Global Mental Health: Five Areas for Value-Driven Training Innovation

PubMed Central

Kohrt, Brandon A.; Marienfeld, Carla B.; Panter-Brick, Catherine; Tsai, Alexander C.; Wainberg, Milton L.

2016-01-01

OBJECTIVE In the field of global mental health, there is a need for identifying core values and competencies to guide training programs in professional practice as well as in academia. This paper presents the results of interdisciplinary discussions fostered during an annual meeting of the Society for the Study of Psychiatry and Culture to develop recommendations for value-driven innovation in global mental health training. METHODS Participants (n=48), who registered for a dedicated workshop on global mental health training advertised in conference proceedings, included both established faculty and current students engaged in learning, practice, and research. They proffered recommendations in five areas of training curriculum: values, competencies, training experiences, resources, and evaluation. RESULTS Priority values included humility, ethical awareness of power differentials, collaborative action, and “deep accountability” when working in low-resource settings in both low- and middle-income countries (LMIC) and high-income countries. Competencies included flexibility and tolerating ambiguity when working across diverse settings, the ability to systematically evaluate personal biases, historical and linguistic proficiency, and evaluation skills across a range of stakeholders. Training experiences included didactics, language, self-awareness, and supervision in immersive activities related to professional or academic work. Resources included connections with diverse faculty such as social scientists and mentors other than medical practitioners, institutional commitment through protected time and funding, and sustainable collaborations with partners in low resource settings. Finally, evaluation skills built upon community-based participatory methods, 360-degree feedback from partners in low-resource settings, and observed structured clinical evaluations (OSCEs) with people of different cultural backgrounds. CONCLUSIONS Global mental health training, as envisioned in this workshop, exemplifies an ethos of working through power differentials across clinical, professional, and social contexts in order to form longstanding collaborations. If incorporated into the ACGME/ABPN Psychiatry Milestone Project, such recommendations will improve training gained through international experiences as well as the everyday training of mental health professionals, global health practitioners, and social scientists. PMID:26983416

Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

PubMed Central

Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K. M.; Zafar, Afia

2015-01-01

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities. PMID:25882388

Success criteria for electronic medical record implementations in low-resource settings: a systematic review.

PubMed

Fritz, Fleur; Tilahun, Binyam; Dugas, Martin

2015-03-01

Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations. Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training. We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed. Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A comparison of work stressors in higher and lower resourced emergency medicine health settings.

PubMed

de Haan, Sebastian; Lamprecht, Hein; Howlett, Michael K; Fraser, Jacqueline; Sohi, Dylan; Adisesh, Anil; Atkinson, Paul R

2018-04-06

CLINICIAN'S CAPSULE What is known about the topic? Emergency physicians and trainees have high rates of stress and burnout. What did this study ask? How do reported stressors for emergency physicians and trainees differ between high and low resource settings? What did this study find? Trainees in the low resource setting reported higher stressors. Trainees reported higher levels of stressors than specialists in general. Why does this study matter to clinicians? High levels of reported stressors among trainees, and in low resource settings should be acknowledged and mitigated where possible.

Catatonia in Resource Limited Settings: A Case Series and Treatment Protocol

PubMed Central

Smith, Stephanie L.; Grelotti, David J.; Fils-Aime, Reginald; Uwimana, Eugenie; Ndikubwimana, Jean-Sauveur; Therosme, Tatiana; Severe, Jennifer; Dushimiyimana, Dominique; Uwamariya, Clemence; Bienvenu, Robert; Alcindor, Yoldie; Eustache, Eddy; Raviola, Giuseppe J.; Fricchione, Gregory L.

2014-01-01

Objective The Catatonic Syndrome (“catatonia”) is characterized by motor and motivation dysregulation and is associated with a number of neuropsychiatric and medical disorders. It is recognizable in a variety of clinical settings. We present observations from the treatment of four individuals with catatonia in Haiti and Rwanda, and introduce a treatment protocol for use in resource limited settings Methods Four patients from rural Haiti and Rwanda with clinical signs of catatonia and a positive screen using the Bush-Francis-Catatonia Rating Scale were treated collaboratively by general physicians and mental health clinicians with either lorazepam or diazepam. Success in treatment was clinically assessed by complete remittance of catatonia symptoms. Results The four patients in this report exhibited a range of characteristic and recognizable signs of catatonia, including immobility/stupor, stereotypic movements, echophenomena, posturing, odd mannerisms, mutism, and refusal to eat or drink. All four cases presented initially to rural outpatient general health services in low resource settings. In some cases, diagnostic uncertainty initially led to treatment with typical antipsychotics. In each case, proper identification and treatment of catatonia with benzodiazepines led to significant clinical improvement. Conclusion Catatonia can be effectively and inexpensively treated in resource limited settings. Identification and management of catatonia is critical for the health and safety of patients with this syndrome. Familiarity with the clinical features of catatonia is essential for health professionals working in low resource settings. To facilitate early recognition of this treatable disorder, catatonia should feature more prominently in global mental health discourse. PMID:25467078

Building surgical capacity in low-resource countries: a qualitative analysis of task shifting from surgeon volunteers' perspectives.

PubMed

Aliu, Oluseyi; Corlew, Scott D; Heisler, Michele E; Pannucci, Christopher J; Chung, Kevin C

2014-01-01

Surgical volunteer organizations (SVOs) focus considerable resources on addressing the backlog of cases in low-resource countries. This model of service may perpetuate dependency. Efforts should focus on models that establish independence in providing surgical care. Independence could be achieved through surgical capacity building. However, there has been scant discussion in literature on SVO involvement in surgical capacity building. Using qualitative methods, we evaluated the perspectives of surgeons with extensive volunteer experience in low-resource countries. We collected data through in-depth interviews that centered on SVOs using task shifting as a tool for surgical capacity building. Some of the key themes from our analysis include the ethical ramifications of task shifting, the challenges of addressing technical and clinical education in capacity building for low-resource settings, and the allocation of limited volunteer resources toward surgical capacity building. These themes will be the foundation of subsequent studies that will focus on other stakeholders in surgical capacity building including host communities and SVO administrators.

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings

PubMed Central

Raykar, Nakul P; Yorlets, Rachel R; Liu, Charles; Goldman, Roberta; Greenberg, Sarah L M; Kotagal, Meera; Farmer, Paul E; Meara, John G; Roy, Nobhojit; Gillies, Rowan D

2016-01-01

Introduction 5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges—the specific circumstances—faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. Methods From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. Results Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient–provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. Discussion While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences. PMID:28588976

Cultural Influences in Women-Friendly Labor-Saving Hand Tool Designs

PubMed Central

Kisaalita, William S.; Katimbo, Abia; Sempiira, Edison J.; Mugisa, Dana J.

2016-01-01

Objective: The aim of this study was to highlight the importance of culture in sustainable, labor-saving solutions design for women in low-resource settings. Background: One of the reasons behind the gender asset gap among Sub-Saharan African women is the higher labor burden these women face, making it difficult for them to produce for the home and markets. Hand tools are the simplest form and therefore the best first step to address this problem. But designing women-friendly (sustainable) hand tools calls for better understanding of the low-resource settings where these women reside. Method: A milk churner was redesigned using a human-centered (participatory) approach with groups of women from two dominant ethnolinguistic groups of Bantu and Nilotic of Uganda, and its usability was tested. Results: The churner reduced labor up to eightfold and has potential to expand the range of uses to include children and husbands due to its simplicity. Also, the churner significantly reduced undesirable health effects, like pain in knee joints. Based on the experience with the churner, a six-item “survival guide” is proposed to complement human-centered design guiding principles for facilitating the generation of solutions in low-resource settings. Conclusion: By paying great attention to culture in relation to human factors, a labor-reducing churner has been successfully introduced among Ugandan women. The ultimate goal is to make the churner available to female smallholder dairy-farming households throughout Sub-Saharan Africa. Applications: This study provides a survival guide for generating solutions to problems from low-resource settings. PMID:26764373

Where do pulse oximeter probes break?

PubMed

Crede, S; Van der Merwe, G; Hutchinson, J; Woods, D; Karlen, W; Lawn, J

2014-06-01

Pulse oximetry, a non-invasive method for accurate assessment of blood oxygen saturation (SPO2), is an important monitoring tool in health care facilities. However, it is often not available in many low-resource settings, due to expense, overly sophisticated design, a lack of organised procurement systems and inadequate medical device management and maintenance structures. Furthermore medical devices are often fragile and not designed to withstand the conditions of low-resource settings. In order to design a probe, better suited to the needs of health care facilities in low-resource settings this study aimed to document the site and nature of pulse oximeter probe breakages in a range of different probe designs in a low to middle income country. A retrospective review of job cards relating to the assessment and repair of damaged or faulty pulse oximeter probes was conducted at a medical device repair company based in Cape Town, South Africa, specializing in pulse oximeter probe repairs. 1,840 job cards relating to the assessment and repair of pulse oximeter probes were reviewed. 60.2 % of probes sent for assessment were finger-clip probes. For all probes, excluding the neonatal wrap probes, the most common point of failure was the probe wiring (>50 %). The neonatal wrap most commonly failed at the strap (51.5 %). The total cost for quoting on the broken pulse oximeter probes and for the subsequent repair of devices, excluding replacement components, amounted to an estimated ZAR 738,810 (USD $98,508). Improving the probe wiring would increase the life span of pulse oximeter probes. Increasing the life span of probes will make pulse oximetry more affordable and accessible. This is of high priority in low-resource settings where frequent repair or replacement of probes is unaffordable or impossible.

Measuring Health-Related Quality of Life of HIV-Positive Adolescents in Resource-Constrained Settings

PubMed Central

Masquillier, Caroline; Wouters, Edwin; Loos, Jasna; Nöstlinger, Christiana

2012-01-01

Background and Objectives Access to antiretroviral treatment among adolescents living with HIV (ALH) is increasing. Health-related quality of life (HRQOL) is relevant for monitoring the impact of the disease on both well-being and treatment outcomes. However, adequate screening tools to assess HRQOL in low-resource settings are scarce. This study aims to fill this research gap, by 1) assessing the psychometric properties and reliability of an Eastern African English version of a European HRQOL scale for adolescents (KIDSCREEN) and 2) determining which version of the KIDSCREEN (52-, 27- and 10-item version) is most suitable for low-resource settings. Methods The KIDSCREEN was translated into Eastern African English, Luganda (Uganda) and Dholuo (Kenya) according to standard procedures. The reconciled version was administered in 2011 to ALH aged 13–17 in Kenya (n = 283) and Uganda (n = 299). All three KIDSCREEN versions were fitted to the data with confirmatory factor analysis (CFA). After comparison, the most suitable version was adapted based on the CFA outcomes utilizing the results of previous formative research. In order to develop a general HRQOL factor, a second-order measurement model was fitted to the data. Results The CFA results showed that without adjustments, the KIDSCREEN cannot be used for measuring the HRQOL of HIV-positive adolescents. After comparison, the most suitable version for low-resource settings - the 27-item version - was adapted further. The introduction of a negative wording factor was required for the Dholuo model. The Dholuo (CFI: 0.93; RMSEA: 0.039) and the Luganda model (CFI: 0.90; RMSEA: 0.052) showed a good fit. All cronbach’s alphas of the factors were 0.70 or above. The alpha value of the Dholuo and Lugandan HRQOL second-order factor was respectively 0.84 and 0.87. Conclusions The study showed that the adapted KIDSCREEN-27 is an adequate tool for measuring HRQOL in low-resource settings with high HIV prevalence. PMID:22815776

Medical devices and diagnostics for cardiovascular diseases in low-resource settings.

PubMed

McGuire, Helen; Weigl, Bernhard H

2014-11-01

Noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes, have emerged as an underappreciated health threat with enormous economic and public health implications for populations in low-resource settings. In order to address these diseases, devices that are to be used in low-resource settings have to conform to requirements that are generally more challenging than those developed for traditional markets. Characteristics and issues that must be considered when working in low- and middle-income countries (LMICs) include challenging environmental conditions, a complex supply chain, sometimes inadequate operator training, and cost. Somewhat counterintuitively, devices for low-resource setting (LRS) markets need to be of at least as high quality and reliability as those for developed countries to be setting-appropriate and achieve impact. Finally, the devices need to be designed and tested for the populations in which they are to be used in order to achieve the performance that is needed. In this review, we focus on technologies for primary and secondary health-care settings and group them according to the continuum of care from prevention to treatment.

Task Shifting in Dermatology: A Call to Action.

PubMed

Brown, Danielle N; Langan, Sinéad M; Freeman, Esther E

2017-11-01

Can task shifting be used to improve the delivery of dermatologic care in resource-poor settings worldwide? Task shifting is a means of redistributing available resources, whereby highly trained individuals train an available workforce to provide necessary care in low-resource settings. Limited evidence exists for task shifting in dermatology; however, studies from psychiatry demonstrate its efficacy. In the field of dermatology there is a need for high-quality evidence including randomized clinical trials to validate the implementation of task shifting in low-resource settings globally.

Implementation of quality management for clinical bacteriology in low-resource settings.

PubMed

Barbé, B; Yansouni, C P; Affolabi, D; Jacobs, J

2017-07-01

The declining trend of malaria and the recent prioritization of containment of antimicrobial resistance have created a momentum to implement clinical bacteriology in low-resource settings. Successful implementation relies on guidance by a quality management system (QMS). Over the past decade international initiatives were launched towards implementation of QMS in HIV/AIDS, tuberculosis and malaria. To describe the progress towards accreditation of medical laboratories and to identify the challenges and best practices for implementation of QMS in clinical bacteriology in low-resource settings. Published literature, online reports and websites related to the implementation of laboratory QMS, accreditation of medical laboratories and initiatives for containment of antimicrobial resistance. Apart from the limitations of infrastructure, equipment, consumables and staff, QMS are challenged with the complexity of clinical bacteriology and the healthcare context in low-resource settings (small-scale laboratories, attitudes and perception of staff, absence of laboratory information systems). Likewise, most international initiatives addressing laboratory health strengthening have focused on public health and outbreak management rather than on hospital based patient care. Best practices to implement quality-assured clinical bacteriology in low-resource settings include alignment with national regulations and public health reference laboratories, participating in external quality assurance programmes, support from the hospital's management, starting with attainable projects, conducting error review and daily bench-side supervision, looking for locally adapted solutions, stimulating ownership and extending existing training programmes to clinical bacteriology. The implementation of QMS in clinical bacteriology in hospital settings will ultimately boost a culture of quality to all sectors of healthcare in low-resource settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial.

PubMed

Paul, Mandira; Iyengar, Sharad D; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Kirti; Bring, Johan; Klingberg-Allvin, Marie

2016-10-17

Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114). There were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use. Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods. Clinicaltrials.gov NCT01827995.

Recombinase polymerase amplification: Emergence as a critical molecular technology for rapid, low-resource diagnostics.

PubMed

James, Ameh; Macdonald, Joanne

2015-01-01

Isothermal molecular diagnostics are bridging the technology gap between traditional diagnostics and polymerase chain reaction-based methods. These new techniques enable timely and accurate testing, especially in settings where there is a lack of infrastructure to support polymerase chain reaction facilities. Despite this, there is a significant lack of uptake of these technologies in developing countries where they are highly needed. Among these novel isothermal technologies, recombinase polymerase amplification (RPA) holds particular potential for use in developing countries. This rapid nucleic acid amplification approach is fast, highly sensitive and specific, and amenable to countries with a high burden of infectious diseases. Implementation of RPA technology in developing countries is critically required to assess limitations and potentials of the diagnosis of infectious disease, and may help identify impediments that prevent adoption of new molecular technologies in low resource- and low skill settings. This review focuses on approaching diagnosis of infectious disease with RPA.

Returning Incidental Findings in Low-Resource Settings: A Case of Rescue?

PubMed

Mackay, Douglas

2018-05-01

In a carefully argued article, Haley K. Sullivan and Benjamin E. Berkman address the important question of whether investigators have a duty to report incidental findings to research participants in low-resource settings. They suggest that the duty to rescue offers the most plausible justification for the duty to return incidental findings, and they explore the implications of this duty for the context of research in low-resource settings. While I think they make valuable headway on an important problem, in this commentary, I identify a significant difference between the paradigmatic rescue case and the return of incidental findings in low-resource settings. This difference, I suggest, implies that their framework may be too narrow in scope. If investigators (and their sponsors) really wish to fulfill their duty to rescue, they must consider factors that are left out of Sullivan and Berkman's framework. © 2018 The Hastings Center.

Comparison of point-of-care-compatible lysis methods for bacteria and viruses.

PubMed

Heiniger, Erin K; Buser, Joshua R; Mireles, Lillian; Zhang, Xiaohong; Ladd, Paula D; Lutz, Barry R; Yager, Paul

2016-09-01

Nucleic acid sample preparation has been an especially challenging barrier to point-of-care nucleic acid amplification tests in low-resource settings. Here we provide a head-to-head comparison of methods for lysis of, and nucleic acid release from, several pathogenic bacteria and viruses-methods that are adaptable to point-of-care usage in low-resource settings. Digestion with achromopeptidase, a mixture of proteases and peptidoglycan-specific hydrolases, followed by thermal deactivation in a boiling water bath, effectively released amplifiable nucleic acid from Staphylococcus aureus, Bordetella pertussis, respiratory syncytial virus, and influenza virus. Achromopeptidase was functional after dehydration and reconstitution, even after eleven months of dry storage without refrigeration. Mechanical lysis methods proved to be effective against a hard-to-lyse Mycobacterium species, and a miniature bead-mill, the AudioLyse, is shown to be capable of releasing amplifiable DNA and RNA from this species. We conclude that point-of-care-compatible sample preparation methods for nucleic acid tests need not introduce amplification inhibitors, and can provide amplification-ready lysates from a wide range of bacterial and viral pathogens. Copyright © 2016. Published by Elsevier B.V.

Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review.

PubMed

Syzdykova, Assel; Malta, André; Zolfo, Maria; Diro, Ermias; Oliveira, José Luis

2017-11-13

Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented. There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings. ©Assel Syzdykova, André Malta, Maria Zolfo, Ermias Diro, José Luis Oliveira. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 13.11.2017.

Health researchers' ancillary care obligations in low-resource settings: how can we tell what is morally required?

PubMed

Merritt, Maria W

2011-12-01

Health researchers working in low-resource settings often encounter serious unmet health needs among participants. What is the nature and extent of researchers' obligations to respond to such needs? Competing accounts have been proposed, but there is no independent standard by which to assess them or to guide future inquiry. I propose an independent standard and demonstrate its use. In conclusion I recommend two areas of focus for future inquiry: what makes an account of researchers' obligations reasonable from the standpoint of both participants and researchers and how general duties of rescue apply to researchers' resource-allocation decision making in low-resource settings.

24 CFR 904.206 - Funding.

Code of Federal Regulations, 2011 CFR

2011-04-01

... ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT LOW RENT... available during the development phase, and a specific amount shall be set aside, in accordance with... community resources to be utilized; (v) The methods of counseling and training to be utilized; (vi) The...

Global Mental Health: Five Areas for Value-Driven Training Innovation.

PubMed

Kohrt, Brandon A; Marienfeld, Carla B; Panter-Brick, Catherine; Tsai, Alexander C; Wainberg, Milton L

2016-08-01

In the field of global mental health, there is a need for identifying core values and competencies to guide training programs in professional practice as well as in academia. This paper presents the results of interdisciplinary discussions fostered during an annual meeting of the Society for the Study of Psychiatry and Culture to develop recommendations for value-driven innovation in global mental health training. Participants (n = 48), who registered for a dedicated workshop on global mental health training advertised in conference proceedings, included both established faculty and current students engaged in learning, practice, and research. They proffered recommendations in five areas of training curriculum: values, competencies, training experiences, resources, and evaluation. Priority values included humility, ethical awareness of power differentials, collaborative action, and "deep accountability" when working in low-resource settings in low- and middle-income countries and high-income countries. Competencies included flexibility and tolerating ambiguity when working across diverse settings, the ability to systematically evaluate personal biases, historical and linguistic proficiency, and evaluation skills across a range of stakeholders. Training experiences included didactics, language training, self-awareness, and supervision in immersive activities related to professional or academic work. Resources included connections with diverse faculty such as social scientists and mentors in addition to medical practitioners, institutional commitment through protected time and funding, and sustainable collaborations with partners in low resource settings. Finally, evaluation skills built upon community-based participatory methods, 360-degree feedback from partners in low-resource settings, and observed structured clinical evaluations (OSCEs) with people of different cultural backgrounds. Global mental health training, as envisioned in this workshop, exemplifies an ethos of working through power differentials across clinical, professional, and social contexts in order to form longstanding collaborations. If incorporated into the ACGME/ABPN Psychiatry Milestone Project, such recommendations will improve training gained through international experiences as well as the everyday training of mental health professionals, global health practitioners, and social scientists.

Development and validation of a noncontact spectroscopic device for hemoglobin estimation at point-of-care

NASA Astrophysics Data System (ADS)

Sarkar, Probir Kumar; Pal, Sanchari; Polley, Nabarun; Aich, Rajarshi; Adhikari, Aniruddha; Halder, Animesh; Chakrabarti, Subhananda; Chakrabarti, Prantar; Pal, Samir Kumar

2017-05-01

Anemia severely and adversely affects human health and socioeconomic development. Measuring hemoglobin with the minimal involvement of human and financial resources has always been challenging. We describe a translational spectroscopic technique for noncontact hemoglobin measurement at low-resource point-of-care settings in human subjects, independent of their skin color, age, and sex, by measuring the optical spectrum of the blood flowing in the vascular bed of the bulbar conjunctiva. We developed software on the LabVIEW platform for automatic data acquisition and interpretation by nonexperts. The device is calibrated by comparing the differential absorbance of light of wavelength 576 and 600 nm with the clinical hemoglobin level of the subject. Our proposed method is consistent with the results obtained using the current gold standard, the automated hematology analyzer. The proposed noncontact optical device for hemoglobin estimation is highly efficient, inexpensive, feasible, and extremely useful in low-resource point-of-care settings. The device output correlates with the different degrees of anemia with absolute and trending accuracy similar to those of widely used invasive methods. Moreover, the device can instantaneously transmit the generated report to a medical expert through e-mail, text messaging, or mobile apps.

Correlates of birth asphyxia using two Apgar score classification methods.

PubMed

Olusanya, Bolajoko O; Solanke, Olumuyiwa A

2010-01-01

Birth asphyxia is commonly indexed by low five-minute Apgar scores especially in resource-constrained settings but the impact of different classification thresholds on the associated risk factors has not been reported. To determine the potential impact of two classification methods of five-minute Apgar score as predictor for birth asphyxia. A cross-sectional study of preterm and term survivors in Lagos, Nigeria in which antepartum and intrapartum factors associated with "very low" (0-3) or "intermediate" (4-6) five-minute Apgar scores were compared with correlates of low five-minute Apgar scores (0-6) based on multinomial and binary logistic regression analyses. Of the 4281 mother-infant pairs enrolled, 3377 (78.9%) were full-term and 904 (21.1%) preterm. Apgar scores were very low in 99 (2.3%) and intermediate in 1115 (26.0%). Antenatal care, premature rupture of membranes (PROM), hypertensive disorders and mode of delivery were associated with very low and intermediate Apgar scores in all infants. Additionally, parity, antepartum haemorrhage and prolonged/obstructed labour (PROL) were predictive in term infants compared with maternal occupation and intrauterine growth restriction (IUGR) in preterm infants. Conversely, PROM in term infants and maternal occupation in preterm infants were not significantly associated with the composite low Apgar scores (0-6) while IUGR was associated with term infants. Predictors of birth asphyxia in preterm and term infants are likely to be affected by the Apgar score classification method adopted and the clinical implications for optimal resuscitation practices merit attention in resource-constrained settings.

Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

PubMed Central

Strother, R. Matthew; Ndiangui, Francis; Chumba, David; Jacobson, William; Dodson, Cecelia; Resnic, Murray B.; Strate, Randall W.; Smith, James W.

2016-01-01

Background Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service. Objectives, methods and outcomes Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme. Conclusion Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment. PMID:28879100

Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries☆

PubMed Central

Tangka, Florence K.L.; Subramanian, Sujha; Edwards, Patrick; Cole-Beebe, Maggie; Parkin, D. Maxwell; Bray, Freddie; Joseph, Rachael; Mery, Les; Saraiya, Mona

2018-01-01

Background The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. Methods Using the Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). Results Host institution contributions accounted for 30%–70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. Conclusion This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries-with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings. PMID:27793574

Efficiency of Health Care Production in Low-Resource Settings: A Monte-Carlo Simulation to Compare the Performance of Data Envelopment Analysis, Stochastic Distance Functions, and an Ensemble Model

PubMed Central

Giorgio, Laura Di; Flaxman, Abraham D.; Moses, Mark W.; Fullman, Nancy; Hanlon, Michael; Conner, Ruben O.; Wollum, Alexandra; Murray, Christopher J. L.

2016-01-01

Low-resource countries can greatly benefit from even small increases in efficiency of health service provision, supporting a strong case to measure and pursue efficiency improvement in low- and middle-income countries (LMICs). However, the knowledge base concerning efficiency measurement remains scarce for these contexts. This study shows that current estimation approaches may not be well suited to measure technical efficiency in LMICs and offers an alternative approach for efficiency measurement in these settings. We developed a simulation environment which reproduces the characteristics of health service production in LMICs, and evaluated the performance of Data Envelopment Analysis (DEA) and Stochastic Distance Function (SDF) for assessing efficiency. We found that an ensemble approach (ENS) combining efficiency estimates from a restricted version of DEA (rDEA) and restricted SDF (rSDF) is the preferable method across a range of scenarios. This is the first study to analyze efficiency measurement in a simulation setting for LMICs. Our findings aim to heighten the validity and reliability of efficiency analyses in LMICs, and thus inform policy dialogues about improving the efficiency of health service production in these settings. PMID:26812685

Use of short messaging services to assess depressive symptoms among refugees in South Africa: Implications for social services providing mental health care in resource-poor settings

PubMed Central

Tomita, Andrew; Kandolo, Ka Muzombo; Susser, Ezra; Burns, Jonathan K

2016-01-01

Few studies in developing nations have assessed the use of short messaging services (SMS) to identify psychological challenges in refugee populations. This study aimed to assess the feasibility of SMS-based methods to screen for depression risk among refugees in South Africa attending mental health services, and to compare its reliability and acceptability with face-to-face consultation. Of the 153 refugees enrolled at baseline, 135 were available for follow-up assessments in our cohort study. Depression symptomatology was assessed using the 16-item Quick Inventory of Depressive Symptomatology (QIDS) instrument. Nearly everyone possessed a mobile phone and utilized SMS. Furthermore, low incomplete item response in QIDS and high perceived ease of interacting via SMS with service providers supported the feasibility of this method. There was a fair level of reliability between face-to-face and SMS-based screening methods, but no significant difference in preference rating between the two methods. Despite potential implementation barriers (network delay/phone theft), depression screening using SMS may be viable for refugee mental health services in low-resource settings. PMID:26407989

Melt-and-mold fabrication (MnM-Fab) of reconfigurable low-cost devices for use in resource-limited settings.

PubMed

Li, Zhi; Tevis, Ian D; Oyola-Reynoso, Stephanie; Newcomb, Lucas B; Halbertsma-Black, Julian; Bloch, Jean-Francis; Thuo, Martin

2015-12-01

Interest in low-cost analytical devices (especially for diagnostics) has recently increased; however, concomitant translation to the field has been slow, in part due to personnel and supply-chain challenges in resource-limited settings. Overcoming some of these challenges require the development of a method that takes advantage of locally available resources and/or skills. We report a Melt-and-mold fabrication (MnM Fab) approach to low-cost and simple devices that has the potential to be adapted locally since it requires a single material that is recyclable and simple skills to access multiple devices. We demonstrated this potential by fabricating entry level bio-analytical devices using an affordable low-melting metal alloy, Field's metal, with molds produced from known materials such as plastic (acrylonitrile-butadiene-styrene (ABS)), glass, and paper. We fabricated optical gratings then 4×4 well plates using the same recycled piece of metal. We then reconfigured the well plates into rapid prototype microfluidic devices with which we demonstrated laminar flow, droplet generation, and bubble formation from T-shaped channels. We conclude that this MnM-Fab method is capable of addressing some challenges typically encountered with device translation, such as technical know-how or material supply, and that it can be applied to other devices, as needed in the field, using a single moldable material. Copyright © 2015 Elsevier B.V. All rights reserved.

