de 7 à 8 semaines et de poids moyen de 0.9 kg étaient divisés en 4 groups de 6 lapins chacun et employés dans un essai d\'alimentation de 12 semaines pour évaluer la biochimie et l\'hématologie de sang de lapins nourris de régimes à base de pelure de manioc séchée de soleil, ensilées et fermentée. Les régimes d\'essai classés A, B, C et D étaient complètement choisis au hasard. Le régime A, le contrôle, était une ration de sevrage avec 16.18% de CP (protéine brute) formulée de maïs, déchets de maïs, farine de graine de soja, farine sanguine, coquille d\'huître, engrais de cendres d\'os, vitamine prémix et sel ordinaire. Les régimes B, C et D étaient aussi des rations de sevrage, respectivement, avec 16.10, 16.20 et 16.08% de CP enquel 10% de maïs du régime de contrôle était remplacé par les pelures de manioc, respectivement, séchée de soleil, ensilées et fermentée. Les régimes étaient approximativement iso-cloriques. Les éléments hématologiques de l\'étude comprenaient la volume de cellule tassée (VCT), le globule sanguin blanc (GSB), le neutrophile (N) et les lymphocytes (L). Les paramètres biochimiques étaient le sérum créatinine, l\'urée, la bilirubine (totale et conjuguée), le sérum glutamique transaminase (SGPT), le sérum glutamique oxaloacétique transaminase (SGOT), l\'éosinophile et le sucre dans le sang. Les poids de foie et de rein étaient également suivis de près. Les résultats montraient que VCT, GSB, les neutrophiles et les lymphocytes étaient modifiés (

Barriers and Facilitators to the Integration of Mental Health Services into Primary Health Care: A Systematic Review Protocol.

Background Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. Methods This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the “Best fit” framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. Discussion The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the “Best fit” framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. Systematic review registration PROSPERO CRD4201605200

A Foundational View on Integration Problems

The integration of reasoning and computation services across system and language boundaries is a challenging problem of computer science. In this paper, we use integration for the scenario where we have two systems that we integrate by moving problems and solutions between them. While this scenario is often approached from an engineering perspective, we take a foundational view. Based on the generic declarative language MMT, we develop a theoretical framework for system integration using theories and partial theory morphisms. Because MMT permits representations of the meta-logical foundations themselves, this includes integration across logics. We discuss safe and unsafe integration schemes and devise a general form of safe integration