Molecular diagnostics for low resource settings

NASA Astrophysics Data System (ADS)

Weigl, Bernhard H.

2010-03-01

As traditional high quality diagnostic laboratories are not widely available or affordable in developing country health care settings, microfluidics-based point-of-care diagnostics may be able to address the need to perform complex assays in under-resourced areas. Many instrument-based as well as non-instrumented microfluidic prototype diagnostics are currently being developed. In addition to various engineering challenges, the greatest remaining issue is the search for truly low-cost disposable manufacturing methods. Diagnostics for global health, and specifically microfluidics and molecular-based low resource diagnostics, have become a very active research area over the last five years, thanks in part to new funding that became available from the Bill and Melinda Gates Foundation, the National Institutes of Health, and other sources. This has led to a number of interesting prototype devices that are now in advanced development or clinical validation. These devices include disposables and instruments that perform multiplexed PCR-based lab-on-a-chips for enteric, febrile, and vaginal diseases, as well as immunoassays for diseases such as malaria, HIV, and various sexually transmitted diseases. More recently, instrument-free diagnostic disposables based on isothermal nucleic acid amplification have been developed as well. Regardless of platform, however, the search for truly low-cost manufacturing methods that would result in cost of goods per disposable of around US1/unit at volume remains a big challenge. This talk will give an overview over existing platform development efforts as well as present some original research in this area at PATH.

Indicators to assess the functionality of clubfoot clinics in low-resource settings: a Delphi consensus approach and pilot study.

PubMed

Smythe, Tracey; Mudariki, Debra; Foster, Allen; Lavy, Christopher

2018-05-19

This study aims to determine the indicators for assessing the functionality of clubfoot clinics in a low-resource setting. The Delphi method was employed with experienced clubfoot practitioners in Africa to rate the importance of indicators of a good clubfoot clinic. The consistency among the participants was determined with the intraclass correlation coefficient. Indicators that achieved strong agreement (mean≥9 [SD <1.5]) were included in the final consensus definition. Based on the final consensus definition, a set of questions was developed to form the Functionality Assessment Clubfoot Clinic Tool (FACT). The FACT was used between February and July 2017 to assess the functionality of clinics in the Zimbabwe clubfoot programme. A set of 10 indicators that includes components of five of the six building blocks of a health system-leadership, human resources, essential medical equipment, health information systems and service delivery-was produced. The most common needs identified in Zimbabwe clubfoot clinics were a standard treatment protocol, a process for surgical referrals and a process to monitor dropout of patients. Practitioners had good consistency in rating indicators. The consensus definition includes components of the World Health Organization building blocks of health systems. Useful information was obtained on how to improve the services in the Zimbabwe clubfoot programme.

Treating Locally Advanced Cervical Cancer With Concurrent Chemoradiation Without Brachytherapy in Low-resource Countries.

PubMed

Chuang, Linus; Kanis, Margaux J; Miller, Brigitte; Wright, Jason; Small, William; Creasman, William

2016-02-01

To summarize the literature on options of management of patients treated for locally advanced cervical cancers with a specific focus on resource-constrained settings where brachytherapy is not available. A Medline search was performed to summarize studies about treatment approaches including neoadjuvant chemotherapy, primary surgery for bulky cervical cancer, and chemoradiation followed by surgery. Summaries are by treatment approaches that are relevant to resource-constrained settings. There are a lack of studies performed on neoadjuvant chemotherapy in low-resource settings. Primary surgery followed by chemoradiation therapy for selected patients with bulky cervical cancer is a feasible option. The disadvantage is the potential increase in treatment complications. Chemoradiation without brachytherapy followed by surgery has been found to have equivalent outcomes and is associated with acceptable morbidity. In resource-constrained settings where brachytherapy is not available, performing radical hysterectomy after chemoradiation therapy without brachytherapy has been shown to produce equivalent outcomes. It seems reasonable to adopt a modified therapeutic protocol of chemoradiation followed by extrafascial hysterectomy as an alternative treatment option in low-resource countries where brachytherapy is not readily available.

Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana.

PubMed

Kallam, Brianne; Pettitt-Schieber, Christie; Owen, Medge; Agyare Asante, Rebecca; Darko, Elizabeth; Ramaswamy, Rohit

2018-05-19

Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the 'Interactive Systems Framework for Dissemination and Implementation' (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts-a group of healthcare workers with typically very low levels of compliance. The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.

Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

PubMed

Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

2017-03-15

Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

Infertility in resource-constrained settings: moving towards amelioration.

PubMed

Hammarberg, Karin; Kirkman, Maggie

2013-02-01

It is often presumed that infertility is not a problem in resource-poor areas where fertility rates are high. This is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproductive technology in low-resource countries. This paper challenges the construct that infertility is not a serious problem in resource-constrained settings and argues that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. It is often presumed that infertility is not a problem in densely populated, resource-poor areas where fertility rates are high. This presumption is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Because many families in low-income countries depend on children for economic survival, childlessness and having fewer children than the number identified as appropriate are social and public health matters, not only medical problems. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources and family planning activities should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproduction technology in low-resource countries. In this paper, we challenge the construct that infertility is not a serious problem in resource-constrained settings and argue that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

10 best resources on ... mixed methods research in health systems.

PubMed

Ozawa, Sachiko; Pongpirul, Krit

2014-05-01

Mixed methods research has become increasingly popular in health systems. Qualitative approaches are often used to explain quantitative results and help to develop interventions or survey instruments. Mixed methods research is especially important in low- and middle-income country (LMIC) settings, where understanding social, economic and cultural contexts are essential to assess health systems performance. To provide researchers and programme managers with a guide to mixed methods research in health systems, we review the best resources with a focus on LMICs. We selected 10 best resources (eight peer-reviewed articles and two textbooks) based on their importance and frequency of use (number of citations), comprehensiveness of content, usefulness to readers and relevance to health systems research in resource-limited contexts. We start with an overview on mixed methods research and discuss resources that are useful for a better understanding of the design and conduct of mixed methods research. To illustrate its practical applications, we provide examples from various countries (China, Vietnam, Kenya, Tanzania, Zambia and India) across different health topics (tuberculosis, malaria, HIV testing and healthcare costs). We conclude with some toolkits which suggest what to do when mixed methods findings conflict and provide guidelines for evaluating the quality of mixed methods research.

Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities.

PubMed

Ruzek, J I; Yeager, C M

2017-01-01

Internet and mobile technologies offer potentially critical ways of delivering mental health support in low-resource settings. Much evidence indicates an enormous negative impact of mental health problems in low- and middle-income countries (LMICs), and many of these problems are caused, or worsened, by exposure to wars, conflicts, natural and human-caused disasters, and other traumatic events. Though specific mental health treatments have been found to be efficacious and cost-effective for low-resource settings, most individuals living in these areas do not have access to them. Low-intensity task-sharing interventions will help, but there is a limit to the scalability and sustainability of human resources in these settings. To address the needs of trauma survivors, it will be important to develop and implement Internet and mobile technology resources to help reduce the scarcity, inequity, and inefficiency of current mental health services in LMICs. Mobile and Internet resources are experiencing a rapid growth in LMICs and can help address time, stigma, and cost barriers and connect those who have been socially isolated by traumatic events. This review discusses current research in technological interventions in low-resource settings and outlines key issues and future challenges and opportunities. Though formidable challenges exist for large-scale deployment of mobile and Internet mental health technologies, work to date indicates that these technologies are indeed feasible to develop, evaluate, and deliver to those in need of mental health services, and that they can be effective.

Study on the potential for delay tolerant networks by health workers in low resource settings.

PubMed

Syed-Abdul, Shabbir; Scholl, Jeremiah; Lee, Peisan; Jian, Wen-Shan; Liou, Der-Ming; Li, Yu-Chuan

2012-09-01

Medical Informatics Systems (MIS) have been suggested as having great potential to improve health care delivery in low resource settings. One of the major barriers for adopting MIS in this context is a lack of adequate network/communication infrastructure. Delay Tolerant Networking (DTN) is an approach for establishing network connectivity in situations where it is possible to support physical transport of the digital information. To date most DTN research has been technically oriented, and very few services have been implemented to support healthcare systems using the technology. It is thus unclear about the potential that DTN may have for supporting MIS systems in low resource settings. The goals of the paper are twofold, first, to gain an initial estimate of interest in different services that can be supported by DTN. Second, to find out the necessary frequency associated with each service for supporting health work in low resource settings. Fifty questionnaires were distributed to attendants at the International Conference on Global Health that had acknowledged having health work experience in a poor connectivity context. The respondents were using a 5-point Likert scale regarding if 9 different potential DTN services "would be useful". They also were asked how often data delivery would be necessary for these services to be useful. The Chi square was calculated to measure acceptance. 37 responses were received, aggregating the response rate of 74%. The respondents represented having work experience from 8 months to 15 years from 35 resource poor countries. The Chi square test showed very high statistical significance for "strongly agree and agree" for the potential usefulness of the proposed DTN services, with a p-value less than 0.001. The frequency of data delivery that would be necessary for services to be useful varied considerably. This study provides evidence of potential for DTN to support useful services that support health work in low resource settings, and that services like access to email, notification of lab results, backup of EHR and teleconsultation are seem to be most important services that can be supported by DTN. The necessary frequency of data delivery for each service, will be highly dependent on context. In a low resource setting with limited mobility, the physical transport of digital data at a frequency of less than once per week should still be sufficient for useful services like notification of lab results and ordering of medical supplies. Research comparing different methods for delivery of DTN data should thus be useful. Further research and collaboration between MIS and Computer Science research communities is recommended in order to help develop DTN services that can be evaluated. Efforts to enhance awareness among stakeholders about how DTN can be used to support health services should be worthwhile. Copyright © 2011. Published by Elsevier Ireland Ltd.

Severe preeclampsia and eclampsia: incidence, complications, and perinatal outcomes at a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

PubMed

Ngwenya, Solwayo

2017-01-01

Severe preeclampsia is a disorder of pregnancy characterized by high blood pressure and significant proteinuria after 20 weeks gestation. Severe preeclampsia and eclampsia have considerable adverse impacts on maternal, fetal, and neonatal health especially in low-resource countries. Hypertensive disorders of pregnancy are the third leading cause of maternal deaths in Sub-Saharan Africa. Significant avoidable maternal and neonatal morbidity and mortality may result. This study aimed 1) to determine the incidence of severe preeclampsia/eclampsia in a low-resource setting; 2) to determine the maternal complications of severe preeclampsia/eclampsia in a low-resource setting; 3) to determine the perinatal outcomes of severe preeclampsia/eclampsia in a low-resource setting. This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the birth registers in labor ward, intensive care unit, and neonatal intensive care unit of patients who had a diagnosis of severe preeclampsia or eclampsia for the period January 1, 2016, to December 31, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered. There were 9,086 deliveries at the institution during the period January 1, 2016, to December 31, 2016. There were 121 cases of severe preeclampsia/eclampsia. The incidence of severe preeclampsia/eclampsia was 1.3% at Mpilo Central Hospital. The most common major complication was HELLP syndrome (9.1%). Maternal mortality was 1.7%. There were 127 babies born with six sets of twins, 49.6% of the babies were lost through stillbirths and early neonatal deaths. The incidence of severe preeclampsia/eclampsia at Mpilo Central Hospital was 1.3%. The most common maternal complication was hemolysis elevated liver enzymes low platelet syndrome. Maternal mortality was 1.7% due to acute renal failure. Nearly half (49.6%) of the babies born were lost to stillbirths and early neonatal deaths.

Early Antibiotic Exposure in Low-resource Settings Is Associated With Increased Weight in the First Two Years of Life

PubMed Central

Rogawski, Elizabeth T.; Platts-Mills, James A.; Seidman, Jessica C.; John, Sushil; Mahfuz, Mustafa; Ulak, Manjeswori; Shrestha, Sanjaya; Soofi, Sajid B.; Yori, Pablo Penataro; Mduma, Estomih; Svensen, Erling; Ahmed, Tahmeed; Lima, Aldo A.M.; Bhutta, Zulfiqar; Kosek, Margaret; Lang, Dennis; Gottlieb, Michael; Zaidi, Anita; Kang, Gagandeep; Bessong, Pascal; Houpt, Eric R.; Guerrant, Richard L.

2017-01-01

ABSTRACT Objectives: The potential growth-promoting effects of antibiotics are not well understood among undernourished children in environments with high pathogen exposure. We aimed to assess whether early antibiotic exposure duration and class were associated with growth to 2 years of age across 8 low-resource sites in the MAL-ED birth cohort study. Methods: We followed 1954 children twice per week from birth to 2 years to record maternally reported antibiotic exposures and measure anthropometry monthly. We estimated the associations between antibiotic exposure before 6 months of age and weight-for-age and length-for-age (LAZ) z scores to 2 years. We assessed the impact of class-specific exposures and duration, and compared these results to effects of antibiotic exposures after 6 months of age. Results: Antibiotic use before 6 months of age was associated with increased weight from 6 months to 2 years, whereas associations with length were less consistent across sites and antibiotic classes. Compared to unexposed children, 2 or more courses of metronidazole, macrolides, and cephalosporins were associated with adjusted increases in weight-for-age of 0.24 (95% confidence interval (CI): 0.04, 0.43), 0.23 (95% CI: 0.05, 0.42), and 0.19 (95% CI: 0.04, 0.35) from 6 months to 2 years, respectively. Conclusions: Antibiotic use in low-resource settings was most associated with the ponderal growth of children who had multiple exposures to antibiotics with broad spectrum and anaerobic activity in early infancy. Opportunities for rational and targeted antibiotic therapy in low resource settings may also promote short-term weight gain in children, although longer-term physical growth and metabolic impacts are unknown. PMID:28604514

A new low-cost method for difficult airway management in non-missile-penetrating cervical spine injury.

PubMed

Rabiu, Taopheeq B; Fadare, Amos E

2012-03-01

Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.

Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings.

PubMed

Acestor, Nathalie; Goett, Jane; Lee, Arthur; Herrick, Tara M; Engelbrecht, Susheela M; Harner-Jay, Claudia M; Howell, Bonnie J; Weigl, Bernhard H

2016-01-01

In recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

Nitrogen Dioxide Sterilization in Low-Resource Environments: A Feasibility Study

PubMed Central

Avasthi, Trisha; Trilling, Ariel

2015-01-01

Access to sterilization is a critical need for global healthcare, as it is one of the prerequisites for safe surgical care. Lack of sterilization capability has driven up healthcare infection rates as well as limited access to healthcare, especially in low-resource environments. Sterilization technology has for the most part been static and none of the established sterilization methods has been so far successfully adapted for use in low-resource environments on a large scale. It is evident that healthcare facilities in low-resource settings require reliable, deployable, durable, affordable, easily operable sterilization equipment that can operate independently of scarce resources. Recently commercialized nitrogen dioxide (NO2) sterilization technology was analyzed and adapted into a form factor suitable for use in low-resource environments. Lab testing was conducted in microbiological testing facilities simulating low-resource environments and in accordance with the requirements of the international sterilization standard ANSI/AAMI/ISO 14937 to assess effectiveness of the device and process. The feasibility of a portable sterilizer based on nitrogen dioxide has been demonstrated, showing that sterilization of medical instruments can occur in a form factor suitable for use in low-resource environments. If developed and deployed, NO2 sterilization technology will have the twin benefits of reducing healthcare acquired infections and limiting a major constraint for access to surgical care on a global scale. Additional benefits are achieved in reducing costs and biohazard waste generated by current health care initiatives that rely primarily on disposable kits, increasing the effectiveness and outreach of these initiatives. PMID:26098905

Evaluation of a low-cost liquid-based Pap test in rural El Salvador: a split-sample study.

PubMed

Guo, Jin; Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Felix, Juan C

2014-04-01

We sought to test the diagnostic efficacy of a low-cost, liquid-based cervical cytology that could be implemented in low-resource settings. A prospective, split-sample Pap study was performed in 595 women attending a cervical cancer screening clinic in rural El Salvador. Collected cervical samples were used to make a conventional Pap (cell sample directly to glass slide), whereas residual material was used to make the liquid-based sample using the ClearPrep method. Selected samples were tested from the residual sample of the liquid-based collection for the presence of high-risk Human papillomaviruses. Of 595 patients, 570 were interpreted with the same diagnosis between the 2 methods (95.8% agreement). There were comparable numbers of unsatisfactory cases; however, ClearPrep significantly increased detection of low-grade squamous intraepithelial lesions and decreased the diagnoses of atypical squamous cells of undetermined significance. ClearPrep identified an equivalent number of high-grade squamous intraepithelial lesion cases as the conventional Pap. High-risk human papillomavirus was identified in all cases of high-grade squamous intraepithelial lesion, adenocarcinoma in situ, and cancer as well as in 78% of low-grade squamous intraepithelial lesions out of the residual fluid of the ClearPrep vials. The low-cost ClearPrep Pap test demonstrated equivalent detection of squamous intraepithelial lesions when compared with the conventional Pap smear and demonstrated the potential for ancillary molecular testing. The test seems a viable option for implementation in low-resource settings.

Microfluidic diagnostics for low-resource settings

NASA Astrophysics Data System (ADS)

Hawkins, Kenneth R.; Weigl, Bernhard H.

2010-02-01

Diagnostics for low-resource settings need to be foremost inexpensive, but also accurate, reliable, rugged and suited to the contexts of the developing world. Diagnostics for global health, based on minimally-instrumented, microfluidicsbased platforms employing low-cost disposables, has become a very active research area recently-thanks, in part, to new funding from the Bill & Melinda Gates Foundation, the National Institutes of Health, and other sources. This has led to a number of interesting prototype devices that are now in advanced development or clinical validation. These devices include disposables and instruments that perform multiplexed PCR-based assays for enteric, febrile, and vaginal diseases, as well as immunoassays for diseases such as malaria, HIV, and various sexually transmitted diseases. More recently, instrument-free diagnostic disposables based on isothermal nucleic-acid amplification have been developed. Regardless of platform, however, the search for truly low-cost manufacturing methods that would enable affordable systems (at volume, in the appropriate context) remains a significant challenge. Here we give an overview of existing platform development efforts, present some original research in this area at PATH, and reiterate a call to action for more.

Service Quality: A Main Determinant Factor for Health Information System Success in Low-resource Settings.

PubMed

Tilahun, Binyam; Fritz, Fleur

2015-01-01

With the increasing implementation of different health information systems in developing countries, there is a growing need to measure the main determinants of their success. The results of this evaluation study on the determinants of HIS success in five low resource setting hospitals show that service quality is the main determinant factor for information system success in those kind of settings.

Recent advances in AIDS-related cryptococcal meningitis treatment with an emphasis on resource limited settings

PubMed Central

Lofgren, Sarah M; Abassi, Mahsa; Rhein, Joshua; Boulware, David R

2017-01-01

Introduction Recent advances in the treatment and prevention of cryptococcal meningitis have the potential to decrease AIDS-related deaths. Areas covered Targeted screening for asymptomatic cryptococcal antigenemia in persons with AIDS is a cost effective method for reducing early mortality in patients on antiretroviral therapy. For persons with symptomatic cryptococcal meningitis, optimal initial management with amphotericin and flucytosine improves survival compared to alternative therapies; however, amphotericin is difficult to administer and flucytosine has not been available in middle or low income countries, where cryptococcal meningitis is most prevalent. Expert Commentary Improved care for cryptococcal meningitis patients in resource-limited settings is possible, and new treatment possibilities are emerging. PMID:28111998

Assessment of terminal cleaning in pediatric isolation rooms: Options for low-resource settings.

PubMed

Dramowski, Angela; Whitelaw, Andrew; Cotton, Mark F

2016-12-01

Few studies have evaluated terminal cleaning in low-resource settings. Adequacy of pediatric isolation room terminal cleaning was evaluated using quantitative bacterial surface cultures, ATP bioluminescence assays, and fluorescent high-touch surface markers at Tygerberg Children's Hospital in South Africa (August 1, 2014-October 31, 2015). Cleaning adequacy was assessed by comparing pre- and postcleaning measurements. Influence of verbal feedback was determined by comparing cleaners' first and subsequent cleaning episodes. Cleaning methods were compared for cost, time, and feasibility. Adequacy of terminal cleaning was evaluated in 25 isolation rooms after hospitalization for pulmonary tuberculosis (n = 13), respiratory (n = 5) and enteric viruses (n = 5), pertussis (n = 1), and methicillin-resistant Staphylococcus aureus (n = 1). Mean aerobic colony counts and mean ATP relative light units declined between pre- and postcleaning evaluations (39 ± 41 to 15 ± 30 [P < .001] and 72 ± 40 to 23 ± 11 [P < .001]). Fluorescent marker removal was initially poor, but improved significantly at subsequent cleaning episodes (17 out of 78 [22%] to 121 out of 198 [61%]; P < .001); mean aerobic colony counts and ATP values also declined significantly following feedback. Cost, time, and resources required for ATP and surface cultures far exceeded that required for fluorescent markers. Adequacy of isolation room cleaning improved following feedback to cleaning staff. Fluorescent markers are an inexpensive option for cleaning evaluation and training in low-resource settings. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Communicating vaccine safety in the context of immunization programs in low resource settings.

PubMed

Arwanire, Edison M; Mbabazi, William; Mugyenyi, Possy

2015-01-01

Vaccines are effective in preventing infectious diseases and their complications, hence reducing morbidity and infectious disease mortaity. Successful immunization programs, however, depend on high vaccine acceptance and coverage rates. In recent years there has been an increased level of public concern towards real or perceived adverse events associated with immunizations, leading to many people in high- as well as low-resource settings to refuse vaccines. Health care workers therefore must be able to provide parents and guardians of children with the most current and accurate information about the benefits and risks of vaccination. Communicating vaccine safety using appropriate channels plays a crucial role in maintaining public trust and confidence in vaccination programs. Several factors render this endeavor especially challenging in low-resource settings where literacy rates are low and access to information is often limited. Many languages are spoken in most countries in low-resource settings, making the provision of appropriate information difficult. Poor infrastructure often results in inadequate logistics. Recently, some concerned consumer groups have been able to propagate misinformation and rumors. To successfully communicate vaccine safety in a resource limited setting it is crucial to use a mix of communication channels that are both culturally acceptable and effective. Social mobilization through cultural, administrative and political leaders, the media or text messages (SMS) as well as the adoption of the Village Health Team (VHT) strategy whereby trained community members (Community Health Workers (CHWs)) are providing primary healthcare, can all be effective in increasing the demand for immunization.

AutoSyP: A Low-Cost, Low-Power Syringe Pump for Use in Low-Resource Settings.

PubMed

Juarez, Alexa; Maynard, Kelley; Skerrett, Erica; Molyneux, Elizabeth; Richards-Kortum, Rebecca; Dube, Queen; Oden, Z Maria

2016-10-05

This article describes the design and evaluation of AutoSyP, a low-cost, low-power syringe pump intended to deliver intravenous (IV) infusions in low-resource hospitals. A constant-force spring within the device provides mechanical energy to depress the syringe plunger. As a result, the device can run on rechargeable battery power for 66 hours, a critical feature for low-resource settings where the power grid may be unreliable. The device is designed to be used with 5- to 60-mL syringes and can deliver fluids at flow rates ranging from 3 to 60 mL/hour. The cost of goods to build one AutoSyP device is approximately $500. AutoSyP was tested in a laboratory setting and in a pilot clinical study. Laboratory accuracy was within 4% of the programmed flow rate. The device was used to deliver fluid to 10 healthy adult volunteers and 30 infants requiring IV fluid therapy at Queen Elizabeth Central Hospital in Blantyre, Malawi. The device delivered fluid with an average mean flow rate error of -2.3% ± 1.9% for flow rates ranging from 3 to 60 mL/hour. AutoSyP has the potential to improve the accuracy and safety of IV fluid delivery in low-resource settings. © The American Society of Tropical Medicine and Hygiene.

Role of cytopathology in cancer control in low-resource settings: sub-Saharan Africa's perspective.

PubMed

Thomas, Jaiyeola

2011-03-01

Cancer is an emerging public health problem in Africa especially with increasing exposure to risky life styles, environmental carcinogens and emergence of AIDS-associated cancers. Of the WHO estimated 7.9 million cancer-related deaths in 2007 more than 72% occurred in the low- and middle-income countries and 80% presented in the late stages. To implement the WHO resolution on cancer control programs in these settings, feasible evidence-based interventions for prevention, early diagnosis and detection need to be widely introduced. Fundamental to appropriate cancer treatment and statistics is accurate diagnosis. In low-resource settings, the diagnostic techniques and procedures should be reliable, cost-effective, simple and acceptable to patients. In addition, the required equipment should be affordable, requiring minimal maintenance and with readily available consumables. Cytology, as a simple standardized low-technology procedure, fulfills these criteria and is most effective in addressing the major components of cancer control programs in these areas. The major obstacles to its widespread establishment are lack of awareness and inadequate numbers of trained personnel compounded by sociopolitical factors, poor national planning and implementation. Rather than investing in new technology or alternative screening methods, efforts should focus on the education and training of local personnel, as feasible options, to improve the chances of implementing meaningful cancer control programs.

Neonatal hypothermia in low-resource settings.

PubMed

Mullany, Luke C

2010-12-01

Hypothermia among newborns is considered an important contributor to neonatal morbidity and mortality in low-resource settings. However, in these settings only limited progress has been made towards understanding the risk of mortality after hypothermia, describing how this relationship is dependent on both the degree or severity of exposure and the gestational age and weight status of the baby, and implementing interventions to mitigate both exposure and the associated risk of poor outcomes. Given the centrality of averting neonatal mortality to achieving global milestones towards reductions in child mortality by 2015, recent years have seen substantial resources and efforts implemented to improve understanding of global epidemiology of neonatal health. In this article, a summary of the burden, consequences, and risk factors of neonatal hypothermia in low-resources settings is presented, with a particular focus on community-based data. Context-appropriate interventions for reducing hypothermia exposure and the role of these interventions in reducing global neonatal mortality burden are explored. Copyright © 2010 Elsevier Inc. All rights reserved.

Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach.

PubMed

Bansil, Pooja; Wittet, Scott; Lim, Jeanette L; Winkler, Jennifer L; Paul, Proma; Jeronimo, Jose

2014-06-12

Vaginal self-sampling with HPV-DNA tests is a promising primary screening method for cervical cancer. However, women's experiences, concerns and the acceptability of such tests in low-resource settings remain unknown. In India, Nicaragua, and Uganda, a mixed-method design was used to collect data from surveys (N = 3,863), qualitative interviews (N = 72; 20 providers and 52 women) and focus groups (N = 30 women) on women's and providers' experiences with self-sampling, women's opinions of sampling at home, and their future needs. Among surveyed women, 90% provided a self- collected sample. Of these, 75% reported it was easy, although 52% were initially concerned about hurting themselves and 24% were worried about not getting a good sample. Most surveyed women preferred self-sampling (78%). However it was not clear if they responded to the privacy of self-sampling or the convenience of avoiding a pelvic examination, or both. In follow-up interviews, most women reported that they didn't mind self-sampling, but many preferred to have a provider collect the vaginal sample. Most women also preferred clinic-based screening (as opposed to home-based self-sampling), because the sample could be collected by a provider, women could receive treatment if needed, and the clinic was sanitary and provided privacy. Self-sampling acceptability was higher when providers prepared women through education, allowed women to examine the collection brush, and were present during the self-collection process. Among survey respondents, aids that would facilitate self-sampling in the future were: staff help (53%), additional images in the illustrated instructions (31%), and a chance to practice beforehand with a doll/model (26%). Self-and vaginal-sampling are widely acceptable among women in low-resource settings. Providers have a unique opportunity to educate and prepare women for self-sampling and be flexible in accommodating women's preference for self-sampling.

Fasting capillary blood glucose: an appropriate measurement in screening for diabetes and pre-diabetes in low-resource rural settings.

PubMed

Zhao, X; Zhao, W; Zhang, H; Li, J; Shu, Y; Li, S; Cai, L; Zhou, J; Li, Y; Hu, R

2013-01-01

To evaluate the efficiency of fasting capillary blood glucose (FCG) measurement as compared with fasting venous plasma glucose (FPG) measurement in screening diabetes and pre-diabetes in low-resource rural settings. In 2010, 993 participants were randomly selected from 9 villages in Yunnan province using cluster sampling method. Samples for FCG and FPG test were obtained after demographics and physical examination. The oral glucose tolerance test was performed in parallel as gold standard for diagnosis. Diagnostic capacities of the FCG measurement in predicting undiagnosed diabetes and pre-diabetes were assessed. The performance of FCG and FPG tests was compared. Fifty-seven individuals with undiagnosed diabetes and 145 subjects with pre-diabetes were detected. The concordance between FCG and FPG levels was high (r = 0.75, p < 0.001). The area under the curve (AUC) for FCG test in predicting diabetes was 0.88 [95% confidence interval (CI) 0.82-0.93] with the optimal cutoff value of 5.65 mmol/l, sensitivity of 84.2%, and specificity of 79.3%. The corresponding values in FPG tests were 0.92 (95% CI 0.88-0.97) (AUC), 6.51 mmol/l (optimal cutoff point), 82.5% (sensitivity) and 98.3% (specificity), respectively. No significant difference was found in the AUC for the two screening strategies. FCG measurement is considered to be a convenient, practicable screening method in low-resource rural communities with acceptable test properties.

Eye-tracking-based assessment of cognitive function in low-resource settings.

PubMed

Forssman, Linda; Ashorn, Per; Ashorn, Ulla; Maleta, Kenneth; Matchado, Andrew; Kortekangas, Emma; Leppänen, Jukka M

2017-04-01

Early development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings. The present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40). Parents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69-85%, Malawi 68-73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks. High test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test-retest stability and predictive validity of the eye-tracking scores in low-income settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing

PubMed Central

McBain, Ryan K; Jerome, Gregory; Warsh, Jonathan; Browning, Micaela; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Rhatigan, Joseph; Leandre, Fernet; Kaplan, Robert

2016-01-01

Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world. PMID:28588971

Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing.

PubMed

McBain, Ryan K; Jerome, Gregory; Warsh, Jonathan; Browning, Micaela; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Rhatigan, Joseph; Leandre, Fernet; Kaplan, Robert

2016-01-01

Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but <20% of global expenditures on health. In this context, judicious resource allocation can mean the difference between life and death, not just for individual patients, but entire patient populations. Understanding the cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world.

Challenges in the surgical management of ectopic pregnancy in a low-resource setting: Mpilo Central Hospital, Bulawayo, Zimbabwe.

PubMed

Ngwenya, Solwayo

2017-10-01

Background Ectopic pregnancy contributes to maternal morbidity and mortality, especially in low-resourced countries with limited facilities for early diagnosis and treatment. It is a very challenging condition to diagnose. Patients may collapse and die while undergoing investigation. Aims To assess surgical treatment given to patients presenting at Mpilo Central Hospital, the challenges that are faced and the outcomes; and also to document how women survive this dangerous condition in a setting challenged by low resources. Results All the patients had prompt life-saving surgery within 48 h of admission despite the challenges faced. The survival rate was 100% during the period of the study. Conclusion It is possible to prevent maternal mortality in low-resource countries by maintaining basic clinical and surgical skills.

Management of abnormal uterine bleeding in low- and high-resource settings: consideration of cultural issues.

PubMed

Haththotuwa, Rohana; Goonewardene, Malik; Desai, Shyam; Senanayake, Lakshman; Tank, Jaydeep; Fraser, Ian S

2011-09-01

In non industrialized countries the incidence of heavy menstrual bleeding (HMB) appears to be similar to that of industrialized countries, although data is scanty. In low-resource settings, women with abnormal uterine bleeding (AUB) often delay seeking medical care because of cultural beliefs that a heavy red menstrual bleed is healthy. Efforts to modify cultural issues are being considered. A detailed history and a meticulous examination are the important foundations of a definitive diagnosis and management in low-resource settings but are subject to time constraints and skill levels of the small numbers of health professionals. Women's subjective assessment of blood loss should be combined, if possible, with a colorimetric hemoglobin assessment, if full blood count is not possible. Outpatient endometrial sampling, transvaginal sonography, and hysteroscopy are available in some non industrialized countries but not in the lowest resource settings. After exclusion of serious underlying pathology, hematinics should be commenced and antifibrinolytic or nonsteroidal anti-inflammatory drugs considered during menses to control the bleeding. Intrauterine or oral progestogens or the combined oral contraceptive are often the most cost-effective long-term medical treatments. When medical treatment is inappropriate or has failed, the surgical options available most often are myomectomy or hysterectomy. Hysteroscopic endometrial resection or newer endometrial ablation procedures are available in some centers. If hysterectomy is indicated the vaginal route is the most appropriate in most low-resource settings. In low-resource settings, lack of resources of all types can lead to empirical treatments or reliance on the unproven therapies of traditional healers. The shortage of human resources is often compounded by a limited availability of operative time. Governments and specialist medical organizations have rarely included attention to AUB and HMB in their health programs. Local guidelines and attention to training of doctors, midwives, and traditional health workers are critical for prevention and improvement in management of HMB and its consequences for iron deficiency anemia and postpartum hemorrhage, the major killer of young women in developing countries. © Thieme Medical Publishers.

Engineering bacteriophage for a pragmatic low-resource setting bacterial diagnostic platform.

PubMed

Talbert, Joey N; Alcaine, Samuel D; Nugen, Sam R

2016-04-01

Bacteriophages represent multifaceted building blocks that can be incorporated as substitutes for, or in unison with other detection methods, to create powerful new diagnostics for the detection of bacteria. The ease of phage manipulation, production, and detection speed clearly highlights that there remains unrealized opportunities to leverage these phage-based components in diagnostics amenable to resource-limited settings. The passage of regulations like the Food Safety Modernization act, and the ever increasing extent of global trade and travel, will create further demand for these types of diagnostics. While phage-based diagnostics have begun to entering the market place, further research is needed to ensure the potential benefits of phage-based technologies for public health are fully realized. We are just beginning to explore the possibilities that phage-based detection can offer us in the future. The combination of engineered phages as well as engineered enzymes could result in ultrasensitive detection systems for low-resource settings. Because the reporter enzyme is synthesized in vivo, we need to consider the options outside of normal enzyme reporters. In this case, common enzyme issues such as purification and long-term stability are less important. Phage-based diagnostics were conceptualized from out-of-the box thinking and the evolution of these systems should be as well.

Development and Implementation of Culturally Tailored Offline Mobile Health Surveys.

PubMed

McIntosh, Scott; Pérez-Ramos, José; Demment, Margaret M; Vélez Vega, Carmen; Avendaño, Esteban; Ossip, Deborah J; Dye, Timothy D

2016-06-02

In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs.

Otolaryngology in Low-Resource Settings: Practical and Ethical Considerations.

PubMed

Cordes, Susan R; Robbins, Kevin Thomas; Woodson, Gayle

2018-06-01

Providing otolaryngology care in low-resource settings requires careful preparation to ensure good outcomes. The level of care that can be provided is dictated by available resources and the supplementary equipment, supplies, and personnel brought in. Other challenges include personal health and safety risks as well as cultural and language differences. Studying outcomes will inform future missions. Educating and developing ongoing partnerships with local physicians can lead to sustained improvements in the local health care system. Copyright © 2018 Elsevier Inc. All rights reserved.

Developing prehospital clinical practice guidelines for resource limited settings: why re-invent the wheel?

PubMed

McCaul, Michael; de Waal, Ben; Hodkinson, Peter; Pigoga, Jennifer L; Young, Taryn; Wallis, Lee A

2018-02-05

Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, the volume of literature is not matched by research into alternative methods of CPG development using existing CPG documents-a specific issue for guideline development groups in low- and middle-income countries. We report on how we developed a context specific prehospital CPG using an alternative guideline development method. Difficulties experienced and lessons learnt in applying existing global guidelines' recommendations to a national context are highlighted. The project produced the first emergency care CPG for prehospital providers in Africa. It included > 270 CPGs and produced over 1000 recommendations for prehospital emergency care. We encountered various difficulties, including (1) applicability issues: few pre-hospital CPGs applicable to Africa, (2) evidence synthesis: heterogeneous levels of evidence classifications and (3) guideline quality. Learning points included (1) focusing on key CPGs and evidence mapping, (2) searching other resources for CPGs, (3) broad representation on CPG advisory boards and (4) transparency and knowledge translation. Re-inventing the wheel to produce CPGs is not always feasible. We hope this paper will encourage further projects to use existing CPGs in developing guidance to improve patient care in resource-limited settings.

Epithelial cancers and photon migration: Monte Carlo simulations and diffuse reflectance measurements

NASA Astrophysics Data System (ADS)

Tubiana, Jerome; Kass, Alex J.; Newman, Maya Y.; Levitz, David

2015-07-01

Detecting pre-cancer in epithelial tissues such as the cervix is a challenging task in low-resources settings. In an effort to achieve low cost cervical cancer screening and diagnostic method for use in low resource settings, mobile colposcopes that use a smartphone as their engine have been developed. Designing image analysis software suited for this task requires proper modeling of light propagation from the abnormalities inside tissues to the camera of the smartphones. Different simulation methods have been developed in the past, by solving light diffusion equations, or running Monte Carlo simulations. Several algorithms exist for the latter, including MCML and the recently developed MCX. For imaging purpose, the observable parameter of interest is the reflectance profile of a tissue under some specific pattern of illumination and optical setup. Extensions of the MCX algorithm to simulate this observable under these conditions were developed. These extensions were validated against MCML and diffusion theory for the simple case of contact measurements, and reflectance profiles under colposcopy imaging geometry were also simulated. To validate this model, the diffuse reflectance profiles of tissue phantoms were measured with a spectrometer under several illumination and optical settings for various homogeneous tissues phantoms. The measured reflectance profiles showed a non-trivial deviation across the spectrum. Measurements of an added absorber experiment on a series of phantoms showed that absorption of dye scales linearly when fit to both MCX and diffusion models. More work is needed to integrate a pupil into the experiment.

Simplified Negative Pressure Wound Therapy Device for Application in Low-Resource Settings.

PubMed

Zurovcik, Danielle R; Mody, Gita N; Riviello, Robert; Slocum, Alex

2015-10-01

Negative pressure wound therapy (NPWT) provides proven wound healing benefits and is often a desirable wound treatment methodology. Unfortunately, NPWT devices are not widely available in low-resource settings. To overcome the identified NPWT barriers, a simplified NPWT (sNPWT) system was designed and iteratively improved during field-based testing. The sNPWT technology, our device design iterations, and the design-based results of our field tests are described in this article. The sNPWT system includes a bellows hand pump, an occlusive drape, and a tube with tube connectors, connecting the drape to the pump. The most critical property of an sNPWT system is that it must be airtight. The details of the design iterations, which are needed to achieve an occlusive system, are explained. During the design process, the sNPWT system was tested during the earthquake relief in Haiti. This testing found that a liquid sealant was necessary to seal the drape to the periwound skin. A study conducted in Rwanda verified that a liquid latex sealant was safe to use, and that the tube connector must be connected to the drape with an airtight method during the manufacturing process. This work has shown that sNPWT is feasible in low-resource settings. Since the completion of the clinical testing, the design has been further evolved, and the developers are working with contract manufacturers to produce the final design and preparing for regulatory approval applications.

MPT64 antigen detection test improves routine diagnosis of extrapulmonary tuberculosis in a low-resource setting: A study from the tertiary care hospital in Zanzibar.

PubMed

Jørstad, Melissa Davidsen; Marijani, Msafiri; Dyrhol-Riise, Anne Ma; Sviland, Lisbet; Mustafa, Tehmina

2018-01-01

Extrapulmonary tuberculosis (EPTB) is a diagnostic challenge. An immunochemistry-based MPT64 antigen detection test (MPT64 test) has reported higher sensitivity in the diagnosis of EPTB compared with conventional methods. The objective of this study was to implement and evaluate the MPT64 test in routine diagnostics in a low-resource setting. Patients with presumptive EPTB were prospectively enrolled at Mnazi Mmoja Hospital, Zanzibar, and followed to the end of treatment. Specimens collected were subjected to routine diagnostics, GeneXpert® MTB/RIF assay and the MPT64 test. The performance of the MPT64 test was assessed using a composite reference standard, defining the patients as tuberculosis (TB) cases or non-TB cases. Patients (n = 132) were classified as confirmed TB (n = 12), probable TB (n = 34), possible TB (n = 18), non-TB (n = 62) and uncategorized (n = 6) cases. Overall, in comparison to the composite reference standard for diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the MPT64 test was 69%, 95%, 94%, 75% and 82%, respectively. The MPT64 test performance was best in TB lymphadenitis cases (n = 67, sensitivity 79%, specificity 97%) and in paediatric TB (n = 41, sensitivity 100%, specificity 96%). We show that the MPT64 test can be implemented in routine diagnostics in a low-resource setting and improves the diagnosis of EPTB, especially in TB lymphadenitis and in children.

Ancillary care in public health intervention research in low-resource settings: researchers' practices and decision-making.

PubMed

Taylor, Holly A; Merritt, Maria W; Mullany, Luke C

2011-09-01

Little is known about researchers' practices regarding the provision of ancillary care (AC) in public health intervention studies they have conducted and the factors that influence their decisions about whether to provide ancillary care in low-resource settings. We conducted 52 in-person in-depth interviews with public health researchers. Data analysis was iterative and led to the identification of themes and patterns among themes. We found that researchers who conduct their research in the community setting are more likely to identify and plan for the AC needs of potential research subjects before a study begins, whereas those affiliated with a permanent facility are more likely to deliver AC to research subjects on an ad hoc basis. Our findings suggest that on the whole, at least for public health intervention research in low-resource settings, researchers conducting research in the community setting confront more complex ethical and operational challenges in their decision-making about AC than do researchers conducting facility-based studies.

SOGC–GOC–SCC Joint Policy Statement. No. 255, March 2011. Cervical cancer prevention in low-resource settings.

PubMed

Elit, Laurie; Jimenez, Waldo; McAlpine, Jessica; Ghatage, Prafull; Miller, Dianne; Plante, Marie

2011-03-01

To help care providers understand the current status of cervical cancer in low-resource countries. The most effective and practical options for cervical screening and treatment in low-resource countries are evaluated. Improvement in rates of prevention and early detection of cervical cancer in low-resource countries. PubMed or Medline, CINAHL, and The Cochrane Library were searched for studies published in English between January 2006 and December 2009. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table). RECOMMENDATIONS 1. All girls 9 years old or over should have access to the cervical cancer vaccine before they become sexually active. (I-A) 2. Cervical cancer screening by visual inspection with acetic acid is suggested for low-resource settings acceptable. Cervical cytology or human papillomavirus testing may also be used when practical. (II-2B) 3. Cryotherapy is a safe, effective, and low-cost therapy that should be included in pre-invasive cervical cancer treatment. (III-B) 4. All countries should have a documented cervical cancer prevention strategy that includes public education built on existing outreach programs. (III-C) 5. Countries should define a centre or centres of excellence for the management of cervical cancer. (III-C) Because these units would serve a larger population, they would be able to identify leaders and develop their skills, and would be able to invest in costly radiation equipment. 6. All women with cervical cancer should have access to pain management. (III-C).

Experiences with food insecurity and risky sex among low-income people living with HIV/AIDS in a resource-rich setting

PubMed Central

Whittle, Henry J; Palar, Kartika; Napoles, Tessa; Hufstedler, Lee Lemus; Ching, Irene; Hecht, Frederick M; Frongillo, Edward A; Weiser, Sheri D

2015-01-01

Background Forty-nine million individuals are food insecure in the United States, where food insecurity and HIV/AIDS are prevalent among the urban poor. Food insecurity is associated with risky sexual behaviours among people living with HIV/AIDS (PLHIV). No qualitative studies, however, have investigated the mechanisms underlying this relationship either in a resource-rich setting or among populations that include men who have sex with men (MSM). Methods Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance in the San Francisco Bay Area. The interviews explored experiences with food insecurity and perceived associations with sexual risk behaviours. Interviews were conducted in English, audio-recorded and transcribed verbatim. Transcripts were coded and analyzed according to content analysis methods using an inductive-deductive approach. Results Food insecurity was reported to be a strong contributor to risky sexual practices among MSM and female participants. Individuals described engaging in transactional sex for food or money to buy food, often during times of destitution. Participants also explained how food insecurity could lead to condomless sex despite knowledge of and desire to use safe sexual practices, largely because the need to obtain food in the short term was prioritized over the desire to use barrier protection. Conclusions Our data extend previous research by demonstrating that food insecurity contributes to transactional and unprotected sex among urban poor individuals in a resource-rich setting, including among MSM. These findings underscore the importance of public health and social intervention efforts focused on structural inequalities. PMID:26546789

Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

PubMed Central

Modesti, Pietro A.; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P.; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O’Brien, Eoin; Kilama, Michael O.; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M.; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

2014-01-01

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on ‘Hypertension and Cardiovascular risk in low resource settings’, which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs. PMID:24577410

A Systematic Review of Palliative Care Intervention Outcomes and Outcome Measures in Low-Resource Countries.

PubMed

Potts, Maryellen; Cartmell, Kathleen B; Nemeth, Lynne; Bhattacharjee, Gautam; Qanungo, Suparna

2018-05-01

To meet the growing need for palliative care in low-resource countries, palliative care programs should be evidence based and contextually appropriate. This study was conducted to synthesize the current evidence to guide future programmatic and research efforts. This systematic review evaluated palliative care outcome measures, outcomes, and interventions in low-resource countries. After title searches, abstracts and full-text articles were screened for inclusion. Data were extracted to report on intervention models, outcome measures used, and intervention outcomes. Eighteen papers were reviewed, reporting on interventions conducted across nine low-resource countries. These interventions evaluated home-based palliative care models; a community-managed model; palliative care integrated with hospitals, hospices, or HIV clinics; and models focused on patients' self-management. Three studies were randomized controlled trials. Other studies used nonrandomized trials, cohort studies, mixed methods, pre-post test evaluation, cost-accounting evaluation, and cross-sectional surveys. Thirteen studies measured physical outcomes, 10 using multidimensional instruments. Nine studies measured psychological outcomes, eight using multidimensional instruments. Nine studies measured social outcomes, seven using multidimensional instruments. Nine studies measured outcomes across multiple domains. Across outcomes evaluated, results were reported in the direction of benefit associated with palliative care interventions. Many palliative care intervention models exist to serve patients in low-resource countries. Yet, limited high-quality evidence from low-resource countries is available to document intervention outcomes. Rigorous experimental studies and greater measurement of multidimensional aspects of palliative care are needed to advance the science of palliative care in low-resource settings. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings.

PubMed

Rispin, Karen; Wee, Joy

2015-07-01

This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings. The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance. The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test. This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision. Implications for Rehabilitation For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent. A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs. This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds.

Implementation of the Thin Layer Agar Method for Diagnosis of Smear-Negative Pulmonary Tuberculosis in a Setting with a High Prevalence of Human Immunodeficiency Virus Infection in Homa Bay, Kenya▿ †

PubMed Central

Martin, Anandi; Munga Waweru, Peter; Babu Okatch, Fred; Amondi Ouma, Naureen; Bonte, Laurence; Varaine, Francis; Portaels, Françoise

2009-01-01

The objective of this study was to evaluate the performance of a low-cost method, the thin layer agar (TLA) method, for the diagnosis of smear-negative patients. This prospective study was performed in Homa Bay District Hospital in Kenya. Out of 1,584 smear-negative sputum samples, 212 (13.5%) were positive by culture in Löwenstein-Jensen medium (LJ) and 220 (14%) were positive by the TLA method. The sensitivities of LJ and TLA were 71% and 74%, respectively. TLA could become an affordable method for the diagnosis of smear-negative tuberculosis in resource-limited settings, with results available within 2 weeks. PMID:19494065

Biomarker detection for disease diagnosis using cost-effective microfluidic platforms.

PubMed

Sanjay, Sharma T; Fu, Guanglei; Dou, Maowei; Xu, Feng; Liu, Rutao; Qi, Hao; Li, XiuJun

2015-11-07

Early and timely detection of disease biomarkers can prevent the spread of infectious diseases, and drastically decrease the death rate of people suffering from different diseases such as cancer and infectious diseases. Because conventional diagnostic methods have limited application in low-resource settings due to the use of bulky and expensive instrumentation, simple and low-cost point-of-care diagnostic devices for timely and early biomarker diagnosis is the need of the hour, especially in rural areas and developing nations. The microfluidics technology possesses remarkable features for simple, low-cost, and rapid disease diagnosis. There have been significant advances in the development of microfluidic platforms for biomarker detection of diseases. This article reviews recent advances in biomarker detection using cost-effective microfluidic devices for disease diagnosis, with the emphasis on infectious disease and cancer diagnosis in low-resource settings. This review first introduces different microfluidic platforms (e.g. polymer and paper-based microfluidics) used for disease diagnosis, with a brief description of their common fabrication techniques. Then, it highlights various detection strategies for disease biomarker detection using microfluidic platforms, including colorimetric, fluorescence, chemiluminescence, electrochemiluminescence (ECL), and electrochemical detection. Finally, it discusses the current limitations of microfluidic devices for disease biomarker detection and future prospects.

Characterization of background concentrations of contaminants using a mixture of normal distributions.

PubMed

Qian, Song S; Lyons, Regan E

2006-10-01

We present a Bayesian approach for characterizing background contaminant concentration distributions using data from sites that may have been contaminated. Our method, focused on estimation, resolves several technical problems of the existing methods sanctioned by the U.S. Environmental Protection Agency (USEPA) (a hypothesis testing based method), resulting in a simple and quick procedure for estimating background contaminant concentrations. The proposed Bayesian method is applied to two data sets from a federal facility regulated under the Resource Conservation and Restoration Act. The results are compared to background distributions identified using existing methods recommended by the USEPA. The two data sets represent low and moderate levels of censorship in the data. Although an unbiased estimator is elusive, we show that the proposed Bayesian estimation method will have a smaller bias than the EPA recommended method.

The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda.

PubMed

Essue, Beverley M; Kapiriri, Lydia

2018-02-20

The double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and development priority. However, there are challenges for translating this global priority into local priorities and action. The aim of this study was to evaluate the influence of national, sub-national and global factors on priority setting for noncommunicable disease control in Uganda and examine the extent to which priority setting was successful. A mixed methods design that used the Kapiriri & Martin framework for evaluating priority setting in low income countries. The evaluation period was 2005-2015. Data collection included a document review (policy documents (n = 19); meeting minutes (n = 28)), media analysis (n = 114) and stakeholder interviews (n = 9). Data were analysed according to the Kapiriri & Martin (2010) framework. Priority setting for noncommunicable diseases was not entirely fair nor successful. While there were explicit processes that incorporated relevant criteria, evidence and wide stakeholder involvement, these criteria were not used systematically or consistently in the contemplation of noncommunicable diseases. There were insufficient resources for noncommunicable diseases, despite being a priority area. There were weaknesses in the priority setting institutions, and insufficient mechanisms to ensure accountability for decision-making. Priority setting was influenced by the priorities of major stakeholders (i.e. development assistance partners) which were not always aligned with national priorities. There were major delays in the implementation of noncommunicable disease-related priorities and in many cases, a failure to implement. This evaluation revealed the challenges that low income countries are grappling with in prioritizing noncommunicable diseases in the context of a double disease burden with limited resources. Strengthening local capacity for priority setting would help to support the development of sustainable and implementable noncommunicable disease-related priorities. Global support (i.e. aid) to low income countries for noncommunicable diseases must also catch up to align with NCDs as a global health priority.

Mentoring for junior medical faculty: Existing models and suggestions for low-resource settings.

PubMed

Menon, Vikas; Muraleedharan, Aparna; Bhat, Ballambhattu Vishnu

2016-02-01

Globally, there is increasing recognition about the positive benefits and impact of mentoring on faculty retention rates, career satisfaction and scholarly output. However, emphasis on research and practice of mentoring is comparatively meagre in low and middle income countries. In this commentary, we critically examine two existing models of mentorship for medical faculty and offer few suggestions for an integrated hybrid model that can be adapted for use in low resource settings. Copyright © 2016 Elsevier B.V. All rights reserved.

Brief Report: Methods for Collecting Sexual Behaviour Information from South African Adolescents--A Comparison of Paper versus Personal Digital Assistant Questionnaires

ERIC Educational Resources Information Center

Jaspan, Heather B.; Flisher, Alan J.; Myer, Landon; Mathews, Catherine; Seebregts, Chris; Berwick, Jessica R.; Wood, Robin; Bekker, Linda-Gail

2007-01-01

Reporting bias in adolescent behavioural research may be overcome with the use of personal digital assistants (PDA) or other computer based technologies. However, there is little insight into the use of these tools among adolescents in low resource settings. We compared self-administered paper questionnaires with PDA questionnaires to collect…

Computational laser intensity stabilisation for organic molecule concentration estimation in low-resource settings

NASA Astrophysics Data System (ADS)

Haider, Shahid A.; Kazemzadeh, Farnoud; Wong, Alexander

2017-03-01

An ideal laser is a useful tool for the analysis of biological systems. In particular, the polarization property of lasers can allow for the concentration of important organic molecules in the human body, such as proteins, amino acids, lipids, and carbohydrates, to be estimated. However, lasers do not always work as intended and there can be effects such as mode hopping and thermal drift that can cause time-varying intensity fluctuations. The causes of these effects can be from the surrounding environment, where either an unstable current source is used or the temperature of the surrounding environment is not temporally stable. This intensity fluctuation can cause bias and error in typical organic molecule concentration estimation techniques. In a low-resource setting where cost must be limited and where environmental factors, like unregulated power supplies and temperature, cannot be controlled, the hardware required to correct for these intensity fluctuations can be prohibitive. We propose a method for computational laser intensity stabilisation that uses Bayesian state estimation to correct for the time-varying intensity fluctuations from electrical and thermal instabilities without the use of additional hardware. This method will allow for consistent intensities across all polarization measurements for accurate estimates of organic molecule concentrations.

Health Worker mHealth Utilization: A Systematic Review

PubMed Central

White, Alice; Thomas, Deborah S.K.; Ezeanochie, Nnamdi; Bull, Sheana

2016-01-01

This systematic review describes mHealth interventions directed at healthcare workers in low resource settings from the PubMed database from March, 2009 to May, 2015. Thirty-one articles were selected for final review. Four categories emerged from the reviewed articles: data collection during patient visits; communication between health workers and patients; communication between health workers; and public health surveillance. Most studies used a combination of quantitative and qualitative methods to assess acceptability of use, barriers to use, changes in healthcare delivery, and improved health outcomes. Few papers included theory explicitly to guide development and evaluation of their mHealth programs. Overall, evidence indicated that mobile technology tools, such as smartphones and tablets, substantially benefit healthcare workers, their patients, and health care delivery. Limitations to mHealth tools included insufficient program use and sustainability, unreliable Internet and electricity, and security issues. Despite these limitations, this systematic review demonstrates the utility of using mHealth in low-resource settings and the potential for widespread health system improvements using technology. PMID:26955009

Screening for cervical cancer in low-resource settings in 2011.

PubMed

Tambouret, Rosemary

2013-06-01

Cervical cancer remains the most common malignancy in women living in low- and middle-income countries, despite the decline of the disease in countries where cervical cytology screening programs have been implemented. To review the current incidence of cervical cancer in low-resource countries, the availability and types of screening programs, and the treatment options. Literature review through PubMed, Internet search, and personal communication. Although data are incomplete, available figures confirm that the rate of cervical cancer deaths and the availability of cervical cancer screening programs are inversely proportional and vary, in general, by the wealth of the nation. Despite the success of cervical cytology screening, many major health care organizations have abandoned screening by cytology in favor of direct visualization methods with immediate treatment of lesions by cryotherapy provided by trained, nonmedical personnel.

Effective Practices in Providing Online, In-Service Training to Health Professionals in Low-Resource Settings

ERIC Educational Resources Information Center

Chio, Karen Sherk

2012-01-01

As doctors, nurses and public health professionals are promoted into management and leadership positions in resource-poor countries around the world, they are tasked with leading teams and managing drugs and financial and material resources. These responsibilities require a set of skills and knowledge different from that needed for their clinical…

Towards an unsupervised device for the diagnosis of childhood pneumonia in low resource settings: automatic segmentation of respiratory sounds.

PubMed

Sola, J; Braun, F; Muntane, E; Verjus, C; Bertschi, M; Hugon, F; Manzano, S; Benissa, M; Gervaix, A

2016-08-01

Pneumonia remains the worldwide leading cause of children mortality under the age of five, with every year 1.4 million deaths. Unfortunately, in low resource settings, very limited diagnostic support aids are provided to point-of-care practitioners. Current UNICEF/WHO case management algorithm relies on the use of a chronometer to manually count breath rates on pediatric patients: there is thus a major need for more sophisticated tools to diagnose pneumonia that increase sensitivity and specificity of breath-rate-based algorithms. These tools should be low cost, and adapted to practitioners with limited training. In this work, a novel concept of unsupervised tool for the diagnosis of childhood pneumonia is presented. The concept relies on the automated analysis of respiratory sounds as recorded by a point-of-care electronic stethoscope. By identifying the presence of auscultation sounds at different chest locations, this diagnostic tool is intended to estimate a pneumonia likelihood score. After presenting the overall architecture of an algorithm to estimate pneumonia scores, the importance of a robust unsupervised method to identify inspiratory and expiratory phases of a respiratory cycle is highlighted. Based on data from an on-going study involving pediatric pneumonia patients, a first algorithm to segment respiratory sounds is suggested. The unsupervised algorithm relies on a Mel-frequency filter bank, a two-step Gaussian Mixture Model (GMM) description of data, and a final Hidden Markov Model (HMM) interpretation of inspiratory-expiratory sequences. Finally, illustrative results on first recruited patients are provided. The presented algorithm opens the doors to a new family of unsupervised respiratory sound analyzers that could improve future versions of case management algorithms for the diagnosis of pneumonia in low-resources settings.

Validating the WHO maternal near miss tool: comparing high- and low-resource settings.

PubMed

Witteveen, Tom; Bezstarosti, Hans; de Koning, Ilona; Nelissen, Ellen; Bloemenkamp, Kitty W; van Roosmalen, Jos; van den Akker, Thomas

2017-06-19

WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received ≥1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.

A systematic review of neonatal treatment intensity scores and their potential application in low-resource setting hospitals for predicting mortality, morbidity and estimating resource use.

PubMed

Aluvaala, Jalemba; Collins, Gary S; Maina, Michuki; Berkley, James A; English, Mike

2017-12-07

Treatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings. We conducted a systematic search of PubMed, EMBASE (OVID), CINAHL, Global Health Library (Global index, WHO) and Google Scholar to identify studies published up until 21 December 2016. Included were all articles that used treatments as predictors in neonatal models. Individual studies were appraised using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). In addition, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used as a guiding framework to assess certainty in the evidence for predicting outcomes across studies. Three thousand two hundred forty-nine articles were screened, of which ten articles were included in the review. All of the studies were conducted in neonatal intensive care units with sample sizes ranging from 22 to 9978, with a median of 163. Two articles reported model development, while eight reported external application of existing models to new populations. Meta-analysis was not possible due heterogeneity in the conduct and reporting of the identified studies. Discrimination as assessed by area under receiver operating characteristic curve was reported for in-hospital mortality, median 0.84 (range 0.75-0.96, three studies), early adverse outcome and late adverse outcome (0.78 and 0.59, respectively, one study). Existing neonatal treatment intensity models show promise in predicting mortality and morbidity. There is however low certainty in the evidence on their performance in essential neonatal care in low resource settings as all studies had methodological limitations and were conducted in intensive care. The approach may however be developed further for low resource settings like Kenya because treatment data may be easier to obtain compared to measures of physiological status. PROSPERO CRD42016034205.

Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts

PubMed Central

van den Boogaard, W.; Van den Bergh, R.; Takarinda, K. C.; Martinez, P.; Bekouanebandi, J. G.; Javed, I.; Ndelema, B.; Lefèvre, A.; Khalid, G. G.; Zuniga, I.

2017-01-01

Setting: Although neonatal mortality is gradually decreasing worldwide, 98% of neonatal deaths occur in low- and middle-income countries, where hospital care for sick and premature neonates is often unavailable. Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) managed eight specialised neonatal care units (SNCUs) at district level in low-resource and conflict-affected settings in seven countries. Objective: To assess the performance of the MSF SNCU model across different settings in Africa and Southern Asia, and to describe the set-up of eight SNCUs, neonate characteristics and clinical outcomes among neonates from 2012 to 2015. Design: Multicentric descriptive study. Results: The MSF SNCU model was characterised by an absence of high-tech equipment and an emphasis on dedicated nursing and medical care. Focus was on the management of hypothermia, hypoglycaemia, feeding support and early identification/treatment of infection. Overall, 11 970 neonates were admitted, 41% of whom had low birthweight (<2500 g). The main diagnoses were low birthweight, asphyxia and neonatal infections. Overall mortality was 17%, with consistency across the sites. Chances of survival increased with higher birthweight. Conclusion: The standardised SNCU model was implemented across different contexts and showed in-patient outcomes within acceptable limits. Low-tech medical care for sick and premature neonates can and should be implemented at district hospital level in low-resource settings. PMID:28695092

Free and simple GIS as appropriate for health mapping in a low resource setting: a case study in eastern Indonesia.

PubMed

Fisher, Rohan P; Myers, Bronwyn A

2011-02-25

Despite the demonstrated utility of GIS for health applications, there are perceived problems in low resource settings: GIS software can be expensive and complex; input data are often of low quality. This study aimed to test the appropriateness of new, inexpensive and simple GIS tools in poorly resourced areas of a developing country. GIS applications were trialled in pilot studies based on mapping of health resources and health indicators at the clinic and district level in the predominantly rural province of Nusa Tenggara Timur in eastern Indonesia. The pilot applications were (i) rapid field collection of health infrastructure data using a GPS enabled PDA, (ii) mapping health indicator data using open source GIS software, and (iii) service availability mapping using a free modelling tool. Through contextualised training, district and clinic staff acquired skills in spatial analysis and visualisation and, six months after the pilot studies, they were using these skills for advocacy in the planning process, to inform the allocation of some health resources, and to evaluate some public health initiatives. We demonstrated that GIS can be a useful and inexpensive tool for the decentralisation of health data analysis to low resource settings through the use of free and simple software, locally relevant training materials and by providing data collection tools to ensure data reliability.

Free and simple GIS as appropriate for health mapping in a low resource setting: a case study in eastern Indonesia

PubMed Central

2011-01-01

Background Despite the demonstrated utility of GIS for health applications, there are perceived problems in low resource settings: GIS software can be expensive and complex; input data are often of low quality. This study aimed to test the appropriateness of new, inexpensive and simple GIS tools in poorly resourced areas of a developing country. GIS applications were trialled in pilot studies based on mapping of health resources and health indicators at the clinic and district level in the predominantly rural province of Nusa Tenggara Timur in eastern Indonesia. The pilot applications were (i) rapid field collection of health infrastructure data using a GPS enabled PDA, (ii) mapping health indicator data using open source GIS software, and (iii) service availability mapping using a free modelling tool. Results Through contextualised training, district and clinic staff acquired skills in spatial analysis and visualisation and, six months after the pilot studies, they were using these skills for advocacy in the planning process, to inform the allocation of some health resources, and to evaluate some public health initiatives. Conclusions We demonstrated that GIS can be a useful and inexpensive tool for the decentralisation of health data analysis to low resource settings through the use of free and simple software, locally relevant training materials and by providing data collection tools to ensure data reliability. PMID:21352553

A Rapid and Low-Cost PCR Thermal Cycler for Low Resource Settings.

PubMed

Wong, Grace; Wong, Isaac; Chan, Kamfai; Hsieh, Yicheng; Wong, Season

2015-01-01

Many modern molecular diagnostic assays targeting nucleic acids are typically confined to developed countries or to the national reference laboratories of developing-world countries. The ability to make technologies for the rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a revolutionary step forward in global health. Many molecular assays are also developed based on polymerase chain reactions (PCR), which require thermal cyclers that are relatively heavy (>20 pounds) and need continuous electrical power. The temperature ramping speed of most economical thermal cyclers are relatively slow (2 to 3 °C/s) so a polymerase chain reaction can take 1 to 2 hours. Most of all, these thermal cyclers are still too expensive ($2k to $4k) for low-resource setting uses. In this article, we demonstrate the development of a low-cost and rapid water bath based thermal cycler that does not require active temperature control or continuous power supply during PCR. This unit costs $130 to build using commercial off-the-shelf items. The use of two or three vacuum-insulated stainless-steel Thermos food jars containing heated water (for denaturation and annealing/extension steps) and a layer of oil on top of the water allow for significantly stabilized temperatures for PCR to take place. Using an Arduino-based microcontroller, we automate the "archaic" method of hand-transferring PCR tubes between water baths. We demonstrate that this innovative unit can deliver high speed PCR (17 s per PCR cycle) with the potential to go beyond the 1,522 bp long amplicons tested in this study and can amplify from templates down to at least 20 copies per reaction. The unit also accepts regular PCR tubes and glass capillary tubes. The PCR efficiency of our thermal cycler is not different from other commercial thermal cyclers. When combined with a rapid nucleic acid detection approach, the thermos thermal cycler (TTC) can enable on-site molecular diagnostics in low-resource settings.

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

PubMed

Heffner, John E; Brower, Kathleen; Ellis, Rosemary; Brown, Shirley

2004-07-01

The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

Consensus recommendations for essential vascular care in low- and middle-income countries

PubMed Central

Stewart, Barclay T; Gyedu, Adam; Giannou, Christos; Mishra, Brijesh; Rich, Norman; Wren, Sherry; Mock, Charles; Kushner, Adam L

2016-01-01

Introduction Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. Methods The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health, as well as with experience in LMIC healthcare. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. Results The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs (i.e. primary health centers, and first-level, referral, and tertiary hospitals). The recommendations include both essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. Conclusion The resources recommended have the potential to improve LMIC healthcare systems’ ability to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning pre- and inter-hospital transport system, and vascular training for both existing and future healthcare providers. PMID:27432199

Consensus and contention in the priority setting process: examining the health sector in Uganda.

PubMed

Colenbrander, Sarah; Birungi, Charles; Mbonye, Anthony K

2015-06-01

Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia

PubMed Central

Devi, B. C. R.; Corbex, M.

2008-01-01

Background: The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. Methods: The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. Results: The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. Conclusion: The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population. PMID:18641007

A hand-powered, portable, low-cost centrifuge for diagnosing anemia in low-resource settings.

PubMed

Brown, Jocelyn; Theis, Lauren; Kerr, Lila; Zakhidova, Nazima; O'Connor, Kelly; Uthman, Margaret; Oden, Z Maria; Richards-Kortum, Rebecca

2011-08-01

This report describes the development of a hand-powered centrifuge to determine hematocrit values in low-resource settings. A hand-powered centrifuge was constructed by using a salad spinner. Hematocrit values were measured by using the hand-powered device, and results were compared with those of a benchtop centrifuge. The packed cell volume (PCV) measured with the hand-powered device correlated linearly with results obtained with a benchtop centrifuge (r = 0.986, P < 0.001). The PCVs measured with the hand-powered centrifuge were consistently 1.14 times higher than those measured with the benchtop system. The 14% increase in PCV measured with the hand-powered centrifuge is caused by increased plasma trapped in the cell column. The reader card was adjusted to compensate for trapped plasma. A hand-powered centrifuge and calibrated reader card can be constructed for U.S. $35 and can accurately determine hematocrit values. It is suitable for use in low-resource settings because it is mechanically-powered, inexpensive, and accurate.

A Hand-Powered, Portable, Low-Cost Centrifuge for Diagnosing Anemia in Low-Resource Settings

PubMed Central

Brown, Jocelyn; Theis, Lauren; Kerr, Lila; Zakhidova, Nazima; O'Connor, Kelly; Uthman, Margaret; Oden, Z. Maria; Richards-Kortum, Rebecca

2011-01-01

This report describes the development of a hand-powered centrifuge to determine hematocrit values in low-resource settings. A hand-powered centrifuge was constructed by using a salad spinner. Hematocrit values were measured by using the hand-powered device, and results were compared with those of a benchtop centrifuge. The packed cell volume (PCV) measured with the hand-powered device correlated linearly with results obtained with a benchtop centrifuge (r = 0.986, P < 0.001). The PCVs measured with the hand-powered centrifuge were consistently 1.14 times higher than those measured with the benchtop system. The 14% increase in PCV measured with the hand-powered centrifuge is caused by increased plasma trapped in the cell column. The reader card was adjusted to compensate for trapped plasma. A hand-powered centrifuge and calibrated reader card can be constructed for U.S. $35 and can accurately determine hematocrit values. It is suitable for use in low-resource settings because it is mechanically-powered, inexpensive, and accurate. PMID:21813855

Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

PubMed

Nishtar, Sania

2003-01-01

This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings.

PubMed

Bennett, Desmond J; Carroll, Ryan W; Kacmarek, Robert M

2018-04-01

Respiratory compromise is a leading contributor to global neonatal death. CPAP is a method of treatment that helps maintain lung volume during expiration, promotes comfortable breathing, and improves oxygenation. Bubble CPAP is an effective alternative to standard CPAP. We sought to determine the reliability and functionality of a low-cost bubble CPAP device designed for low-resource settings. The low-cost bubble CPAP device was compared to a commercially available bubble CPAP system. The devices were connected to a lung simulator that simulated neonates of 4 different weights with compromised respiratory mechanics (∼1, ∼3, ∼5, and ∼10 kg). The devices' abilities to establish and maintain pressure and flow under normal conditions as well as under conditions of leak were compared. Multiple combinations of pressure levels (5, 8, and 10 cm H 2 O) and flow levels (3, 6, and 10 L/min) were tested. The endurance of both devices was also tested by running the systems continuously for 8 h and measuring the changes in pressure and flow. Both devices performed equivalently during the no-leak and leak trials. While our testing revealed individual differences that were statistically significant and clinically important (>10% difference) within specific CPAP and flow-level settings, no overall comparisons of CPAP or flow were both statistically significant and clinically important. Each device delivered pressures similar to the desired pressures, although the flows delivered by both machines were lower than the set flows in most trials. During the endurance trials, the low-cost device was marginally better at maintaining pressure, while the commercially available device was better at maintaining flow. The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness. Copyright © 2018 by Daedalus Enterprises.

The challenge of treating conduct disorder in low-resourced settings: rap music to the rescue.

PubMed

Evans, Dylan J

2010-12-01

Conduct disorder is one of the most frequent serious childhood problems that present for treatment in community clinic settings. Evidence-based treatments for conduct disorder are intensive and require considerable resources to implement. In low-resourced contexts it is often not feasible to implement evidence-based treatments in their current form, which poses significant challenges for clinicians attempting to treat children in these settings. This article explores these challenges using a case study of the treatment of a young adolescent boy with a short-term multisystem intervention where rap music was employed as a powerful tool to facilitate an empathic connection in therapy and as a projective technique to explore underlying emotional difficulties.

Improved Methods for Fire Risk Assessment in Low-Income and Informal Settlements.

PubMed

Twigg, John; Christie, Nicola; Haworth, James; Osuteye, Emmanuel; Skarlatidou, Artemis

2017-02-01

Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum) settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix.

Priority setting in practice: participants opinions on vertical and horizontal priority setting for reallocation.

PubMed

Waldau, Susanne; Lindholm, Lars; Wiechel, Anna Helena

2010-08-01

In the Västerbotten County Council in Sweden a priority setting process was undertaken to reallocate existing resources for funding of new methods and activities. Resources were created by limiting low priority services. A procedure for priority setting was constructed and fully tested by engaging the entire organisation. The procedure included priority setting within and between departments and political decision making. Participants' views and experiences were collected as a basis for future improvement of the process. Results indicate that participants appreciated the overall approach and methodology and wished to engage in their improvement. Among the improvement proposals is prolongation of the process in order to improve the knowledge base quality. The procedure for identification of new items for funding also needs to be revised. The priority setting process was considered an overall success because it fulfilled its political goals. Factors considered crucial for success are a wish among managers for an economic strategy that addresses existing internal resource allocation; process management characterized by goal orientation and clear leadership; an elaborate communications strategy integrated early in the process and its management; political unity in support of the procedure, and a strong political commitment throughout the process. Generalizability has already been demonstrated by several health care organisations that performed processes founded on this working model. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings.

PubMed

St-Louis, Etienne; Séguin, Jade; Roizblatt, Daniel; Deckelbaum, Dan Leon; Baird, Robert; Razek, Tarek

2017-03-01

Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings. A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis. The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC. An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.

Precision chemical heating for diagnostic devices.

PubMed

Buser, J R; Diesburg, S; Singleton, J; Guelig, D; Bishop, J D; Zentner, C; Burton, R; LaBarre, P; Yager, P; Weigl, B H

2015-12-07

Decoupling nucleic acid amplification assays from infrastructure requirements such as grid electricity is critical for providing effective diagnosis and treatment at the point of care in low-resource settings. Here, we outline a complete strategy for the design of electricity-free precision heaters compatible with medical diagnostic applications requiring isothermal conditions, including nucleic acid amplification and lysis. Low-cost, highly energy dense components with better end-of-life disposal options than conventional batteries are proposed as an alternative to conventional heating methods to satisfy the unique needs of point of care use.

Point-of-Care Diagnostics in Low-Resource Settings and Their Impact on Care in the Age of the Noncommunicable and Chronic Disease Epidemic.

PubMed

Weigl, Bernhard H; Neogi, Tina; McGuire, Helen

2014-06-01

The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics. © 2013 Society for Laboratory Automation and Screening.

Geophysical techniques for low enthalpy geothermal exploration in New Zealand

NASA Astrophysics Data System (ADS)

Soengkono, Supri; Bromley, Chris; Reeves, Robert; Bennie, Stewart; Graham, Duncan

2013-05-01

Shallow warm water resources associated with low enthalpy geothermal systems are often difficult to explore using geophysical techniques, mainly because the warm water creates an insufficient physical change from the host rocks to be easily detectable. In addition, often the system also has a limited or narrow size. However, appropriate use of geophysical techniques can still help the exploration and further investigation of low enthalpy geothermal resources. We present case studies on the use of geophysical techniques for shallow warm water explorations over a variety of settings in New Zealand (mostly in the North Island) with variable degrees of success. A simple and direct method for the exploration of warm water systems is shallow temperature measurements. In some New Zealand examples, measurements of near surface temperatures helped to trace the extent of deeper thermal water. The gravity method was utilised as a structural technique for the exploration of some warm water systems in New Zealand. Our case studies show the technique can be useful in identifying basement depths and tracing fault systems associated with the occurrence of hot springs. Direct current (DC) ground resistivity measurements using a variety of electrode arrays have been the most common method for the exploration of low enthalpy geothermal resources in New Zealand. The technique can be used to detect the extent of shallow warm waters that are more electrically conductive than the surrounding cold groundwater. Ground resistivity investigations using the electromagnetic (EM) techniques of audio magnetotellurics (AMT or shallow MT), controlled source audio magnetotellurics (CSAMT) and transient electromagnetic (TEM) methods have also been used. Highly conductive clays of thermal or sedimentary origin often limit the penetration depth of the resistivity techniques and can create some interpretation difficulties. Interpretation of resistivity anomalies needs to be treated in a site specific manner.

HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings

PubMed Central

2010-01-01

Background The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors. Methods/Design This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools). The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles. The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component. Discussion This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings. PMID:20604914

Analysis of high-throughput biological data using their rank values.

PubMed

Dembélé, Doulaye

2018-01-01

High-throughput biological technologies are routinely used to generate gene expression profiling or cytogenetics data. To achieve high performance, methods available in the literature become more specialized and often require high computational resources. Here, we propose a new versatile method based on the data-ordering rank values. We use linear algebra, the Perron-Frobenius theorem and also extend a method presented earlier for searching differentially expressed genes for the detection of recurrent copy number aberration. A result derived from the proposed method is a one-sample Student's t-test based on rank values. The proposed method is to our knowledge the only that applies to gene expression profiling and to cytogenetics data sets. This new method is fast, deterministic, and requires a low computational load. Probabilities are associated with genes to allow a statistically significant subset selection in the data set. Stability scores are also introduced as quality parameters. The performance and comparative analyses were carried out using real data sets. The proposed method can be accessed through an R package available from the CRAN (Comprehensive R Archive Network) website: https://cran.r-project.org/web/packages/fcros .

Pediatric Cerebral Palsy in Botswana: Etiology, Outcomes, and Comorbidities

PubMed Central

Bearden, David R.; Monokwane, Baphaleng; Khurana, Esha; Baier, James; Baranov, Esther; Westmoreland, Kate; Mazhani, Loeto; Steenhoff, Andrew P.

2016-01-01

BACKGROUND Cerebral palsy is the most common cause of motor dysfunction in children worldwide and is often accompanied by multiple comorbidities. Although cerebral palsy has been studied extensively in high-resource settings, there are few published studies on cerebral palsy etiology, outcomes and comorbidities in low-resource settings. METHODS Children with cerebral palsy were prospectively enrolled from inpatient and outpatient settings at a referral center in Gaborone, Botswana, in a cross-sectional study conducted from 2013 to 2014. Cerebral palsy etiology, outcomes, and comorbidities were determined through caregiver interviews, review of medical records, and direct physical examination. RESULTS Sixty-eight children with cerebral palsy were enrolled. Subjects were 41% male, with a median age of 4 years (interquartile range = 2 to 7). The most common etiologies for cerebral palsy in our cohort were intrapartum hypoxic events (18%), postnatal infections (15%), prematurity (15%), focal ischemic strokes (10%), and prenatal infections (10%). Severe motor impairment was common, with the most severe category present in 41%. The predominant comorbidities were cognitive impairment (84%), epilepsy (77%), and visual impairment (46%). CONCLUSIONS Cerebral palsy in Botswana has different etiologies and is associated with poorer outcomes and higher prevalence of comorbidities than what has been reported in high-resource settings. Further studies are necessary to determine optimal preventative and treatment strategies in this population. PMID:27114082

Resource availability for the management of maternal sepsis in Malawi, other low-income countries, and lower-middle-income countries.

PubMed

Abdu, Mohammed; Wilson, Amie; Mhango, Chisale; Taki, Fatima; Coomarasamy, Arri; Lissauer, David

2018-02-01

To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Comparison and cost analysis of drinking water quality monitoring requirements versus practice in seven developing countries.

PubMed

Crocker, Jonny; Bartram, Jamie

2014-07-18

Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country's ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states), Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H2S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries.

Wind and solar resource data sets: Wind and solar resource data sets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clifton, Andrew; Hodge, Bri-Mathias; Draxl, Caroline

The range of resource data sets spans from static cartography showing the mean annual wind speed or solar irradiance across a region to high temporal and high spatial resolution products that provide detailed information at a potential wind or solar energy facility. These data sets are used to support continental-scale, national, or regional renewable energy development; facilitate prospecting by developers; and enable grid integration studies. This review first provides an introduction to the wind and solar resource data sets, then provides an overview of the common methods used for their creation and validation. A brief history of wind and solarmore » resource data sets is then presented, followed by areas for future research.« less

How Are Health Research Priorities Set in Low and Middle Income Countries? A Systematic Review of Published Reports

PubMed Central

McGregor, Skye; Henderson, Klara J.; Kaldor, John M.

2014-01-01

Background Priority setting is increasingly recognised as essential for directing finite resources to support research that maximizes public health benefits and drives health equity. Priority setting processes have been undertaken in a number of low- and middle-income country (LMIC) settings, using a variety of methods. We undertook a critical review of reports of these processes. Methods and Findings We searched electronic databases and online for peer reviewed and non-peer reviewed literature. We found 91 initiatives that met inclusion criteria. The majority took place at the global level (46%). For regional or national initiatives, most focused on Sub Saharan Africa (49%), followed by East Asia and Pacific (20%) and Latin America and the Caribbean (18%). A quarter of initiatives aimed to cover all areas of health research, with a further 20% covering communicable diseases. The most frequently used process was a conference or workshop to determine priorities (24%), followed by the Child Health and Nutrition Initiative (CHNRI) method (18%). The majority were initiated by an international organization or collaboration (46%). Researchers and government were the most frequently represented stakeholders. There was limited evidence of any implementation or follow-up strategies. Challenges in priority setting included engagement with stakeholders, data availability, and capacity constraints. Conclusions Health research priority setting (HRPS) has been undertaken in a variety of LMIC settings. While not consistently used, the application of established methods provides a means of identifying health research priorities in a repeatable and transparent manner. In the absence of published information on implementation or evaluation, it is not possible to assess what the impact and effectiveness of health research priority setting may have been. PMID:25275315

Implementation of 5S management method for lean healthcare at a health center in Senegal: a qualitative study of staff perception.

PubMed

Kanamori, Shogo; Sow, Seydou; Castro, Marcia C; Matsuno, Rui; Tsuru, Akiko; Jimba, Masamine

2015-01-01

5S is a lean method for workplace organization; it is an abbreviation representing five Japanese words that can be translated as sort, set in order, shine, standardize, and sustain. The 5S management method has been recognized recently as a potential solution for improving the quality of government healthcare services in low- and middle-income countries. To assess how the 5S management method creates changes in the workplace and in the process and outcomes of healthcare services, and how it can be applicable in a resource-poor setting, based on data from a pilot intervention of the 5S program implemented in a health facility in Senegal. In this qualitative study, we interviewed 21 health center staff members 1 year after the pilot intervention. We asked them about their views on the changes brought on by the 5S program in their workplace, daily routines, and services provided. We then transcribed interview records and organized the narrative information by emerging themes using thematic analysis in the coding process. Study participants indicated that, despite resource constraints and other demotivating factors present at the health center, the 5S program created changes in the work environment, including fewer unwanted items, improved orderliness, and improved labeling and directional indicators of service units. These efforts engendered changes in the quality of services (e.g. making services more efficient, patient-centered, and safe), and in the attitude and behavior of staff and patients. The pilot intervention of the 5S management method was perceived to have improved the quality of healthcare services and staff motivation in a resource-poor healthcare facility with a disorderly work environment in Senegal. Quantitative and qualitative research based on a larger-scale intervention would be needed to elaborate and validate these findings and to identify the cost-effectiveness of such intervention in low- and middle-income countries.

Implementation of 5S management method for lean healthcare at a health center in Senegal: a qualitative study of staff perception

PubMed Central

Kanamori, Shogo; Sow, Seydou; Castro, Marcia C.; Matsuno, Rui; Tsuru, Akiko; Jimba, Masamine

2015-01-01

Background 5S is a lean method for workplace organization; it is an abbreviation representing five Japanese words that can be translated as sort, set in order, shine, standardize, and sustain. The 5S management method has been recognized recently as a potential solution for improving the quality of government healthcare services in low- and middle-income countries. Objective To assess how the 5S management method creates changes in the workplace and in the process and outcomes of healthcare services, and how it can be applicable in a resource-poor setting, based on data from a pilot intervention of the 5S program implemented in a health facility in Senegal. Design In this qualitative study, we interviewed 21 health center staff members 1 year after the pilot intervention. We asked them about their views on the changes brought on by the 5S program in their workplace, daily routines, and services provided. We then transcribed interview records and organized the narrative information by emerging themes using thematic analysis in the coding process. Results Study participants indicated that, despite resource constraints and other demotivating factors present at the health center, the 5S program created changes in the work environment, including fewer unwanted items, improved orderliness, and improved labeling and directional indicators of service units. These efforts engendered changes in the quality of services (e.g. making services more efficient, patient-centered, and safe), and in the attitude and behavior of staff and patients. Conclusions The pilot intervention of the 5S management method was perceived to have improved the quality of healthcare services and staff motivation in a resource-poor healthcare facility with a disorderly work environment in Senegal. Quantitative and qualitative research based on a larger-scale intervention would be needed to elaborate and validate these findings and to identify the cost-effectiveness of such intervention in low- and middle-income countries. PMID:25854781

Impact of hypothermia on implementation of CPAP for neonatal respiratory distress syndrome in a low-resource setting

PubMed Central

Kawaza, Kondwani; Quinn, MK; Miao, Yinsen; Guerra, Rudy; Molyneux, Elizabeth; Oden, Maria; Richards-Kortum, Rebecca

2018-01-01

Background Neonatal hypothermia is widely associated with increased risks of morbidity and mortality, but remains a pervasive global problem. No studies have examined the impact of hypothermia on outcomes for preterm infants treated with CPAP for respiratory distress syndrome (RDS). Methods This retrospective analysis assessed the impact of hypothermia on outcomes of 65 neonates diagnosed with RDS and treated with either nasal oxygen (N = 17) or CPAP (N = 48) in a low-resource setting. A classification tree approach was used to develop a model predicting survival for subjects diagnosed with RDS. Findings Survival to discharge was accurately predicted based on three variables: mean temperature, treatment modality, and mean respiratory rate. None of the 23 neonates with a mean temperature during treatment below 35.8°C survived to discharge, regardless of treatment modality. Among neonates with a mean temperature exceeding 35.8°C, the survival rate was 100% for the 31 neonates treated with CPAP and 36.4% for the 11 neonates treated with nasal oxygen (p<0.001). For neonates treated with CPAP, outcomes were poor if more than 50% of measured temperatures indicated hypothermia (5.6% survival). In contrast, all 30 neonates treated with CPAP and with more than 50% of temperature measurements above 35.8°C survived to discharge, regardless of initial temperature. Conclusion The results of our study suggest that successful implementation of CPAP to treat RDS in low-resource settings will require aggressive action to prevent persistent hypothermia. However, our results show that even babies who are initially cold can do well on CPAP with proper management of hypothermia. PMID:29543861

The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management.

PubMed

Bowry, Ashna D K; Lewey, Jennifer; Dugani, Sagar B; Choudhry, Niteesh K

2015-09-01

Cardiovascular disease (CVD) is the second leading cause of mortality worldwide, accounting for 17 million deaths in 2013. More than 80% of these cases were in low- and middle-income countries (LMICs). Although the risk factors for the development of CVD are similar throughout the world, the evolving change in lifestyle and health behaviours in LMICs-including tobacco use, decreased physical activity, and obesity-are contributing to the escalating presence of CVD and mortality. Although CVD mortality is falling in high-income settings because of more effective preventive and management programs, access to evidence-based interventions for combating CVD in resource-limited settings is variable. The existing pressures on both human and financial resources impact the efforts of controlling CVD. The implementation of emerging innovative interventions to improve medication adherence, introducing m-health programs, and decentralizing the management of chronic diseases are promising methods to reduce the burden of chronic disease management on such fragile health care systems. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Human, animal and environmental contributors to antibiotic resistance in low-resource settings: integrating behavioural, epidemiological and One Health approaches

PubMed Central

Unicomb, Leanne; Islam, Mohammad Aminul

2018-01-01

Antibiotic resistance (ABR) is recognized as a One Health challenge because of the rapid emergence and dissemination of resistant bacteria and genes among humans, animals and the environment on a global scale. However, there is a paucity of research assessing ABR contemporaneously in humans, animals and the environment in low-resource settings. This critical review seeks to identify the extent of One Health research on ABR in low- and middle-income countries (LMICs). Existing research has highlighted hotspots for environmental contamination; food-animal production systems that are likely to harbour reservoirs or promote transmission of ABR as well as high and increasing human rates of colonization with ABR commensal bacteria such as Escherichia coli. However, very few studies have integrated all three components of the One Health spectrum to understand the dynamics of transmission and the prevalence of community-acquired resistance in humans and animals. Microbiological, epidemiological and social science research is needed at community and population levels across the One Health spectrum in order to fill the large gaps in knowledge of ABR in low-resource settings. PMID:29643217

Case-Mix, Care Processes, and Outcomes in Medically-Ill Patients Receiving Mechanical Ventilation in a Low-Resource Setting from Southern India: A Prospective Clinical Case Series.

PubMed

Karthikeyan, Balasubramanian; Kadhiravan, Tamilarasu; Deepanjali, Surendran; Swaminathan, Rathinam Palamalai

2015-01-01

Mechanical ventilation is a resource intensive organ support treatment, and historical studies from low-resource settings had reported a high mortality. We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting. We prospectively studied the characteristics and outcomes (disease-related, mechanical ventilation-related, and process of care-related) in 237 adults mechanically ventilated for a medical illness at a teaching hospital in southern India during February 2011 to August 2012. Vital status of patients discharged from hospital was ascertained on Day 90 or later. Mean age of the patients was 40 ± 17 years; 140 (51%) were men. Poisoning and envenomation accounted for 98 (41%) of 237 admissions. In total, 87 (37%) patients died in-hospital; 16 (7%) died after discharge; 115 (49%) were alive at 90-day assessment; and 19 (8%) were lost to follow-up. Weaning was attempted in 171 (72%) patients; most patients (78 of 99 [79%]) failing the first attempt could be weaned off. Prolonged mechanical ventilation was required in 20 (8%) patients. Adherence to head-end elevation and deep vein thrombosis prophylaxis were 164 (69%) and 147 (62%) respectively. Risk of nosocomial infections particularly ventilator-associated pneumonia was high (57.2 per 1,000 ventilator-days). Higher APACHE II score quartiles (adjusted HR [95% CI] quartile 2, 2.65 [1.19-5.89]; quartile 3, 2.98 [1.24-7.15]; quartile 4, 5.78 [2.45-13.60]), and new-onset organ failure (2.98 [1.94-4.56]) were independently associated with the risk of death. Patients with poisoning had higher risk of reintubation (43% vs. 20%; P = 0.001) and ventilator-associated pneumonia (75% vs. 53%; P = 0.001). But, their mortality was significantly lower compared to the rest (24% vs. 44%; P = 0.002). The case-mix considerably differs from other settings. Mortality in this low-resource setting is similar to high-resource settings. But, further improvements in care processes and prevention of nosocomial infections are required.

Distance-based microfluidic quantitative detection methods for point-of-care testing.

PubMed

Tian, Tian; Li, Jiuxing; Song, Yanling; Zhou, Leiji; Zhu, Zhi; Yang, Chaoyong James

2016-04-07

Equipment-free devices with quantitative readout are of great significance to point-of-care testing (POCT), which provides real-time readout to users and is especially important in low-resource settings. Among various equipment-free approaches, distance-based visual quantitative detection methods rely on reading the visual signal length for corresponding target concentrations, thus eliminating the need for sophisticated instruments. The distance-based methods are low-cost, user-friendly and can be integrated into portable analytical devices. Moreover, such methods enable quantitative detection of various targets by the naked eye. In this review, we first introduce the concept and history of distance-based visual quantitative detection methods. Then, we summarize the main methods for translation of molecular signals to distance-based readout and discuss different microfluidic platforms (glass, PDMS, paper and thread) in terms of applications in biomedical diagnostics, food safety monitoring, and environmental analysis. Finally, the potential and future perspectives are discussed.

Building capacity for cognitive behavioral therapy delivery for depression in disaster-impacted contexts.

PubMed

Ngo, Victoria K; Centanni, Angela; Wong, Eunice; Wennerstrom, Ashley; Miranda, Jeanne

2011-01-01

Numerous challenges exist in implementing evidence-based practices, such as cognitive behavioral therapy, in resource poor, ethnic minority, and/or disaster-affected communities with disparities in mental health. Community-academic participatory partnerships are a promising approach to addressing disparities by implementing community-appropriate, evidence-based depression care. A community-academic collaborative was formed in New Orleans after Hurricane Katrina to expand resources for effective depression care, including cognitive behavioral therapy. In this article, we: 1) describe our model of building capacity to deliver cognitive behavioral therapy for depression in post-disaster community-based settings; 2) discuss the impact of this training program on therapist reported practice; and 3) share lessons learned regarding disseminating and sustaining evidence-based interventions in the context of a disaster impacted community. Using a mixed methods approach, we found that this model was feasible, acceptable, and disseminated knowledge about cognitive behavioral therapy in community settings. Over the course of two years, community providers demonstrated the feasibility of implementing evidence-based practice and potential for local community leadership. The lessons learned from this model of implementation may help address barriers to disseminating evidence-based interventions in other low-resource, disaster-impacted community settings.

Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study

PubMed Central

Carrara, Verena I.; Simpson, Julie A.; Thin, Nant War War; Say, Wah Wah; Paw, Naw Ta Mlar; Chotivanich, Kesinee; Turner, Claudia; Crawley, Jane; McGready, Rose

2018-01-01

Background Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable. Methods Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border. Findings From 21,225 newbonrs delivered, 15,073 (71%) met the inclusion criteria (liveborn, singleton, ≥28 weeks’ gestation, delivered in SMRU). Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced) cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40–8.06). Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66–2.55; p = 0.442), and 6.32 (95%CI 3.01–13.26; p<0.001) respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001). Neurodevelopmental follow-up to one year was performed in 1,608 (10.5%) of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565) versus 63 (n = 41); p = 0.732), while advanced resuscitation scores were significantly lower (56 (n = 5); p = 0.017). Interpretations Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery) associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills. PMID:29304139

Improved Linear Algebra Methods for Redshift Computation from Limited Spectrum Data - II

NASA Technical Reports Server (NTRS)

Foster, Leslie; Waagen, Alex; Aijaz, Nabella; Hurley, Michael; Luis, Apolo; Rinsky, Joel; Satyavolu, Chandrika; Gazis, Paul; Srivastava, Ashok; Way, Michael

2008-01-01

Given photometric broadband measurements of a galaxy, Gaussian processes may be used with a training set to solve the regression problem of approximating the redshift of this galaxy. However, in practice solving the traditional Gaussian processes equation is too slow and requires too much memory. We employed several methods to avoid this difficulty using algebraic manipulation and low-rank approximation, and were able to quickly approximate the redshifts in our testing data within 17 percent of the known true values using limited computational resources. The accuracy of one method, the V Formulation, is comparable to the accuracy of the best methods currently used for this problem.

Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings.

PubMed

Bitter, Cindy C; Erickson, Timothy B

2016-12-01

Burns are a common source of injuries worldwide, with a high burden of disease in low- and middle-income countries. Burns also account for 2%-8% of wilderness injuries. Although many are minor, the potential for serious morbidity and mortality exists, and standard treatments used in high-resource settings are not readily available in the backcountry. A literature review was performed to find evidence from low-resource settings that supports alternative or improvised therapies that may be adapted to care of burns in the wilderness. There is good evidence for use of oral rehydration to support volume status in burn patients. There is moderate evidence to support cold therapy as first aid and adjunct for pain control. Some evidence supports use of alternative dressings such as boiled potato peel, banana leaf, aloe vera, honey, sugar paste, and papaya when standard therapies are not available. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?

PubMed Central

Jan, Stephen; Bian, Ying; Jumpa, Manuel; Meng, Qingyue; Nyazema, Norman; Prakongsai, Phusit; Mills, Anne

2005-01-01

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date. PMID:16283054

Comparison of numerical weather prediction based deterministic and probabilistic wind resource assessment methods

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Jie; Draxl, Caroline; Hopson, Thomas

Numerical weather prediction (NWP) models have been widely used for wind resource assessment. Model runs with higher spatial resolution are generally more accurate, yet extremely computational expensive. An alternative approach is to use data generated by a low resolution NWP model, in conjunction with statistical methods. In order to analyze the accuracy and computational efficiency of different types of NWP-based wind resource assessment methods, this paper performs a comparison of three deterministic and probabilistic NWP-based wind resource assessment methodologies: (i) a coarse resolution (0.5 degrees x 0.67 degrees) global reanalysis data set, the Modern-Era Retrospective Analysis for Research and Applicationsmore » (MERRA); (ii) an analog ensemble methodology based on the MERRA, which provides both deterministic and probabilistic predictions; and (iii) a fine resolution (2-km) NWP data set, the Wind Integration National Dataset (WIND) Toolkit, based on the Weather Research and Forecasting model. Results show that: (i) as expected, the analog ensemble and WIND Toolkit perform significantly better than MERRA confirming their ability to downscale coarse estimates; (ii) the analog ensemble provides the best estimate of the multi-year wind distribution at seven of the nine sites, while the WIND Toolkit is the best at one site; (iii) the WIND Toolkit is more accurate in estimating the distribution of hourly wind speed differences, which characterizes the wind variability, at five of the available sites, with the analog ensemble being best at the remaining four locations; and (iv) the analog ensemble computational cost is negligible, whereas the WIND Toolkit requires large computational resources. Future efforts could focus on the combination of the analog ensemble with intermediate resolution (e.g., 10-15 km) NWP estimates, to considerably reduce the computational burden, while providing accurate deterministic estimates and reliable probabilistic assessments.« less

Diagnostic accuracy of self-administered urine glucose test strips as a diabetes screening tool in a low-resource setting in Cambodia.

PubMed

Storey, Helen L; van Pelt, Maurits H; Bun, Socheath; Daily, Frances; Neogi, Tina; Thompson, Matthew; McGuire, Helen; Weigl, Bernhard H

2018-03-22

Screening for diabetes in low-resource countries is a growing challenge, necessitating tests that are resource and context appropriate. The aim of this study was to determine the diagnostic accuracy of a self-administered urine glucose test strip compared with alternative diabetes screening tools in a low-resource setting of Cambodia. Prospective cross-sectional study. Members of the Borey Santepheap Community in Cambodia (Phnom Penh Municipality, District Dangkao, Commune Chom Chao). All households on randomly selected streets were invited to participate, and adults at least 18 years of age living in the study area were eligible for inclusion. The accuracy of self-administered urine glucose test strip positivity, Hemoglobin A1c (HbA1c)>6.5% and capillary fasting blood glucose (cFBG) measurement ≥126 mg/dL were assessed against a composite reference standard of cFBGmeasurement ≥200 mg/dL or venous blood glucose 2 hours after oral glucose tolerance test (OGTT) ≥200 mg/dL. Of the 1289 participants, 234 (18%) had diabetes based on either cFBG measurement (74, 32%) or the OGTT (160, 68%). The urine glucose test strip was 14% sensitive and 99% specific and failed to identify 201 individuals with diabetes while falsely identifying 7 without diabetes. Those missed by the urine glucose test strip had lower venous fasting blood glucose, lower venous blood glucose 2 hours after OGTT and lower HbA1c compared with those correctly diagnosed. Low cost, easy to use diabetes tools are essential for low-resource communities with minimal infrastructure. While the urine glucose test strip may identify persons with diabetes that might otherwise go undiagnosed in these settings, its poor sensitivity cannot be ignored. The massive burden of diabetes in low-resource settings demands improvements in test technologies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Use of a commercial ELISA for the detection of measles-specific immunoglobulin G (IgG) in dried blood spots collected from children living in low-resource settings.

PubMed

Colson, K Ellicott; Potter, Alan; Conde-Glez, Carlos; Hernandez, Bernardo; Ríos-Zertuche, Diego; Zúñiga-Brenes, Paola; Iriarte, Emma; Mokdad, Ali H

2015-09-01

Seroepidemiological monitoring of population immunity to vaccine-preventable diseases is critical to prevent future outbreaks. Dried blood spots (DBS), drops of capillary blood dried on filter paper, are an affordable, minimally invasive alternative to venipuncture for collecting blood in field settings. However, few proven methods exist to analyze DBS for the presence of protective antibodies. This study validates a novel technique for measuring measles-specific immunoglobulin G (IgG) in capillary DBS using a commercial ELISA. The predictive performance of a new method for analyzing DBS was tested by comparing matched serum and DBS samples from 50 children. The accuracy, precision, and reliability of the procedure were evaluated, and the optimal cut points to classify positive and negative samples were determined. The method was then applied to 1,588 DBS collected during a large survey of children in Mexico and Nicaragua. Measles-specific IgG in serum samples were 62% negative, 10% equivocal, and 28% positive. In comparisons with matched serum, DBS results were 100% sensitive and 96 · 8% specific, and agreed in 46 of 50 (92%) cases. The inter-assay and intra-assay coefficients of variation from kit-provided controls were greater than desired (24.8% and 8.4%, respectively). However, in predictive simulations the average misclassification was only 3.9%. Procedures were found to be acceptable to surveyors and participants. Analyzing DBS collected in low-resources settings is a feasible and accurate means of measuring population immunity to measles and should be used to generate objective measures of health status and health system performance. © 2015 Wiley Periodicals, Inc.

Improved Methods for Fire Risk Assessment in Low-Income and Informal Settlements

PubMed Central

Twigg, John; Christie, Nicola; Haworth, James; Osuteye, Emmanuel; Skarlatidou, Artemis

2017-01-01

Fires cause over 300,000 deaths annually worldwide and leave millions more with permanent injuries: some 95% of these deaths are in low- and middle-income countries. Burn injury risk is strongly associated with low-income and informal (or slum) settlements, which are growing rapidly in an urbanising world. Fire policy and mitigation strategies in poorer countries are constrained by inadequate data on incidence, impacts, and causes, which is mainly due to a lack of capacity and resources for data collection, analysis, and modelling. As a first step towards overcoming such challenges, this project reviewed the literature on the subject to assess the potential of a range of methods and tools for identifying, assessing, and addressing fire risk in low-income and informal settlements; the process was supported by an expert workshop at University College London in May 2016. We suggest that community-based risk and vulnerability assessment methods, which are widely used in disaster risk reduction, could be adapted to urban fire risk assessment, and could be enhanced by advances in crowdsourcing and citizen science for geospatial data creation and collection. To assist urban planners, emergency managers, and community organisations who are working in resource-constrained settings to identify and assess relevant fire risk factors, we also suggest an improved analytical framework based on the Haddon Matrix. PMID:28157149

Application of economic principles in healthcare priority setting.

PubMed

Bate, Angela; Mitton, Craig

2006-06-01

In healthcare, resources are often insufficient to meet all claims on them. In this respect, resources are considered scarce and have to be managed by prioritizing between competing claims. Economics as a discipline explicitly addresses this reality by acknowledging resource scarcity. However, the extent to which economics actually influences such prioritizing decisions in healthcare is unclear. The purpose of this paper is to review the use of economics in priority setting decision making. We outline the key principles of economics as they apply to priority setting and review the methods reported in the literature with respect to these. We find that these methods, even economic methods (e.g., those typically used in conducting economic evaluations such as cost-effectiveness analyses) do not tend to explicitly incorporate economic principles. We argue therefore that these methods, when applied to the context of priority setting, are not sufficient and that what is required is a broader framework that can incorporate the output from economic methods yet also be pragmatically applicable. We then go on to present an alternative approach - namely program budgeting and marginal analysis. Finally, we put forward our case for using program budgeting and marginal analysis in priority setting practice and set out some future research challenges.

Acceptability of Home-Assessment Post Medical Abortion and Medical Abortion in a Low-Resource Setting in Rajasthan, India. Secondary Outcome Analysis of a Non-Inferiority Randomized Controlled Trial

PubMed Central

Paul, Mandira; Iyengar, Kirti; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Sharad D.; Bring, Johan; Soni, Sunita; Klingberg-Allvin, Marie

2015-01-01

Background Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective To investigate women’s acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main Outcome Measures Women’s acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women’s preference should be offered to foster women’s reproductive autonomy. Trial Registration ClinicalTrials.gov NCT01827995 PMID:26327217

Recent advances in low-cost microfluidic platforms for diagnostic applications.

PubMed

Tomazelli Coltro, Wendell Karlos; Cheng, Chao-Min; Carrilho, Emanuel; de Jesus, Dosil Pereira

2014-08-01

The use of inexpensive materials and cost-effective manufacturing processes for mass production of microfluidic devices is very attractive and has spurred a variety of approaches. Such devices are particularly suited for diagnostic applications in limited resource settings. This review describes the recent and remarkable advances in the use of low-cost substrates for the development of microfluidic devices for diagnostics and clinical assays. Thus, a plethora of new and improved fabrication methods, designs, capabilities, detections, and applications of microfluidic devices fabricated with paper, plastic, and threads are covered. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

A Rapid and Low-Cost PCR Thermal Cycler for Low Resource Settings

PubMed Central

Wong, Grace; Wong, Isaac; Chan, Kamfai; Hsieh, Yicheng; Wong, Season

2015-01-01

Background Many modern molecular diagnostic assays targeting nucleic acids are typically confined to developed countries or to the national reference laboratories of developing-world countries. The ability to make technologies for the rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a revolutionary step forward in global health. Many molecular assays are also developed based on polymerase chain reactions (PCR), which require thermal cyclers that are relatively heavy (>20 pounds) and need continuous electrical power. The temperature ramping speed of most economical thermal cyclers are relatively slow (2 to 3°C/s) so a polymerase chain reaction can take 1 to 2 hours. Most of all, these thermal cyclers are still too expensive ($2k to $4k) for low-resource setting uses. Methodology/Principal Findings In this article, we demonstrate the development of a low-cost and rapid water bath based thermal cycler that does not require active temperature control or continuous power supply during PCR. This unit costs $130 to build using commercial off-the-shelf items. The use of two or three vacuum-insulated stainless-steel Thermos food jars containing heated water (for denaturation and annealing/extension steps) and a layer of oil on top of the water allow for significantly stabilized temperatures for PCR to take place. Using an Arduino-based microcontroller, we automate the “archaic” method of hand-transferring PCR tubes between water baths. Conclusions/Significance We demonstrate that this innovative unit can deliver high speed PCR (17 s per PCR cycle) with the potential to go beyond the 1,522 bp long amplicons tested in this study and can amplify from templates down to at least 20 copies per reaction. The unit also accepts regular PCR tubes and glass capillary tubes. The PCR efficiency of our thermal cycler is not different from other commercial thermal cyclers. When combined with a rapid nucleic acid detection approach, the thermos thermal cycler (TTC) can enable on-site molecular diagnostics in low-resource settings. PMID:26146999

Combining evidence and values in priority setting: testing the balance sheet method in a low-income country.

PubMed

Makundi, Emmanuel; Kapiriri, Lydia; Norheim, Ole Frithjof

2007-09-24

Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.

Point-of-Care Diagnostics in Low Resource Settings: Present Status and Future Role of Microfluidics

PubMed Central

Sharma, Shikha; Zapatero-Rodríguez, Julia; Estrela, Pedro; O’Kennedy, Richard

2015-01-01

The inability to diagnose numerous diseases rapidly is a significant cause of the disparity of deaths resulting from both communicable and non-communicable diseases in the developing world in comparison to the developed world. Existing diagnostic instrumentation usually requires sophisticated infrastructure, stable electrical power, expensive reagents, long assay times, and highly trained personnel which is not often available in limited resource settings. This review will critically survey and analyse the current lateral flow-based point-of-care (POC) technologies, which have made a major impact on diagnostic testing in developing countries over the last 50 years. The future of POC technologies including the applications of microfluidics, which allows miniaturisation and integration of complex functions that facilitate their usage in limited resource settings, is discussed The advantages offered by such systems, including low cost, ruggedness and the capacity to generate accurate and reliable results rapidly, are well suited to the clinical and social settings of the developing world. PMID:26287254

Reducing user error in dipstick urinalysis with a low-cost slipping manifold and mobile phone platform (Conference Presentation)

NASA Astrophysics Data System (ADS)

Smith, Gennifer T.; Dwork, Nicholas; Khan, Saara A.; Millet, Matthew; Magar, Kiran; Javanmard, Mehdi; Bowden, Audrey K.

2017-03-01

Urinalysis dipsticks were designed to revolutionize urine-based medical diagnosis. They are cheap, extremely portable, and have multiple assays patterned on a single platform. They were also meant to be incredibly easy to use. Unfortunately, there are many aspects in both the preparation and the analysis of the dipsticks that are plagued by user error. This high error is one reason that dipsticks have failed to flourish in both the at-home market and in low-resource settings. Sources of error include: inaccurate volume deposition, varying lighting conditions, inconsistent timing measurements, and misinterpreted color comparisons. We introduce a novel manifold and companion software for dipstick urinalysis that eliminates the aforementioned error sources. A micro-volume slipping manifold ensures precise sample delivery, an opaque acrylic box guarantees consistent lighting conditions, a simple sticker-based timing mechanism maintains accurate timing, and custom software that processes video data captured by a mobile phone ensures proper color comparisons. We show that the results obtained with the proposed device are as accurate and consistent as a properly executed dip-and-wipe method, the industry gold-standard, suggesting the potential for this strategy to enable confident urinalysis testing. Furthermore, the proposed all-acrylic slipping manifold is reusable and low in cost, making it a potential solution for at-home users and low-resource settings.

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings.

PubMed

Raykar, Nakul P; Yorlets, Rachel R; Liu, Charles; Goldman, Roberta; Greenberg, Sarah L M; Kotagal, Meera; Farmer, Paul E; Meara, John G; Roy, Nobhojit; Gillies, Rowan D

2016-01-01

5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges-the specific circumstances-faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient-provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.

Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices.

PubMed

Utz, Bettina; Delamou, Alexandre; Belaid, Loubna; De Brouwere, Vincent

2016-01-01

Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective . To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods . We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results . We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion . The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.

[Calculation of workers' health care costs].

PubMed

Rydlewska-Liszkowska, Izabela

2006-01-01

In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials.

A Rapid and Low-Cost PCR Thermal Cycler for Infectious Disease Diagnostics

PubMed Central

Chan, Kamfai; Wong, Pui-Yan; Yu, Peter; Hardick, Justin; Wong, Kah-Yat; Wilson, Scott A.; Wu, Tiffany; Hui, Zoe; Gaydos, Charlotte; Wong, Season S.

2016-01-01

The ability to make rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a great step forward in global health. Many molecular diagnostic assays are developed based on using thermal cyclers to carry out polymerase chain reaction (PCR) and reverse-transcription PCR for DNA and RNA amplification and detection, respectively. Unfortunately, most commercial thermal cyclers are expensive and need continuous electrical power supply, so they are not suitable for uses in low-resource settings. We have previously reported a low-cost and simple approach to amplify DNA using vacuum insulated stainless steel thermoses food cans, which we have named it thermos thermal cycler or TTC. Here, we describe the use of an improved set up to enable the detection of viral RNA targets by reverse-transcription PCR (RT-PCR), thus expanding the TTC’s ability to identify highly infectious, RNA virus-based diseases in low resource settings. The TTC was successful in demonstrating high-speed and sensitive detection of DNA or RNA targets of sexually transmitted diseases, HIV/AIDS, Ebola hemorrhagic fever, and dengue fever. Our innovative TTC costs less than $200 to build and has a capacity of at least eight tubes. In terms of speed, the TTC’s performance exceeded that of commercial thermal cyclers tested. When coupled with low-cost endpoint detection technologies such as nucleic acid lateral-flow assay or a cell-phone-based fluorescence detector, the TTC will increase the availability of on-site molecular diagnostics in low-resource settings. PMID:26872358

Prospective cohort study of a new vacuum delivery device to assist with complicated labour in low-resource settings.

PubMed

Khan, Mishal; Hashmani, Farah Naz; Ahmed, Sajjad; Ahmed, Owais; Asim, Shabnam S; Wajahat, Yasmin; Sobani, Shoaib; Syed, Shershah; Qazi, Fahad

2015-02-01

Currently available vacuum devices used to assist women undergoing complicated labour are unsuitable for use in low-resource settings. The objective of this study was to evaluate the safety and feasibility of a new low-cost vacuum device, named Koohi Goth Vacuum Delivery System (KGVDS), designed for use in low-resource settings. A hospital-based, multicentre, prospective cohort study with no control group was conducted in Karachi, Pakistan. After training, KGVDS devices were made available for use by labour room staff at their discretion when instrumental delivery was indicated. Women to whom KGVDS was applied were followed from the start of labour until discharge. Feasibility was assessed in terms of successful expulsion of the foetal head following application of KGVDS and ease of use ratings. Safety was assessed by observing maternal and newborn post-delivery outcomes prior to discharge. Koohi Goth Vacuum Delivery System was applied to 137 women requiring instrumental delivery, of whom 111 (81%; 95% CI = 74-88%) successfully expelled the foetal head assisted by KGVDS and 103 (75%) stated that they would agree to use KGVDS again. There were no serious maternal or neonatal injuries or infections related to KGVDS use. The mean score for 'ease of use' given by doctors and midwives using the device was 8 of 10. Koohi Goth Vacuum Delivery System was feasible and safe to use for assisting complicated deliveries in low-resource hospitals in this initial evaluation. Our results indicate that this new device may have the potential to improve birth outcomes in settings where most mortality occurs and that further evaluations should be conducted. © 2014 John Wiley & Sons Ltd.

mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings

PubMed Central

Ginsburg, Amy Sarah; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Sundt, Mitch; Larson, Clarice; Tawiah Agyemang, Charlotte; Newton, Sam; Borriello, Gaetano; Anderson, Richard

2015-01-01

Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings—using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider’s ability to manually count respiratory rate—has proven inadequate. Furthermore, hypoxemia—a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death—is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop “mPneumonia,” an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality from pneumonia and other childhood illnesses in low-resource settings. PMID:26474321

Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncommunicable Disease Interventions

PubMed Central

Mendis, S.; Al Bashir, Igbal; Dissanayake, Lanka; Varghese, Cherian; Fadhil, Ibtihal; Marhe, Esha; Sambo, Boureima; Mehta, Firdosi; Elsayad, Hind; Sow, Idrisa; Algoe, Maltie; Tennakoon, Herbert; Truong, Lai Die; Lan, Le Thi Tuyet; Huiuinato, Dismond; Hewageegana, Neelamni; Fahal, Naiema A. W.; Mebrhatu, Goitom; Tshering, Gado; Chestnov, Oleg

2012-01-01

Objective. The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes. Methods. A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems. Results and Conclusions. Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs. PMID:23251789

Current and future role of voluntary surgical contraception in increasing access to and utilization of family planning services in Africa.

PubMed

Gaym, Asheber

2012-10-01

Voluntary surgical contraception is the most widely utilized method of contraception in the world. High effectiveness, low complication rates and reduced cost in the long term make them the ideal contraceptive choice to diverse group of clients including clients from low resource settings. To assess the current status of utilization and effectiveness of voluntary surgical contraception in Africa and suggest possible future roles in contraceptive method choice. A review of available literature on voluntary surgical contraception and synthesis of information under relevant headings. Despite very high total fertility rates in most countries of Africa, surgical contraceptives still contribute to a very small proportion ofcontraceptive method choice in the continent. Client profile and acceptability studies indicate a large unmet need for permanent contraception in the continent. Lack of information, misconceptions and weak health systems (particularly surgical care) are the major impediments to increasing availability of surgical contraception. Lack of knowledge and low levels of motivation among health care providers may also be significant barriers to access. Ihcreasing availability of information on the safety and effectiveness of these methods to both health care providers and the general population can increase demand and acceptability. Delegating service provision to appropriately trained non-physician providers at primary care settings can assist in increasing accessibility of these important family planning methods.

Human, animal and environmental contributors to antibiotic resistance in low-resource settings: integrating behavioural, epidemiological and One Health approaches.

PubMed

Rousham, Emily K; Unicomb, Leanne; Islam, Mohammad Aminul

2018-04-11

Antibiotic resistance (ABR) is recognized as a One Health challenge because of the rapid emergence and dissemination of resistant bacteria and genes among humans, animals and the environment on a global scale. However, there is a paucity of research assessing ABR contemporaneously in humans, animals and the environment in low-resource settings. This critical review seeks to identify the extent of One Health research on ABR in low- and middle-income countries (LMICs). Existing research has highlighted hotspots for environmental contamination; food-animal production systems that are likely to harbour reservoirs or promote transmission of ABR as well as high and increasing human rates of colonization with ABR commensal bacteria such as Escherichia coli However, very few studies have integrated all three components of the One Health spectrum to understand the dynamics of transmission and the prevalence of community-acquired resistance in humans and animals. Microbiological, epidemiological and social science research is needed at community and population levels across the One Health spectrum in order to fill the large gaps in knowledge of ABR in low-resource settings. © 2018 The Author(s).

Microfluidic point-of-care diagnostics for resource-poor environments

NASA Astrophysics Data System (ADS)

Laksanasopin, Tassaneewan; Chin, Curtis D.; Moore, Hannah; Wang, Jennifer; Cheung, Yuk Kee; Sia, Samuel K.

2009-05-01

Point-of-care (POC) diagnostics have tremendous potential to improve human health in remote and resource-poor settings. However, the design criteria for diagnostic tests appropriate in settings with limited infrastructure are unique and challenging. Here we present a custom optical reader which quantifies silver absorbance from heterogeneous immunoassays. The reader is simple and low-cost and suited for POC diagnostics.

Electrochemical magneto-actuated biosensor for CD4 count in AIDS diagnosis and monitoring.

PubMed

Carinelli, S; Xufré Ballesteros, C; Martí, M; Alegret, S; Pividori, M I

2015-12-15

The counting of CD4(+) T lymphocytes is a clinical parameter used for AIDS diagnosis and follow-up. As this disease is particularly prevalent in developing countries, simple and affordable CD4 cell counting methods are urgently needed in resource-limited settings. This paper describes an electrochemical magneto-actuated biosensor for CD4 count in whole blood. The CD4(+) T lymphocytes were isolated, preconcentrated and labeled from 100 μL of whole blood by immunomagnetic separation with magnetic particles modified with antiCD3 antibodies. The captured cells were labeled with a biotinylated antiCD4 antibody, followed by the reaction with the electrochemical reporter streptavidin-peroxidase conjugate. The limit of detection for the CD4 counting magneto-actuated biosensor in whole blood was as low as 44 cells μL(-1) while the logistic range was found to be from 89 to 912 cells μL(-1), which spans the whole medical interest range for CD4 counts in AIDS patients. The electrochemical detection together with the immunomagnetic separation confers high sensitivity, resulting in a rapid, inexpensive, robust, user-friendly method for CD4 counting. This approach is a promising alternative for the costly standard flow cytometry and suitable as diagnostic tool at decentralized practitioner sites in low resource settings, especially in less developed countries. Copyright © 2015 Elsevier B.V. All rights reserved.

Teaching surgical skills using video internet communication in a resource-limited setting.

PubMed

Autry, Amy M; Knight, Sharon; Lester, Felicia; Dubowitz, Gerald; Byamugisha, Josaphat; Nsubuga, Yosam; Muyingo, Mark; Korn, Abner

2013-07-01

To study the feasibility and acceptability of using video Internet communication to teach and evaluate surgical skills in a low-resource setting. This case-controlled study used video Internet communication for surgical skills teaching and evaluation. We randomized intern physicians rotating in the Obstetrics and Gynecology Department at Mulago Hospital at Makerere University in Kampala, Uganda, to the control arm (usual practice) or intervention arm (three video teaching sessions with University of California, San Francisco faculty). We made preintervention and postintervention videos of all interns tying knots using a small video camera and uploaded the files to a file hosting service that offers cloud storage. A blinded faculty member graded all of the videos. Both groups completed a survey at the end of the study. We randomized 18 interns with complete data for eight in the intervention group and seven in the control group. We found score improvement of 50% or more in six of eight (75%) interns in the intervention group compared with one of seven (14%) in the control group (P=.04). Scores declined in five of the seven (71%) controls but in none in the intervention group. Both intervention and control groups used attendings, colleagues, and the Internet as sources for learning about knot-tying. The control group was less likely to practice knot-tying than the intervention group. The trainees and the instructors felt this method of training was enjoyable and helpful. Remote teaching in low-resource settings, where faculty time is limited and access to visiting faculty is sporadic, is feasible, effective, and well-accepted by both learner and teacher. II.

Experiences with food insecurity and risky sex among low-income people living with HIV/AIDS in a resource-rich setting.

PubMed

Whittle, Henry J; Palar, Kartika; Napoles, Tessa; Hufstedler, Lee Lemus; Ching, Irene; Hecht, Frederick M; Frongillo, Edward A; Weiser, Sheri D

2015-01-01

Forty-nine million individuals are food insecure in the United States, where food insecurity and HIV/AIDS are prevalent among the urban poor. Food insecurity is associated with risky sexual behaviours among people living with HIV/AIDS (PLHIV). No qualitative studies, however, have investigated the mechanisms underlying this relationship either in a resource-rich setting or among populations that include men who have sex with men (MSM). Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance in the San Francisco Bay Area. The interviews explored experiences with food insecurity and perceived associations with sexual risk behaviours. Interviews were conducted in English, audio-recorded and transcribed verbatim. Transcripts were coded and analyzed according to content analysis methods using an inductive-deductive approach. Food insecurity was reported to be a strong contributor to risky sexual practices among MSM and female participants. Individuals described engaging in transactional sex for food or money to buy food, often during times of destitution. Participants also explained how food insecurity could lead to condomless sex despite knowledge of and desire to use safe sexual practices, largely because the need to obtain food in the short term was prioritized over the desire to use barrier protection. Our data extend previous research by demonstrating that food insecurity contributes to transactional and unprotected sex among urban poor individuals in a resource-rich setting, including among MSM. These findings underscore the importance of public health and social intervention efforts focused on structural inequalities.

Cognitive stimulation therapy as a low-resource intervention for dementia in sub-Saharan Africa (CST-SSA): Adaptation for rural Tanzania and Nigeria.

PubMed

Mkenda, Sarah; Olakehinde, Olaide; Mbowe, Godfrey; Siwoku, Akeem; Kisoli, Aloyce; Paddick, Stella-Maria; Adediran, Babatunde; Gray, William K; Dotchin, Catherine L; Adebiyi, Akinpelumi; Walker, Richard W; Mushi, Declare; Ogunniyi, Adesola

2016-06-21

Cognitive stimulation therapy is a non-pharmacological intervention for people with dementia. Its use has been associated with substantial improvements in cognition and quality of life in studies from high-income countries, equivalent to those achieved by pharmacological treatments. Cognitive stimulation therapy may be particularly suited to low resource settings, such as sub-Saharan Africa, because it requires little specialist equipment and can be delivered by non-specialist health workers. The aim of this study was to adapt cognitive stimulation therapy for use in sub-Saharan Africa taking into account socio-cultural differences and resource implications. Cognitive stimulation therapy is a structured programme, originally developed in the United Kingdom. Substantial adaptations were required for use in sub-Saharan Africa. The formative method for adapting psychotherapy was used as a framework for the adaption process. The feasibility of using the adapted cognitive stimulation therapy programme to manage dementia was assessed in Tanzania and Nigeria in November 2013. Further adaptations were made following critical appraisal of feasibility. The adapted cognitive stimulation therapy intervention appeared feasible and acceptable to participants and carers. Key adaptations included identification of suitable treatment settings, task adaptation to accommodate illiteracy and uncorrected sensory impairment, awareness of cultural differences and usage of locally available materials and equipment to ensure sustainability. Cognitive stimulation therapy was successfully adapted for use in sub-Saharan Africa. Future work will focus on a trial of cognitive stimulation therapy in each setting. © The Author(s) 2016.

Measuring Post-Partum Haemorrhage in Low-Resource Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in Hemoglobin

PubMed Central

Atukunda, Esther Cathyln; Mugyenyi, Godfrey Rwambuka; Obua, Celestino; Atuhumuza, Elly Bronney; Musinguzi, Nicholas; Tornes, Yarine Fajardo; Agaba, Amon Ganaafa; Siedner, Mark Jacob

2016-01-01

Background Accurate estimation of blood loss is central to prompt diagnosis and management of post-partum hemorrhage (PPH), which remains a leading cause of maternal mortality in low-resource countries. In such settings, blood loss is often estimated visually and subjectively by attending health workers, due to inconsistent availability of laboratory infrastructure. We evaluated the diagnostic accuracy of weighed blood loss (WBL) versus changes in peri-partum hemoglobin to detect PPH. Methods Data from this analysis were collected as part of a randomized controlled trial comparing oxytocin with misoprostol for PPH (NCT01866241). Blood samples for complete blood count were drawn on admission and again prior to hospital discharge or before blood transfusion. During delivery, women were placed on drapes and had pre-weighed sanitary towels placed around their perineum. Blood was then drained into a calibrated container and the sanitary towels were added to estimate WBL, where each gram of blood was estimated as a milliliter. Sensitivity, specificity, negative and positive predictive values (PPVs) were calculated at various blood volume loss and time combinations, and we fit receiver-operator curves using blood loss at 1, 2, and 24 hours compared to a reference standard of haemoglobin decrease of >10%. Results A total of 1,140 women were enrolled in the study, of whom 258 (22.6%) developed PPH, defined as a haemoglobin drop >10%, and 262 (23.0%) had WBL ≥500mL. WBL generally had a poor sensitivity for detection of PPH (<75% for most volume-time combinations). In contrast, the specificity of WBL was high with blood loss ≥ 500mL at 1h and ≥750mL at any time points excluding PPH in over 97% of women. As such, WBL has a high PPV (>85%) in high prevalence settings when WBL exceeds 750mL. Conclusion WBL has poor sensitivity but high specificity compared to laboratory-based methods of PPH diagnosis. These characteristics correspond to a high PPV in areas with high PPH prevalence. Although WBL is not useful for excluding PPH, this low-cost, simple and reproducible method is promising as a reasonable method to identify significant PPH in such settings where quantifiable red cell indices are unavailable. PMID:27050823

Cultural Influences in Women-Friendly Labor-Saving Hand Tool Designs: The Milk Churner Case.

PubMed

Kisaalita, William S; Katimbo, Abia; Sempiira, Edison J; Mugisa, Dana J

2016-02-01

The aim of this study was to highlight the importance of culture in sustainable, labor-saving solutions design for women in low-resource settings. One of the reasons behind the gender asset gap among Sub-Saharan African women is the higher labor burden these women face, making it difficult for them to produce for the home and markets. Hand tools are the simplest form and therefore the best first step to address this problem. But designing women-friendly (sustainable) hand tools calls for better understanding of the low-resource settings where these women reside. A milk churner was redesigned using a human-centered (participatory) approach with groups of women from two dominant ethnolinguistic groups of Bantu and Nilotic of Uganda, and its usability was tested. The churner reduced labor up to eightfold and has potential to expand the range of uses to include children and husbands due to its simplicity. Also, the churner significantly reduced undesirable health effects, like pain in knee joints. Based on the experience with the churner, a six-item "survival guide" is proposed to complement human-centered design guiding principles for facilitating the generation of solutions in low-resource settings. By paying great attention to culture in relation to human factors, a labor-reducing churner has been successfully introduced among Ugandan women. The ultimate goal is to make the churner available to female smallholder dairy-farming households throughout Sub-Saharan Africa. This study provides a survival guide for generating solutions to problems from low-resource settings. © 2016, Human Factors and Ergonomics Society.

Demonstrating the Efficacy of the FoneAstra Pasteurization Monitor for Human Milk Pasteurization in Resource-Limited Settings

PubMed Central

Coutsoudis, Anna; Israel-Ballard, Kiersten; Chaudhri, Rohit; Perin, Noah; Mlisana, Koleka

2015-01-01

Abstract Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. Materials and Methods: For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. Results: In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. Conclusions: Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives. PMID:25668396

Comparison and Cost Analysis of Drinking Water Quality Monitoring Requirements versus Practice in Seven Developing Countries

PubMed Central

Crocker, Jonny; Bartram, Jamie

2014-01-01

Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country’s ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states), Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H2S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries. PMID:25046632

Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings).

PubMed

Bensman, Rachel S; Slusher, Tina M; Butteris, Sabrina M; Pitt, Michael B; On Behalf Of The Sugar Pearls Investigators; Becker, Amanda; Desai, Brinda; George, Alisha; Hagen, Scott; Kiragu, Andrew; Johannsen, Ron; Miller, Kathleen; Rule, Amy; Webber, Sarah

2017-11-01

The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.

Using the U.S. Geological Survey National Water Quality Laboratory LT-MDL to Evaluate and Analyze Data

USGS Publications Warehouse

Bonn, Bernadine A.

2008-01-01

A long-term method detection level (LT-MDL) and laboratory reporting level (LRL) are used by the U.S. Geological Survey?s National Water Quality Laboratory (NWQL) when reporting results from most chemical analyses of water samples. Changing to this method provided data users with additional information about their data and often resulted in more reported values in the low concentration range. Before this method was implemented, many of these values would have been censored. The use of the LT-MDL and LRL presents some challenges for the data user. Interpreting data in the low concentration range increases the need for adequate quality assurance because even small contamination or recovery problems can be relatively large compared to concentrations near the LT-MDL and LRL. In addition, the definition of the LT-MDL, as well as the inclusion of low values, can result in complex data sets with multiple censoring levels and reported values that are less than a censoring level. Improper interpretation or statistical manipulation of low-range results in these data sets can result in bias and incorrect conclusions. This document is designed to help data users use and interpret data reported with the LTMDL/ LRL method. The calculation and application of the LT-MDL and LRL are described. This document shows how to extract statistical information from the LT-MDL and LRL and how to use that information in USGS investigations, such as assessing the quality of field data, interpreting field data, and planning data collection for new projects. A set of 19 detailed examples are included in this document to help data users think about their data and properly interpret lowrange data without introducing bias. Although this document is not meant to be a comprehensive resource of statistical methods, several useful methods of analyzing censored data are demonstrated, including Regression on Order Statistics and Kaplan-Meier Estimation. These two statistical methods handle complex censored data sets without resorting to substitution, thereby avoiding a common source of bias and inaccuracy.

Diagnosing and treating rare lesions in a low resource setting: lessons from ahybrid epithelioid trophoblastic tumor and choriocarcinoma.

PubMed

Akakpo, Patrick K; Ulzen-Appiah, Kofi; Agbeno, Evans; Derkyi-Kwarteng, Leonard

2017-12-01

To raise awareness of the existence of a rare type of malignant trophoblastic tumor and discuss the diagnostic challenges and management of this lesion in a low resource setting. A 35 -year -old G 6 P 3 woman was referred to our facility on account of persistent vaginal bleeding due to a suspected incomplete miscarriage with a cervical mass. Her serum β-HCG was elevated (36,900 mIU/ml) and examination showed a bleeding cervical mass. An initial histopathological diagnosis of moderately differentiated squamous cell carcinoma was reviewed to epithelioid trophoblastic tumor resulting in an extra-fascial hysterectomy. A final histopathological diagnosis of hybrid Epithelioid Trophoblastic Tumor and Choriocarcinoma (ETT/CC) was made after external review and immunohistochemistry. She received subsequent chemotherapy. Epithelioid trophoblastic tumor and its hybrids are difficult to diagnose. They may be diagnosed as moderately differentiated squamous cell carcinoma especially in low resource settings where cervical squamous cell carcinoma is relatively more common. A high index of suspicion, a serum β HCG test and close collaboration between clinicians and pathologists can help make the diagnosis. None.

Rural Indonesian health care workers' constructs of infection prevention and control knowledge.

PubMed

Marjadi, Brahmaputra; McLaws, Mary-Louise

2010-06-01

Understanding the constructs of knowledge behind clinical practices in low-resource rural health care settings with limited laboratory facilities and surveillance programs may help in designing resource-appropriate infection prevention and control education. Multiple qualitative methods of direct observations, individual and group focus discussions, and document analysis were used to examine health care workers' knowledge of infection prevention and control practices in intravenous therapy, antibiotic therapy, instrument reprocessing, and hand hygiene in 10 rural Indonesian health care facilities. Awareness of health care-associated infections was low. Protocols were in the main based on verbal instructions handed down through the ranks of health care workers. The evidence-based knowledge gained across professional training was overridden by empiricism, nonscientific modifications, and organizational and societal cultures when resources were restricted or patients demanded inappropriate therapies. This phenomenon remained undetected by accreditation systems and clinical educators. Rural Indonesian health care workers would benefit from a formal introduction to evidence-based practice that would deconstruct individual protocols that include nonscientific knowledge. To achieve levels of acceptable patient safety, protocols would have to be both evidence-based and resource-appropriate. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Providing oxygen to children in hospitals: a realist review

PubMed Central

Tosif, Shidan; Gray, Amy; Qazi, Shamim; Campbell, Harry; Peel, David; McPake, Barbara; Duke, Trevor

2017-01-01

Abstract Objective To identify and describe interventions to improve oxygen therapy in hospitals in low-resource settings, and to determine the factors that contribute to success and failure in different contexts. Methods Using realist review methods, we scanned the literature and contacted experts in the field to identify possible mechanistic theories of how interventions to improve oxygen therapy systems might work. Then we systematically searched online databases for evaluations of improved oxygen systems in hospitals in low- or middle-income countries. We extracted data on the effectiveness, processes and underlying theory of selected projects, and used these data to test the candidate theories and identify the features of successful projects. Findings We included 20 improved oxygen therapy projects (45 papers) from 15 countries. These used various approaches to improving oxygen therapy, and reported clinical, quality of care and technical outcomes. Four effectiveness studies demonstrated positive clinical outcomes for childhood pneumonia, with large variation between programmes and hospitals. We identified factors that help or hinder success, and proposed a practical framework depicting the key requirements for hospitals to effectively provide oxygen therapy to children. To improve clinical outcomes, oxygen improvement programmes must achieve good access to oxygen and good use of oxygen, which should be facilitated by a broad quality improvement capacity, by a strong managerial and policy support and multidisciplinary teamwork. Conclusion Our findings can inform practitioners and policy-makers about how to improve oxygen therapy in low-resource settings, and may be relevant for other interventions involving the introduction of health technologies. PMID:28479624

Community-based interventions to optimize early childhood development in low resource settings.

PubMed

Maulik, P K; Darmstadt, G L

2009-08-01

Interventions targeting the early childhood period (0 to 3 years) help to improve neuro-cognitive functioning throughout life. Some of the more low cost, low resource-intensive community practices for this age-group are play, reading, music and tactile stimulation. This research was conducted to summarize the evidence regarding the effectiveness of such strategies on child development, with particular focus on techniques that may be transferable to developing countries and to children at risk of developing secondary impairments. PubMed, PsycInfo, Embase, ERIC, CINAHL and Cochrane were searched for studies involving the above strategies for early intervention. Reference lists of these studies were scanned and other studies were incorporated based on snow-balling. Overall, 76 articles corresponding to 53 studies, 24 of which were randomized controlled trials, were identified. Sixteen of those studies were from low- and middle-income countries. Play and reading were the two commonest interventions and showed positive impact on intellectual development of the child. Music was evaluated primarily in intensive care settings. Kangaroo Mother Care, and to a lesser extent massage, also showed beneficial effects. Improvement in parent-child interaction was common to all the interventions. Play and reading were effective interventions for early childhood interventions in low- and middle-income countries. More research is needed to judge the effectiveness of music. Kangaroo Mother Care is effective for low birth weight babies in resource poor settings, but further research is needed in community settings. Massage is useful, but needs more rigorous research prior to being advocated for community-level interventions.

A Paper and Plastic Device for Performing Recombinase Polymerase Amplification of HIV DNA

PubMed Central

Rohrman, Brittany A.; Richards-Kortum, Rebecca R.

2013-01-01

Despite the importance of early diagnosis and treatment of HIV, only a small fraction of HIV-exposed infants in low- and middle-income countries are tested for the disease. The gold standard for early infant diagnosis, DNA PCR, requires resources that are unavailable in poor settings, and no point-of-care HIV DNA test is currently available. We have developed a device constructed of layers of paper, glass fiber, and plastic that is capable of performing isothermal, enzymatic amplification of HIV DNA. The device is inexpensive, small, light-weight, and easy to assemble. The device stores lyophilized enzymes, facilitates mixing of reaction components, and supports recombinase polymerase amplification in five steps of operation. Using commercially available lateral flow strips as a detection method, we demonstrate the ability of our device to amplify 10 copies of HIV DNA to detectable levels in 15 minutes. Our results suggest that our device, which is designed to be used after DNA extraction from dried-blood spots, may serve in conjunction with lateral flow strips as part of a point-of-care HIV DNA test to be used in low resource settings. PMID:22733333

A paper and plastic device for performing recombinase polymerase amplification of HIV DNA.

PubMed

Rohrman, Brittany A; Richards-Kortum, Rebecca R

2012-09-07

Despite the importance of early diagnosis and treatment of HIV, only a small fraction of HIV-exposed infants in low- and middle-income countries are tested for the disease. The gold standard for early infant diagnosis, DNA PCR, requires resources that are unavailable in poor settings, and no point-of-care HIV DNA test is currently available. We have developed a device constructed of layers of paper, glass fiber, and plastic that is capable of performing isothermal, enzymatic amplification of HIV DNA. The device is inexpensive, small, light-weight, and easy to assemble. The device stores lyophilized enzymes, facilitates mixing of reaction components, and supports recombinase polymerase amplification in five steps of operation. Using commercially available lateral flow strips as a detection method, we demonstrate the ability of our device to amplify 10 copies of HIV DNA to detectable levels in 15 min. Our results suggest that our device, which is designed to be used after DNA extraction from dried-blood spots, may serve in conjunction with lateral flow strips as part of a point-of-care HIV DNA test to be used in low resource settings.

Community Perspectives on Access to and Availability of Healthy Food in Rural, Low-Resource, Latino Communities

PubMed Central

Ramírez, A. Susana; Estrada, Erendira; Grassi, Kathleen; Nathan, Stephanie

2016-01-01

Introduction Attention has focused on the food environment as a result of the growing concern with obesity rates among Latinos in rural areas. Researchers have observed associations between a lack of physical access to affordable produce in areas where supermarkets and grocery stores are limited and poor dietary intake and obesity; these associations are high in rural, low-resource neighborhoods with a high population of Latino residents. We aimed to engage residents of low-resource, Latino-majority neighborhoods in discussions of food access in a rural yet agricultural community setting, which is typically described as a “food desert.” Methods We used a mixed-methods approach and conducted 3 focus groups (n = 20) and in-depth interviews (n = 59) and surveys (n = 79) with residents of a rural yet agricultural community. We used thematic analysis to explore residents’ perceptions of access to healthy foods. Results Residents (n = 79; mean age, 41.6 y; 72% female; 79% Latino; 53% Spanish-speaking) reported that dollar and discount stores in this agricultural area provided access to produce; however, produce at retail stores was less affordable than produce at nonretail outlets such as fruit and vegetable stands. Gifts and trades of fruits and vegetables from neighbors and community organizations supplied no-cost or low-cost healthy foods. Residents’ suggestions to improve food access centered on lowering the cost of produce in existing retail outlets and seeking out nonretail outlets. Conclusion Our findings contribute to understanding of the food environment in low-resource, rural yet agricultural areas. Although such areas are characterized as “food deserts,” residents identified nonretail outlets as a viable source of affordable produce, while indicating that the cost of retail produce was a concern. Innovative policy solutions to increase healthy food consumption must focus on affordability as well as accessibility, and consider alternate, nonretail food outlets in agricultural areas. PMID:27978407

Exclusion-Based Capture and Enumeration of CD4+ T Cells from Whole Blood for Low-Resource Settings.

PubMed

Howard, Alexander L; Pezzi, Hannah M; Beebe, David J; Berry, Scott M

2014-06-01

In developing countries, demand exists for a cost-effective method to evaluate human immunodeficiency virus patients' CD4(+) T-helper cell count. The TH (CD4) cell count is the current marker used to identify when an HIV patient has progressed to acquired immunodeficiency syndrome, which results when the immune system can no longer prevent certain opportunistic infections. A system to perform TH count that obviates the use of costly flow cytometry will enable physicians to more closely follow patients' disease progression and response to therapy in areas where such advanced equipment is unavailable. Our system of two serially-operated immiscible phase exclusion-based cell isolations coupled with a rapid fluorescent readout enables exclusion-based isolation and accurate counting of T-helper cells at lower cost and from a smaller volume of blood than previous methods. TH cell isolation via immiscible filtration assisted by surface tension (IFAST) compares well against the established Dynal T4 Quant Kit and is sensitive at CD4 counts representative of immunocompromised patients (less than 200 TH cells per microliter of blood). Our technique retains use of open, simple-to-operate devices that enable IFAST as a high-throughput, automatable sample preparation method, improving throughput over previous low-resource methods. © 2013 Society for Laboratory Automation and Screening.

Teachers' Lives in Context: A Framework for Understanding Barriers to High Quality Teaching within Resource Deprived Settings

ERIC Educational Resources Information Center

Schwartz, Kate; Cappella, Elise; Aber, J. Lawrence

2016-01-01

Within low-income communities in low- and high-resource countries, there is a profound need for more effective schools that are better able to foster child and youth development and support student learning. This paper presents a theoretical framework for understanding the role of teacher ecology in influencing teacher effectiveness and, through…

A Simple, Low-Cost Platform for Real-Time Isothermal Nucleic Acid Amplification

PubMed Central

Craw, Pascal; Mackay, Ruth E.; Naveenathayalan, Angel; Hudson, Chris; Branavan, Manoharanehru; Sadiq, S. Tariq; Balachandran, Wamadeva

2015-01-01

Advances in microfluidics and the introduction of isothermal nucleic acid amplification assays have resulted in a range of solutions for nucleic acid amplification tests suited for point of care and field use. However, miniaturisation of instrumentation for such assays has not seen such rapid advances and fluorescence based assays still depend on complex, bulky and expensive optics such as fluorescence microscopes, photomultiplier tubes and sensitive lens assemblies. In this work we demonstrate a robust, low cost platform for isothermal nucleic acid amplification on a microfluidic device. Using easily obtainable materials and commercial off-the-shelf components, we show real time fluorescence detection using a low cost photodiode and operational amplifier without need for lenses. Temperature regulation on the device is achieved using a heater fabricated with standard printed circuit board fabrication methods. These facile construction methods allow fabrications at a cost compatible with widespread deployment to resource poor settings. PMID:26389913

Closing the mental health gap in low-income settings by building research capacity: perspectives from Mozambique.

PubMed

Sweetland, Annika C; Oquendo, Maria A; Sidat, Mohsin; Santos, Palmira F; Vermund, Sten H; Duarte, Cristiane S; Arbuckle, Melissa; Wainberg, Milton L

2014-01-01

Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability. Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, although nonallopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need mental health treatment and those who have access to it include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. We describe a new North-South and South-South research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (United States), Vanderbilt University (United States), and Universidade Federal de São Paulo (Brazil), to build research capacity in Mozambique and other Portuguese-speaking African countries. Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country's ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and among low- and high-income settings, ultimately reducing the mental health treatment gap worldwide. Copyright © 2014 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Barriers to Neurosurgical Training in Sub-Saharan Africa: The Need for a Phased Approach to Global Surgery Efforts to Improve Neurosurgical Care.

PubMed

Sader, Elie; Yee, Philip; Hodaie, Mojgan

2017-02-01

Neurosurgery in low-income countries is faced with multiple challenges. Although the most common challenges include infrastructure and physical resource deficits, an underemphasized barrier relates to the methods and components of surgical training. The role of important aspects, including didactic surgical training, surgical decision-making, workshops, conferences, and assessment methods, has not been duly studied. Knowledge of these issues is a crucial step to move closer to strengthening surgical capacity in low-income countries. We designed an online survey to assess self-perceived and objectively measured barriers to neurosurgical training in various Sub-Saharan African countries. Key outcomes included perception toward adequacy of neurosurgery training and barriers to neurosurgical training at each individual site. Only 37% of responders felt that their training program adequately prepared them for handling incoming neurosurgical cases. Top perceived limitations of neurosurgery training included lack of physical resources (25% of all responses), lack of practical workshops (22%), lack of program structure (18%), and lack of topic-specific lectures (10%). Our results show that most responders believe their training program is inadequate and are interested in improving it through international collaborations. This implies that activities directed at strengthening surgical capacity must address this important necessity. One important strategy is the use of online educational tools. In consideration of the observed limitations in care, resources, and training, we recommend a phased approach to neurosurgical growth in low-income settings. Copyright © 2016. Published by Elsevier Inc.

Perceived behavioral control as a potential precursor of walking three times a week: Patient's perspectives

PubMed Central

Busse, Peter

2018-01-01

Background Behavior change theories can identify people’s main motivations to engage in recommended health practices and thus provide better tools to design interventions, particularly human centered design interventions. Objectives This study had two objectives: (a) to identify salient beliefs about walking three times a week for 30 minutes nonstop among patients with hypertension in a low-resource setting and, (b) to measure the relationships among intentions, attitudes, perceived social pressure and perceived behavioral control about this behavior. Methods Face-to-face interviews with 34 people living with hypertension were conducted in September-October 2011 in Lima, Peru, and data analysis was performed in 2015. The Reasoned Action Approach was used to study the people’s decisions to walk. We elicited people’s salient beliefs and measured the theoretical constructs associated with this behavior. Results Results pointed at salient key behavioral, normative and control beliefs. In particular, perceived behavioral control appeared as an important determinant of walking and a small set of control beliefs were identified as potential targets of health communication campaigns, including (not) having someone to walk with, having work or responsibilities, or having no time. Conclusions This theory-based study with a focus on end-users provides elements to inform the design of an intervention that would motivate people living with hypertension to walk on a regular basis in low-resource settings. PMID:29451917

FPGA Implementation of Optimal 3D-Integer DCT Structure for Video Compression

PubMed Central

2015-01-01

A novel optimal structure for implementing 3D-integer discrete cosine transform (DCT) is presented by analyzing various integer approximation methods. The integer set with reduced mean squared error (MSE) and high coding efficiency are considered for implementation in FPGA. The proposed method proves that the least resources are utilized for the integer set that has shorter bit values. Optimal 3D-integer DCT structure is determined by analyzing the MSE, power dissipation, coding efficiency, and hardware complexity of different integer sets. The experimental results reveal that direct method of computing the 3D-integer DCT using the integer set [10, 9, 6, 2, 3, 1, 1] performs better when compared to other integer sets in terms of resource utilization and power dissipation. PMID:26601120

Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review

PubMed Central

Scarf, Vanessa; Catling, Christine; Viney, Rosalie; Homer, Caroline

2016-01-01

Background There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications. Methods Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data. Results Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care. Conclusions There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers. PMID:26891444

Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries.

PubMed

Tangka, Florence K L; Subramanian, Sujha; Edwards, Patrick; Cole-Beebe, Maggie; Parkin, D Maxwell; Bray, Freddie; Joseph, Rachael; Mery, Les; Saraiya, Mona

2016-12-01

The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. Using the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania

PubMed Central

2016-01-01

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting. Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases that are assigned caesarean section, re-training and supervision on use and interpretation of partograph and, strengthening team work between doctors, mid-wives and theatre staff. After implementing these interventions in March, a re-audit was performed from July 2015 to November, 2015, and the results were compared to those of the baseline audit. Results Two hundred and sixty deliveries in the baseline survey and 250 deliveries in the follow-up survey were audited. Implementing the new criteria improved the diagnosis from 74% to 81% (p = 0.049) and also the management of obstructed labour from 4.2% at baseline audit to 9.2% at re-audit (p = 0.025). Improved detection of prolonged labour through heightened observation of regular contractions, protracted cervical dilatation, protracted descent of presenting part, arrested cervical dilation, and severe moulding contributed to improved standards of diagnosis (all p < 0.04). Patient reviews by senior obstetricians increased from 34% to 43% (p = 0.045) and reduced time for caesarean section intervention from the median time of 120 to 90 minutes (p = 0.001) improved management (all p < 0.05). Perinatal outcomes, neonatal distress and fresh stillbirths, were reduced from 16% to. 8.8% (p = 0.01). Conclusion A criteria-based audit proved to be a feasible and useful tool in improving diagnosis and management of obstructed labour using available resources. Some of the observed changes in practice were of modest magnitude implying demand for further improvements, while sustaining those already put in place. PMID:27893765

Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings.

PubMed

Naicker, Mageshree; Coutsoudis, Anna; Israel-Ballard, Kiersten; Chaudhri, Rohit; Perin, Noah; Mlisana, Koleka

2015-03-01

Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis.

PubMed

Abdelgadir, Jihad; Tran, Tu; Muhindo, Alex; Obiga, Doomwin; Mukasa, John; Ssenyonjo, Hussein; Muhumza, Michael; Kiryabwire, Joel; Haglund, Michael M; Sloan, Frank A

2017-05-01

There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning. In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda). During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%). This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals. Copyright © 2017 Elsevier Inc. All rights reserved.

Treatment of retained placenta with misoprostol: a randomised controlled trial in a low-resource setting (Tanzania).

PubMed

van Beekhuizen, Heleen J; Pembe, Andrea B; Fauteck, Heiner; Lotgering, Fred K

2009-10-23

Retained placenta is one of the common causes of maternal mortality in developing countries where access to appropriate obstetrical care is limited. Current treatment of retained placenta is manual removal of the placenta under anaesthesia, which can only take place in larger health care facilities. Medical treatment of retained placenta with prostaglandins E1 (misoprostol) could be cost-effective and easy-to-use and could be a life-saving option in many low-resource settings. The aim of this study is to assess the efficacy and safety of sublingually administered misoprostol in women with retained placenta in a low resource setting. Multicentered randomised, double-blind, placebo-controlled trial, to be conducted in 5 hospitals in Tanzania, Africa. Women with retained placenta, at a gestational age of 28 weeks or more and blood loss less than 750 ml, 30 minutes after delivery of the newborn despite active management of third stage of labour. Trial Entry & Randomisation & Study Medication: After obtaining informed consent, eligible women will be allocated randomly to the treatment groups using numbered envelopes that will be randomized in variable blocks containing identical capsules with either 800 microgram of misoprostol or placebo. The drugs will be given sublingually. The women, maternal care providers and researchers will be blinded to treatment allocation. 117 women, to show a 40% reduction in manual removals of the placenta (p = 0.05, 80% power). The randomization will be misoprostol: placebo = 2:1. PRIMARY STUDY OUTCOME: Expulsion of the placenta without manual removal. Secondary outcome is the number of blood transfusions. This is a protocol for a randomized trial in a low resource setting to assess if medical treatment of women with retained placenta with misoprostol reduces the incidence of manual removal of the placenta. Current Controlled Trials ISRCTN16104753.

Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

PubMed

Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

2016-01-01

In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

Mapping Malaria Risk in Low Transmission Settings: Challenges and Opportunities.

PubMed

Sturrock, Hugh J W; Bennett, Adam F; Midekisa, Alemayehu; Gosling, Roly D; Gething, Peter W; Greenhouse, Bryan

2016-08-01

As malaria transmission declines, it becomes increasingly focal and prone to outbreaks. Understanding and predicting patterns of transmission risk becomes an important component of an effective elimination campaign, allowing limited resources for control and elimination to be targeted cost-effectively. Malaria risk mapping in low transmission settings is associated with some unique challenges. This article reviews the main challenges and opportunities related to risk mapping in low transmission areas including recent advancements in risk mapping low transmission malaria, relevant metrics, and statistical approaches and risk mapping in post-elimination settings. Copyright © 2016. Published by Elsevier Ltd.

The Frequency and Pattern of Female Genital Tract Malignancies at the University of Nigeria Teaching Hospital, Enugu, Nigeria

PubMed Central

Okeke, TC; Onah, N; Ikeako, LC; Ezenyeaku, CCT

2013-01-01

Background: Female genital tract malignancy is common in our low resource setting. Options now exist for prevention, detection, treatment, and palliative care for the wide spectrum of female genital tract malignancies. Women will continue to die from these cancers unless health professionals and civil society adopt means to control female genital tract cancers in our low resource setting. Aim: The objective was to determine the frequency and patterns of female genital tract malignancy at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Materials and Methods: A 6-year retrospective study of female genital tract malignancies was conducted at the UNTH, Enugu. The case notes of patients admitted for female genital tract malignancy between January 1, 2003 and December 31, 2008 were retrieved from the medical records and cancer registry of the University of Nigeria Teaching Hospital, Enugu and relevant data were extracted. The data were analyzed using SPSS version 12 (SPSS Inc., Chicago, IL, USA) and the results expressed in descriptive statistics by simple percentages. Results: One hundred and sixty six (166) cases of genital malignancies were recorded during the 6-year review. Majority of the patients were in the fifth and sixth decades of life. Cancer of the cervix accounted for 66.3% (110/166) followed by ovarian cancer 21.1% (35/166). The other tumors seen during the period were tumors involving corpus uteri 9% (15/166) and vulva 3.6% (6/166). Tumors of fallopian tube and vagina were not seen during the study period. Conclusion: Despite the preventable nature of cancer of cervix, it remained the most common female genital tract malignancy in Enugu, South-East Nigeria. In our low resource setting in the developing countries, education and public enlightenment on the importance of routine screening and treatment of premalignant lesions of the cervix are necessary tools to reduce the incidence and mortality of cervical cancer. PMID:24116311

Health system preparedness for integration of mental health services in rural Liberia.

PubMed

Gwaikolo, Wilfred S; Kohrt, Brandon A; Cooper, Janice L

2017-07-27

There are increasing efforts and attention focused on the delivery of mental health services in primary care in low resource settings (e.g., mental health Gap Action Programme, mhGAP). However, less attention is devoted to systematic approaches that identify and address barriers to the development and uptake of mental health services within primary care in low-resource settings. Our objective was to prepare for optimal uptake by identifying barriers in rural Liberia. The country's need for mental health services is compounded by a 14-year history of political violence and the largest Ebola virus disease outbreak in history. Both events have immediate and lasting mental health effects. A mixed-methods approach was employed, consisting of qualitative interviews with 22 key informants and six focus group discussions. Additional qualitative data as well as quantitative data were collected through semi-structured assessments of 19 rural primary care health facilities. Data were collected from March 2013 to March 2014. Potential barriers to development and uptake of mental health services included lack of mental health knowledge among primary health care staff; high workload for primary health care workers precluding addition of mental health responsibilities; lack of mental health drugs; poor physical infrastructure of health facilities including lack of space for confidential consultation; poor communication support including lack of electricity and mobile phone networks that prevent referrals and phone consultation with supervisors; absence of transportation for patients to facilitate referrals; negative attitudes and stigma towards people with severe mental disorders and their family members; and stigma against mental health workers. To develop and facilitate effective primary care mental health services in a post-conflict, low resource setting will require (1) addressing the knowledge and clinical skills gap in the primary care workforce; (2) improving physical infrastructure of health facilities at care delivery points; and (3) implementing concurrent interventions designed to improve attitudes towards people with mental illness, their family members and mental health care providers.

Cervical cancer screening and treatment training course in El Salvador: experience and lessons learned.

PubMed

Masch, Rachel; Ditzian, Lauren R; April, Ayana K; Maza, Mauricio; Peralta, Ethel; Cremer, Miriam L

2011-09-01

Visual inspection with acetic acid (VIA) is a simple, low-cost alternative to traditional Pap smears that could greatly benefit the amount of screening and treatment available in low-resource areas, such as rural El Salvador. The objective of this study was to train Salvadoran health providers in VIA and cryotherapy using a week-long competency course. Health providers participated in the VIA training course, which consisted of 1 half-day of didactics, followed by 4 and 1 half days of clinical training. Pretests and posttests were administered. A 1-day didactic refresher course was administered to assess the quality of services being provided. Sixty-eight nurses and physicians completed the training course. Each trainee screened approximately 120 women and performed, on average, seven cryotherapy treatments. The average trainee improved his or her score by 15% on the theoretical test and 16.7% on the image test. At the completion of the 1-day refresher, average test scores were the highest among all the courses. The final assessment was based on 41 providers. The course proved a successful tool for training healthcare providers in methods of cervical cancer screening and treatment. The course is replicable in other low-resource settings in different countries. It also provided trainees with the opportunity to adapt their clinical skills in their realistic work setting.

Clinical prognostic rules for severe acute respiratory syndrome in low- and high-resource settings.

PubMed

Cowling, Benjamin J; Muller, Matthew P; Wong, Irene O L; Ho, Lai-Ming; Lo, Su-Vui; Tsang, Thomas; Lam, Tai Hing; Louie, Marie; Leung, Gabriel M

2006-07-24

An accurate prognostic model for patients with severe acute respiratory syndrome (SARS) could provide a practical clinical decision aid. We developed and validated prognostic rules for both high- and low-resource settings based on data available at the time of admission. We analyzed data on all 1755 and 291 patients with SARS in Hong Kong (derivation cohort) and Toronto (validation cohort), respectively, using a multivariable logistic scoring method with internal and external validation. Scores were assigned on the basis of patient history in a basic model, and a full model additionally incorporated radiological and laboratory results. The main outcome measure was death. Predictors for mortality in the basic model included older age, male sex, and the presence of comorbid conditions. Additional predictors in the full model included haziness or infiltrates on chest radiography, less than 95% oxygen saturation on room air, high lactate dehydrogenase level, and high neutrophil and low platelet counts. The basic model had an area under the receiver operating characteristic (ROC) curve of 0.860 in the derivation cohort, which was maintained on external validation with an area under the ROC curve of 0.882. The full model improved discrimination with areas under the ROC curve of 0.877 and 0.892 in the derivation and validation cohorts, respectively. The model performs well and could be useful in assessing prognosis for patients who are infected with re-emergent SARS.

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis

PubMed Central

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-01

Objective Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting The study focused on all 72 health districts of Zambia. Methods We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. PMID:28057650

Acceptability and performance of the menstrual cup in South Africa: a randomized crossover trial comparing the menstrual cup to tampons or sanitary pads.

PubMed

Beksinska, Mags E; Smit, Jenni; Greener, Ross; Todd, Catherine S; Lee, Mei-ling Ting; Maphumulo, Virginia; Hoffmann, Vivian

2015-02-01

In low-income settings, many women and girls face activity restrictions during menses, owing to lack of affordable menstrual products. The menstrual cup (MC) is a nonabsorbent reusable cup that collects menstrual blood. We assessed the acceptability and performance of the MPower® MC compared to pads or tampons among women in a low-resource setting. We conducted a randomized two-period crossover trial at one site in Durban, South Africa, between January and November 2013. Participants aged 18-45 years with regular menstrual cycles were eligible for inclusion if they had no intention of becoming pregnant, were using an effective contraceptive method, had water from the municipal system as their primary water source, and had no sexually transmitted infections. We used a computer-generated randomization sequence to assign participants to one of two sequences of menstrual product use, with allocation concealed only from the study investigators. Participants used each method over three menstrual cycles (total 6 months) and were interviewed at baseline and monthly follow-up visits. The product acceptability outcome compared product satisfaction question scores using an ordinal logistic regression model with individual random effects. This study is registered on the South African Clinical Trials database: number DOH-27-01134273. Of 124 women assessed, 110 were eligible and randomly assigned to selected menstrual products. One hundred and five women completed all follow-up visits. By comparison to pads/tampons (usual product used), the MC was rated significantly better for comfort, quality, menstrual blood collection, appearance, and preference. Both of these comparative outcome measures, along with likelihood of continued use, recommending the product, and future purchase, increased for the MC over time. MC acceptance in a population of novice users, many with limited experience with tampons, indicates that there is a pool of potential users in low-resource settings.

A Label-Free, Quantitative Fecal Hemoglobin Detection Platform for Colorectal Cancer Screening

PubMed Central

Soraya, Gita V.; Nguyen, Thanh C.; Abeyrathne, Chathurika D.; Huynh, Duc H.; Chan, Jianxiong; Nguyen, Phuong D.; Nasr, Babak; Chana, Gursharan; Kwan, Patrick; Skafidas, Efstratios

2017-01-01

The early detection of colorectal cancer is vital for disease management and patient survival. Fecal hemoglobin detection is a widely-adopted method for screening and early diagnosis. Fecal Immunochemical Test (FIT) is favored over the older generation chemical based Fecal Occult Blood Test (FOBT) as it does not require dietary or drug restrictions, and is specific to human blood from the lower digestive tract. To date, no quantitative FIT platforms are available for use in the point-of-care setting. Here, we report proof of principle data of a novel low cost quantitative fecal immunochemical-based biosensor platform that may be further developed into a point-of-care test in low-resource settings. The label-free prototype has a lower limit of detection (LOD) of 10 µg hemoglobin per gram (Hb/g) of feces, comparable to that of conventional laboratory based quantitative FIT diagnostic systems. PMID:28475117

African Swine Fever in Uganda: Qualitative Evaluation of Three Surveillance Methods with Implications for Other Resource-Poor Settings.

PubMed

Chenais, Erika; Sternberg-Lewerin, Susanna; Boqvist, Sofia; Emanuelson, Ulf; Aliro, Tonny; Tejler, Emma; Cocca, Giampaolo; Masembe, Charles; Ståhl, Karl

2015-01-01

Animal diseases impact negatively on households and on national economies. In low-income countries, this pertains especially to socio-economic effects on household level. To control animal diseases and mitigate their impact, it is necessary to understand the epidemiology of the disease in its local context. Such understanding, gained through disease surveillance, is often lacking in resource-poor settings. Alternative surveillance methods have been developed to overcome some of the hurdles obstructing surveillance. The objective of this study was to evaluate and qualitatively compare three methods for surveillance of acute infectious diseases using African swine fever in northern Uganda as an example. Report-driven outbreak investigations, participatory rural appraisals (PRAs), and a household survey using a smartphone application were evaluated. All three methods had good disease-detecting capacity, and each of them detected many more outbreaks compared to those reported to the World Organization for Animal Health during the same time period. Apparent mortality rates were similar for the three methods although highest for the report-driven outbreak investigations, followed by the PRAs, and then the household survey. The three methods have different characteristics and the method of choice will depend on the surveillance objective. The optimal situation might be achieved by a combination of the methods: outbreak detection via smartphone-based real-time surveillance, outbreak investigation for collection of biological samples, and a PRA for a better understanding of the epidemiology of the specific outbreak. All three methods require initial investments and continuous efforts. The sustainability of the surveillance system should, therefore, be carefully evaluated before making such investments.

Psychological interventions for post-traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review.

PubMed

Verhey, Ruth; Chibanda, Dixon; Brakarsh, Jonathan; Seedat, Soraya

2016-10-01

Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries. © 2016 John Wiley & Sons Ltd.

Adoption of recommended practices and basic technologies in a low-income setting

PubMed Central

English, Mike; Gathara, David; Mwinga, Stephen; Ayieko, Philip; Opondo, Charles; Aluvaala, Jalemba; Kihuba, Elesban; Mwaniki, Paul; Were, Fred; Irimu, Grace; Wasunna, Aggrey; Mogoa, Wycliffe; Nyamai, Rachel

2014-01-01

Objective In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent. Design and setting We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002–2012). Main outcome measures Basic resource availability, use of diagnostics and uptake of recommended practices. Results There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines. Conclusions Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions. PMID:24482351

Reaching the end of the line: Operational issues with implementing phone-based unannounced pill counts in resource-limited settings.

PubMed

Hirsch-Moverman, Yael; Burkot, Camilla; Saito, Suzue; Frederix, Koen; Pitt, Blanche; Melaku, Zenebe; Gadisa, Tsigereda; Howard, Andrea A

2017-01-01

Accurate measurement of adherence is necessary to ensure that therapeutic outcomes can be attributed to the recommended treatment. Phone-based unannounced pill counts were shown to be feasible and reliable measures of adherence in developed settings; and have been further used as part of medication adherence interventions. However, it is not clear whether this method can be implemented successfully in resource-limited settings, where cellular network and mobile phone coverage may be low. Our objective is to describe operational issues surrounding the use of phone-based unannounced pill counts in Lesotho and Ethiopia. Phone-based monthly unannounced pill counts, using an adaptation of a standardized protocol from previous US-based studies, were utilized to measure anti-TB and antiretroviral medication adherence in two implementation science studies in resource-limited settings, START (Lesotho) and ENRICH (Ethiopia). In START, 19.6% of calls were completed, with 71.9% of participants reached at least once; majority of failed call attempts were due to phones not being available (54.8%) or because participants were away from the pills (32.7%). In ENRICH, 33.5% of calls were completed, with 86.7% of participants reached at least once; the main reasons for failed call attempts were phones being switched off (31.5%), participants not answering (27.3%), participants' discomfort speaking on the phone (15.4%), and network problems (13.2%). Structural, facility-level, participant-level, and data collection challenges were encountered in these settings. Phone-based unannounced pill counts were found to be challenging, and response rates suboptimal. While some of these challenges were specific to local contexts, most of them are generalizable to resource-limited settings. In a research study context, a possible solution to ease operational challenges may be to focus phone-based unannounced pill count efforts on a randomly selected sample from participants who are provided with study phones and rigorously ensure that call attempts are made for these participants.

The relative contribution of profile body shape and weight to judgements of women's physical attractiveness in Britain and Malaysia.

PubMed

Swami, Viren; Tovée, Martin J

2007-12-01

Ninety-six Malaysian and British men rated for physical attractiveness a set of photographs of real women in profile, with known body mass index (BMI) and waist-to-hip ratio (WHR). Results showed that BMI accounted for the greater amount of variance in all settings. There were also significant differences in preferences for body weight, with low resource, low socioeconomic status (SES) raters preferring a significantly heavier partner than high resource, high SES raters. The disparity with previous findings using line drawings of women in profile was discussed in terms of the weaknesses of line-drawn stimuli.

The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers

PubMed Central

Krieger, James W.; Takaro, Tim K.; Song, Lin; Weaver, Marcia

2005-01-01

Objectives. We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers. Methods. We conducted a randomized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4–12 years who had asthma. Community health workers provided in-home environmental assessments, education, support for behavior change, and resources. Participants were assigned to either a high-intensity group receiving 7 visits and a full set of resources or a low-intensity group receiving a single visit and limited resources. Results. The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721. Conclusions. Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention. PMID:15798126

Special considerations--Induction of labor in low-resource settings.

PubMed

Smid, Marcela; Ahmed, Yusuf; Ivester, Thomas

2015-10-01

Induction of labor in resource-limited settings has the potential to significantly improve health outcomes for both mothers and infants. However, there are relatively little context-specific data to guide practice, and few specific guidelines. Also, there may be considerable issues regarding the facilities and organizational capacities necessary to support safe practices in many aspects of obstetrical practice, and for induction of labor in particular. Herein we describe the various opportunities as well as challenges presented by induction of labor in these settings. Copyright © 2015 Elsevier Inc. All rights reserved.

The Significance of HIV ‘Blips’ in Resource-Limited Settings: Is It the Same? Analysis of the Treat Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD)

PubMed Central

Kanapathipillai, Rupa; McManus, Hamish; Kamarulzaman, Adeeba; Lim, Poh Lian; Templeton, David J.; Law, Matthew; Woolley, Ian

2014-01-01

Introduction Magnitude and frequency of HIV viral load blips in resource-limited settings, has not previously been assessed. This study was undertaken in a cohort from a high income country (Australia) known as AHOD (Australian HIV Observational Database) and another cohort from a mixture of Asian countries of varying national income per capita, TAHOD (TREAT Asia HIV Observational Database). Methods Blips were defined as detectable VL (≥ 50 copies/mL) preceded and followed by undetectable VL (<50 copies/mL). Virological failure (VF) was defined as two consecutive VL ≥50 copies/ml. Cox proportional hazard models of time to first VF after entry, were developed. Results 5040 patients (AHOD n = 2597 and TAHOD n = 2521) were included; 910 (18%) of patients experienced blips. 744 (21%) and 166 (11%) of high- and middle/low-income participants, respectively, experienced blips ever. 711 (14%) experienced blips prior to virological failure. 559 (16%) and 152 (10%) of high- and middle/low-income participants, respectively, experienced blips prior to virological failure. VL testing occurred at a median frequency of 175 and 91 days in middle/low- and high-income sites, respectively. Longer time to VF occurred in middle/low income sites, compared with high-income sites (adjusted hazards ratio (AHR) 0.41; p<0.001), adjusted for year of first cART, Hepatitis C co-infection, cART regimen, and prior blips. Prior blips were not a significant predictor of VF in univariate analysis (AHR 0.97, p = 0.82). Differing magnitudes of blips were not significant in univariate analyses as predictors of virological failure (p = 0.360 for blip 50–≤1000, p = 0.309 for blip 50–≤400 and p = 0.300 for blip 50–≤200). 209 of 866 (24%) patients were switched to an alternate regimen in the setting of a blip. Conclusion Despite a lower proportion of blips occurring in low/middle-income settings, no significant difference was found between settings. Nonetheless, a substantial number of participants were switched to alternative regimens in the setting of blips. PMID:24516527

Comparison of a brain-based adaptive system and a manual adaptable system for invoking automation.

PubMed

Bailey, Nathan R; Scerbo, Mark W; Freeman, Frederick G; Mikulka, Peter J; Scott, Lorissa A

2006-01-01

Two experiments are presented examining adaptive and adaptable methods for invoking automation. Empirical investigations of adaptive automation have focused on methods used to invoke automation or on automation-related performance implications. However, no research has addressed whether performance benefits associated with brain-based systems exceed those in which users have control over task allocations. Participants performed monitoring and resource management tasks as well as a tracking task that shifted between automatic and manual modes. In the first experiment, participants worked with an adaptive system that used their electroencephalographic signals to switch the tracking task between automatic and manual modes. Participants were also divided between high- and low-reliability conditions for the system-monitoring task as well as high- and low-complacency potential. For the second experiment, participants operated an adaptable system that gave them manual control over task allocations. Results indicated increased situation awareness (SA) of gauge instrument settings for individuals high in complacency potential using the adaptive system. In addition, participants who had control over automation performed more poorly on the resource management task and reported higher levels of workload. A comparison between systems also revealed enhanced SA of gauge instrument settings and decreased workload in the adaptive condition. The present results suggest that brain-based adaptive automation systems may enhance perceptual level SA while reducing mental workload relative to systems requiring user-initiated control. Potential applications include automated systems for which operator monitoring performance and high-workload conditions are of concern.

Amperometric immunosensor for rapid detection of Mycobacterium tuberculosis

NASA Astrophysics Data System (ADS)

Hiraiwa, Morgan; Kim, Jong-Hoon; Lee, Hyun-Boo; Inoue, Shinnosuke; Becker, Annie L.; Weigel, Kris M.; Cangelosi, Gerard A.; Lee, Kyong-Hoon; Chung, Jae-Hyun

2015-05-01

Tuberculosis (TB) has been a major public health problem, which can be better controlled by using accurate and rapid diagnosis in low-resource settings. A simple, portable, and sensitive detection method is required for point-of-care (POC) settings. This paper studies an amperometric biosensor using a microtip immunoassay for a rapid and low-cost detection of Mycobacterium tuberculosis (MTB) in sputum. MTB in sputum is specifically captured on the functionalized microtip surface and detected by electric current. According to the numerical study, the current signal on the microtip surface is linearly changed with increasing immersion depth. Using a reference microtip, the immersion depth is compensated for a sensing microtip. On the microtip surface, target bacteria are concentrated and organized by a coffee-ring effect, which amplifies the electric current. To enhance the signal-to-noise ratio, both the sample processing and rinsing steps are presented with the use of deionized water as a medium for the amperometric measurement. When applied to cultured MTB cells spiked into human sputum, the detection limit was 100 CFU mL-1, comparable to a more labor-intensive fluorescence detection method reported previously.

Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

PubMed Central

Burke, Thomas F; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

2014-01-01

Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings. PMID:25260371

A systematic review of portable electronic technology for health education in resource-limited settings.

PubMed

McHenry, Megan S; Fischer, Lydia J; Chun, Yeona; Vreeman, Rachel C

2017-08-01

The objective of this study is to conduct a systematic review of the literature of how portable electronic technologies with offline functionality are perceived and used to provide health education in resource-limited settings. Three reviewers evaluated articles and performed a bibliography search to identify studies describing health education delivered by portable electronic device with offline functionality in low- or middle-income countries. Data extracted included: study population; study design and type of analysis; type of technology used; method of use; setting of technology use; impact on caregivers, patients, or overall health outcomes; and reported limitations. Searches yielded 5514 unique titles. Out of 75 critically reviewed full-text articles, 10 met inclusion criteria. Study locations included Botswana, Peru, Kenya, Thailand, Nigeria, India, Ghana, and Tanzania. Topics addressed included: development of healthcare worker training modules, clinical decision support tools, patient education tools, perceptions and usability of portable electronic technology, and comparisons of technologies and/or mobile applications. Studies primarily looked at the assessment of developed educational modules on trainee health knowledge, perceptions and usability of technology, and comparisons of technologies. Overall, studies reported positive results for portable electronic device-based health education, frequently reporting increased provider/patient knowledge, improved patient outcomes in both quality of care and management, increased provider comfort level with technology, and an environment characterized by increased levels of technology-based, informal learning situations. Negative assessments included high investment costs, lack of technical support, and fear of device theft. While the research is limited, portable electronic educational resources present promising avenues to increase access to effective health education in resource-limited settings, contingent on the development of culturally adapted and functional materials to be used on such devices.

Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

PubMed Central

2012-01-01

Background A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this ‘know-do’ gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the sub-elements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. Methods This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. Results The sub-elements of organizational context in the PARIHS framework—i.e., receptive context, culture, leadership, and evaluation—also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. Conclusions In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings—resources, community involvement, and commitment and informal payment—should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate sub-element of the PARIHS framework as a whole. PMID:23206670

Effect of routine mental health screening in a low-resource pediatric primary care population.

PubMed

Berger-Jenkins, Evelyn; McCord, Mary; Gallagher, Trish; Olfson, Mark

2012-04-01

Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.

A Summary Catalogue of Microbial Drinking Water Tests for Low and Medium Resource Settings

PubMed Central

Bain, Robert; Bartram, Jamie; Elliott, Mark; Matthews, Robert; McMahan, Lanakila; Tung, Rosalind; Chuang, Patty; Gundry, Stephen

2012-01-01

Microbial drinking-water quality testing plays an essential role in measures to protect public health. However, such testing remains a significant challenge where resources are limited. With a wide variety of tests available, researchers and practitioners have expressed difficulties in selecting the most appropriate test(s) for a particular budget, application and setting. To assist the selection process we identified the characteristics associated with low and medium resource settings and we specified the basic information that is needed for different forms of water quality monitoring. We then searched for available faecal indicator bacteria tests and collated this information. In total 44 tests have been identified, 18 of which yield a presence/absence result and 26 of which provide enumeration of bacterial concentration. The suitability of each test is assessed for use in the three settings. The cost per test was found to vary from $0.60 to $5.00 for a presence/absence test and from $0.50 to $7.50 for a quantitative format, though it is likely to be only a small component of the overall costs of testing. This article presents the first comprehensive catalogue of the characteristics of available and emerging low-cost tests for faecal indicator bacteria. It will be of value to organizations responsible for monitoring national water quality, water service providers, researchers and policy makers in selecting water quality tests appropriate for a given setting and application. PMID:22754460

A summary catalogue of microbial drinking water tests for low and medium resource settings.

PubMed

Bain, Robert; Bartram, Jamie; Elliott, Mark; Matthews, Robert; McMahan, Lanakila; Tung, Rosalind; Chuang, Patty; Gundry, Stephen

2012-05-01

Microbial drinking-water quality testing plays an essential role in measures to protect public health. However, such testing remains a significant challenge where resources are limited. With a wide variety of tests available, researchers and practitioners have expressed difficulties in selecting the most appropriate test(s) for a particular budget, application and setting. To assist the selection process we identified the characteristics associated with low and medium resource settings and we specified the basic information that is needed for different forms of water quality monitoring. We then searched for available faecal indicator bacteria tests and collated this information. In total 44 tests have been identified, 18 of which yield a presence/absence result and 26 of which provide enumeration of bacterial concentration. The suitability of each test is assessed for use in the three settings. The cost per test was found to vary from $0.60 to $5.00 for a presence/absence test and from $0.50 to $7.50 for a quantitative format, though it is likely to be only a small component of the overall costs of testing. This article presents the first comprehensive catalogue of the characteristics of available and emerging low-cost tests for faecal indicator bacteria. It will be of value to organizations responsible for monitoring national water quality, water service providers, researchers and policy makers in selecting water quality tests appropriate for a given setting and application.

Assessment of the status of resources for essential trauma care in Hanoi and Khanh Hoa, Vietnam.

PubMed

Son, Nguyen Thai; Thu, Nguyen Hoai; Tu, Nguyen Thi Hong; Mock, Charles

2007-09-01

The World Health Organization and the International Association for Trauma Surgery and Intensive Care have published the Guidelines for Essential Trauma Care. This provides recommendations for the human and physical resources needed to provide an adequate, essential level of trauma care services in countries at all economic levels worldwide. We sought to use this set of recommendations as a basis to assess the trauma care capabilities in two locations in Vietnam and thus to identify affordable and sustainable methods to strengthen trauma care nationwide. A needs assessment tool was created that incorporated the recommendations of the Guidelines. This was used to conduct in-depth, onsite evaluations of 11 health care facilities in Hanoi and Khanh Hoa Province, including commune health stations, district hospitals, provincial hospitals, and a central hospital. Resources for trauma care were mostly adequate at provincial and central hospitals. There were several deficiencies at the district hospitals and especially at commune health stations. These included low level of trauma related training and shortages of supplies and equipment. In many cases these shortages were of low-cost items. However, in general, capabilities had improved compared with prior evaluations. This study has identified several low-cost ways in which to strengthen trauma care in Vietnam. These include greater use of continuing education courses for trauma care and more attention to trauma related curriculum in schools of medicine and nursing. These also include defining and assuring the availability of a core set of essential trauma related equipment and supplies. A policy recommendation that follows from the above findings is the need for programs to strengthen the organization and planning for trauma care.

Access to infertility care in the developing world: the family promotion gap.

PubMed

Asemota, Obehi A; Klatsky, Peter

2015-01-01

Infertility in resource-poor settings is an overlooked global health problem. Although scarce health care resources must be deployed thoughtfully, prioritization of resources may be different for recipient and donor countries, the latter of whom focus on maternal health care, prevention, and family planning. For women and couples with involuntary childlessness, the negative psychosocial, sociocultural, and economic consequences in low-income countries are severe, possibly more so than in most Western societies. Despite the local importance of infertility, few resources are committed to help advance infertility care in regions like sub-Saharan Africa. The worldwide prevalence of infertility is remarkably similar across low-, middle-, and high-income countries. The World Health Organization (WHO) recognizes infertility as a global health problem and established universal access to reproductive health care as one of the United Nation's Millennium Developmental Goals for 2015. Currently, access to infertility care is varied and is usually only attainable by the very wealthy in low-income countries. We provide an overview on the current state of access to infertility care in low-income countries such as in sub-Saharan Africa and a rationale for providing comprehensive reproductive care and possible solutions for providing cost-effective infertility services in these settings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of a large healthy lifestyle program: informing program implementation and scale-up in the prevention of obesity.

PubMed

Kozica, S L; Lombard, C B; Harrison, C L; Teede, H J

2016-11-24

The Healthy Lifestyle Program for women (HeLP-her) is a low-intensity, self-management program which has demonstrated efficacy in preventing excess weight gain in women. However, little is known about the implementation, reach, and sustainability of low-intensity prevention programs in rural settings, where risk for obesity in women is higher than urban settings. We aimed to evaluate a low-intensity healthy lifestyle program delivered to women in a rural setting to inform development of effective community prevention programs. A mixed method hybrid implementation and evaluation study, guided by the RE-AIM framework (addressing the Reach, Effectiveness, Adoption, Implementation, and Maintenance), was undertaken. Data collection tools included anthropometric measures, program checklists, questionnaires, and semi-structured interviews with participants and local stakeholders. The RE-AIM self-audit tool was applied to assess evaluation rigor. Six hundred and forty-nine women from 41 relatively socio-economic disadvantaged communities in Australia participated: mean age 39.6 years (±SD 6.7) and body mass index of 28.8 kg/m 2 (±SD 6.9). A between-group weight difference of -0.92 kg (95% CI -1.67 to -0.16) showed program effectiveness. Reach was broad across 41 towns with 62% of participants reporting influencing some of the health behaviors of their families. Strong implementation fidelity was achieved with good retention rates at 1 year (76%) and high participant satisfaction (82% of participants willing to recommend this program). Over 300 multi-level community partnerships were established supporting high adoption. Stakeholders reported potential capacity to implement and sustain the prevention program in resource poor rural settings, due to the low-intensity design and minimal resources required. Our comprehensive RE-AIM evaluation demonstrates that an evidence-based obesity prevention program can be successfully implemented in real-world settings. The program achieved broad reach, effectiveness, and satisfaction at the community and stakeholder level, revealing potential for program sustainability. The evaluation addressed implementation knowledge gaps to support future obesity prevention program scale-up. Australian and New Zealand Clinical Trial Registry ACTRN 12612000115831 [ http://www.anzctr.org.au/ ].

HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings.

PubMed

Finkelstein, Julia L; Gala, Pooja; Rochford, Rosemary; Glesby, Marshall J; Mehta, Saurabh

2015-01-01

Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n = 799), 90 studies were included in this review. Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.

Discerning trends in multiplex immunoassay technology with potential for resource-limited settings.

PubMed

Gordon, Julian; Michel, Gerd

2012-04-01

In the search for more powerful tools for diagnoses of endemic diseases in resource-limited settings, we have been analyzing technologies with potential applicability. Increasingly, the process focuses on readily accessible bodily fluids combined with increasingly powerful multiplex capabilities to unambiguously diagnose a condition without resorting to reliance on a sophisticated reference laboratory. Although these technological advances may well have important implications for the sensitive and specific detection of disease, to date their clinical utility has not been demonstrated, especially in resource-limited settings. Furthermore, many emerging technological developments are in fields of physics or engineering, which are not readily available to or intelligible to clinicians or clinical laboratory scientists. This review provides a look at technology trends that could have applicability to high-sensitivity multiplexed immunoassays in resource-limited settings. Various technologies are explained and assessed according to potential for reaching relevant limits of cost, sensitivity, and multiplex capability. Frequently, such work is reported in technical journals not normally read by clinical scientists, and the authors make enthusiastic claims for the potential of their technology while ignoring potential pitfalls. Thus it is important to draw attention to technical hurdles that authors may not be publicizing. Immunochromatographic assays, optical methods including those involving waveguides, electrochemical methods, magnetorestrictive methods, and field-effect transistor methods based on nanotubes, nanowires, and nanoribbons reveal possibilities as next-generation technologies.

Surveillance of intestinal schistosomiasis during control: a comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region.

PubMed

Al-Shehri, Hajri; Koukounari, Artemis; Stanton, Michelle C; Adriko, Moses; Arinaitwe, Moses; Atuhaire, Aaron; Kabatereine, Narcis B; Stothard, J Russell

2018-03-21

Programmatic surveillance of intestinal schistosomiasis during control can typically use four diagnostic tests, either singularly or in combination, but these have yet to be cross-compared directly. Our study assembled a complete diagnostic dataset, inclusive of infection intensities, from 258 children from five Ugandan primary schools. The schools were purposely selected as typical of the endemic landscape near Lake Albert and reflective of high- and low-transmission settings. Overall prevalence was: 44.1% (95% CI 38.0-50.2) by microscopy of duplicate Kato-Katz smears from two consecutive stools, 56.9% (95% CI 50.8-63.0) by urine-circulating cathodic antigen (CCA) dipstick, 67.4% (95% CI 61.6-73.1) by DNA-TaqMan® and 75.1% (95% CI 69.8-80.4) by soluble egg antigen enzyme-linked immunosorbent assay (SEA-ELISA). A cross-comparison of diagnostic sensitivities, specificities, positive and negative predictive values was undertaken, inclusive of a latent class analysis (LCA) with a LCA-model estimate of prevalence by each school. The latter ranged from 9.6% to 100.0%, and prevalence by school for each diagnostic test followed a static ascending order or monotonic series of Kato-Katz, urine-CCA dipstick, DNA-TaqMan® and SEA-ELISA. We confirm that Kato-Katz remains a satisfactory diagnostic standalone in high-transmission settings but in low-transmission settings should be augmented or replaced by urine-CCA dipsticks. DNA-TaqMan® appears suitable in both endemic settings though is only implementable if resources permit. In low-transmission settings, SEA-ELISA remains the method of choice to evidence an absence infection. We discuss the pros and cons of each method concluding that future surveillance of intestinal schistosomiasis would benefit from a flexible, context-specific approach both in choice and application of each diagnostic method, rather than a single one-size fits all approach.

Involved LEEP excision margins as predictor of residual/recurrent disease in HIV-positive and HIV-negative women in a low-resource setting.

PubMed

van Bogaert, Louis-Jacques

2015-04-01

To describe the accuracy of the diagnosis of involved excision margins after loop electrosurgical excision procedure (LEEP) in a low-resource setting. Cross-sectional study of 176 LEEPs indicated for a cytological report of high-grade squamous intraepithelial lesion (HGSIL). A total of 72 HIV-positive and 104 HIV-negative women with cervical intraepithelial neoplasia (CIN) ≥ 2 on their LEEP histology report with involved excision margins were enrolled in the study. All patients underwent either a repeat LEEP or a hysterectomy. The specimens were evaluated for residual/recurrent CIN ≥ 2 or less. Persistent/recurrent CIN ≥ 2 was diagnosed in 139 (79.4%) instances and microinvasive squamous cell carcinoma in 6 (3.4%). Thirty (17.2%) showed CIN1. The persistence/recurrence rate was 72.2% and 88.5% in HIV-positive and HIV-negative women, respectively (χ2 = 7.5, p = 0.006). In > 80% the diagnosis of involved excision margins was confirmed, a positive predictive value of 82.4%. In the absence of more accurate follow-up methods such as HPV testing or co-testing with cytology, a correct diagnosis of margin status, especially when involved, is an important guide to further management and follow-up.

Standard Setting in a Small Scale OSCE: A Comparison of the Modified Borderline-Group Method and the Borderline Regression Method

ERIC Educational Resources Information Center

Wood, Timothy J.; Humphrey-Murto, Susan M.; Norman, Geoffrey R.

2006-01-01

When setting standards, administrators of small-scale OSCEs often face several challenges, including a lack of resources, a lack of available expertise in statistics, and difficulty in recruiting judges. The Modified Borderline-Group Method is a standard setting procedure that compensates for these challenges by using physician examiners and is…

Respiratory distress in term neonates in low-resource settings.

PubMed

Sivanandan, Sindhu; Agarwal, Ramesh; Sethi, Amanpreet

2017-08-01

Most neonatal deaths worldwide occur in low- and middle-income countries (LMICs). Respiratory distress is an important cause of neonatal morbidity and mortality. The epidemiology of respiratory distress among term neonates who constitute the vast majority of births is under reported. The scarcely available data from LMICs suggest an incidence of 1.2% to 7.2% among term live births and greater morbidity compared to that in high-income countries. Pneumonia and meconium aspiration syndrome are the predominant causes among outborn neonates, but next only to transient tachypnea among inborn neonates. Community management of neonatal sepsis/pneumonia using simplified antibiotic regimens when referral is not feasible, implementation of non-invasive ventilation, and innovative low-cost technologies to deliver respiratory therapy are important advances that have taken place in these settings. There is an urgent need to generate data on respiratory morbidities among term neonates so that the limited resources in these settings can be allocated judiciously. Copyright © 2017 Elsevier Ltd. All rights reserved.

Resource-constrained scheduling with hard due windows and rejection penalties

NASA Astrophysics Data System (ADS)

Garcia, Christopher

2016-09-01

This work studies a scheduling problem where each job must be either accepted and scheduled to complete within its specified due window, or rejected altogether. Each job has a certain processing time and contributes a certain profit if accepted or penalty cost if rejected. There is a set of renewable resources, and no resource limit can be exceeded at any time. Each job requires a certain amount of each resource when processed, and the objective is to maximize total profit. A mixed-integer programming formulation and three approximation algorithms are presented: a priority rule heuristic, an algorithm based on the metaheuristic for randomized priority search and an evolutionary algorithm. Computational experiments comparing these four solution methods were performed on a set of generated benchmark problems covering a wide range of problem characteristics. The evolutionary algorithm outperformed the other methods in most cases, often significantly, and never significantly underperformed any method.

Development of mobile phone based transcutaneous billirubinometry

NASA Astrophysics Data System (ADS)

Dumont, Alexander P.; Harrison, Brandon; McCormick, Zachary T.; Ganesh Kumar, Nishant; Patil, Chetan A.

2017-03-01

Infants in the US are routinely screened for risk of neurodevelopmental impairment due to neonatal jaundice using transcutaneous bilirubinometry (TcB). In low-resource settings, such as sub-Saharan Africa, TcB devices are not common, however, mobile camera-phones are now widespread. We provide an update on the development of TcB using the built-in camera and flash of a mobile phone, along with a snap-on adapter containing optical filters. We will present Monte Carlo Extreme modeling of diffuse reflectance in neonatal skin, implications in design, and refined analysis methods.

Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers' views in two African hospitals.

PubMed

Aveling, Emma-Louise; Kayonga, Yvette; Nega, Ansha; Dixon-Woods, Mary

2015-02-25

The views of practitioners at the sharp end of health care provision are now recognised as a valuable source of intelligence that can inform efforts to improve patient safety in high-income countries. Yet despite growing policy emphasis on patient safety in low-income countries, little research examines the views of practitioners in these settings. We aimed to give voice to how healthcare workers in two East African hospitals identify and explain the major obstacles to ensuring the safety of patients in their care. We conducted in-depth, face to face interviews with healthcare workers in two East African hospitals. Our sample included a total of 57 hospital staff, including nurses, physicians, technicians, clinical services staff, administrative staff and hospital managers. Hospital staff in low-income settings offered broadly encompassing and aspirational definitions of patient safety. They identified obstacles to patient safety across three major themes: material context, staffing issues and inter-professional working relationships. Participants distinguished between the proximal influences on patient safety that posed an immediate threat to patient care, and the distal influences that generated the contexts for such hazards. These included contexts of severe material deprivation, but also the impact of relational factors such as teamwork and professional hierarchies. Structures of authority, governance and control that were not optimally aligned with achieving patient safety were widely reported. As in high-income countries, the accounts of healthcare workers in low-income countries provide sophisticated and valuable insights into the challenges of patient safety. Though the impact of resource constraints and weak governance structures are particularly marked in low-income countries, the congruence between accounts of health workers in diverse settings suggest that the origins and solutions to patient safety problems are likely to be similar everywhere and are rooted in human factors, resources, culture and behaviour. While additional resources are essential to patient safety improvement in low-income settings, such resources on their own will not be sufficient to secure the changes needed.

Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings.

PubMed

Amissah, Nana Ama; Buultjens, Andrew H; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L; Bulach, Dieter; Tetteh, Caitlin S; Prah, Isaac; van der Werf, Tjip S; Friedrich, Alexander W; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P; Rossen, John W

2017-01-01

Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa. Methods: Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana. Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical) were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA). Notably, 25 (81%) of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%), aminoglycosides (33%), oxacillin (33%), chloramphenicol (50%), tetracycline (59%) and fluoroquinolones (100%). Conclusion: Population genomics uncovered multiple transmission events of S. aureus , especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

Autofocus method for automated microscopy using embedded GPUs.

PubMed

Castillo-Secilla, J M; Saval-Calvo, M; Medina-Valdès, L; Cuenca-Asensi, S; Martínez-Álvarez, A; Sánchez, C; Cristóbal, G

2017-03-01

In this paper we present a method for autofocusing images of sputum smears taken from a microscope which combines the finding of the optimal focus distance with an algorithm for extending the depth of field (EDoF). Our multifocus fusion method produces an unique image where all the relevant objects of the analyzed scene are well focused, independently to their distance to the sensor. This process is computationally expensive which makes unfeasible its automation using traditional embedded processors. For this purpose a low-cost optimized implementation is proposed using limited resources embedded GPU integrated on cutting-edge NVIDIA system on chip. The extensive tests performed on different sputum smear image sets show the real-time capabilities of our implementation maintaining the quality of the output image.

Evolutionarily stable range limits set by interspecific competition.

PubMed

Price, Trevor D; Kirkpatrick, Mark

2009-04-22

A combination of abiotic and biotic factors probably restricts the range of many species. Recent evolutionary models and tests of those models have asked how a gradual change in environmental conditions can set the range limit, with a prominent idea being that gene flow disrupts local adaptation. We investigate how biotic factors, explicitly competition for limited resources, result in evolutionarily stable range limits even in the absence of the disruptive effect of gene flow. We model two competing species occupying different segments of the resource spectrum. If one segment of the resource spectrum declines across space, a species that specializes on that segment can be driven to extinction, even though in the absence of competition it would evolve to exploit other abundant resources and so be saved. The result is that a species range limit is set in both evolutionary and ecological time, as the resources associated with its niche decline. Factors promoting this outcome include: (i) inherent gaps in the resource distribution, (ii) relatively high fitness of the species when in its own niche, and low fitness in the alternative niche, even when resource abundances are similar in each niche, (iii) strong interspecific competition, and (iv) asymmetric interspecific competition. We suggest that these features are likely to be common in multispecies communities, thereby setting evolutionarily stable range limits.

Evolutionarily stable range limits set by interspecific competition

PubMed Central

Price, Trevor D.; Kirkpatrick, Mark

2009-01-01

A combination of abiotic and biotic factors probably restricts the range of many species. Recent evolutionary models and tests of those models have asked how a gradual change in environmental conditions can set the range limit, with a prominent idea being that gene flow disrupts local adaptation. We investigate how biotic factors, explicitly competition for limited resources, result in evolutionarily stable range limits even in the absence of the disruptive effect of gene flow. We model two competing species occupying different segments of the resource spectrum. If one segment of the resource spectrum declines across space, a species that specializes on that segment can be driven to extinction, even though in the absence of competition it would evolve to exploit other abundant resources and so be saved. The result is that a species range limit is set in both evolutionary and ecological time, as the resources associated with its niche decline. Factors promoting this outcome include: (i) inherent gaps in the resource distribution, (ii) relatively high fitness of the species when in its own niche, and low fitness in the alternative niche, even when resource abundances are similar in each niche, (iii) strong interspecific competition, and (iv) asymmetric interspecific competition. We suggest that these features are likely to be common in multispecies communities, thereby setting evolutionarily stable range limits. PMID:19324813

Closing the mental health gap in low-income settings by building research capacity: Perspectives from Mozambique

PubMed Central

Sweetland, Annika C.; Oquendo, Maria A.; Sidat, Mohsin; Santos, Palmira F.; Vermund, Sten H.; Duarte, Cristiane S.; Arbuckle, Melissa; Wainberg, Milton L.

2014-01-01

Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability (YLDs). Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, though non-allopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need and those who have access to mental health treatment include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. In Mozambique, the World Health Organization estimates only 0.04 psychiatrists per 100,000 population, representing 30 times less than the global median, and more than 150 times lower than the median in high income countries. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country’s ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and among low- and high-income settings, ultimately reducing the mental health treatment gap worldwide. Through new research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (USA), Vanderbilt University (USA), and Universidade Federal de São Paulo (Brazil), we are working towards a North-South and South-South collaboration to build research capacity in Mozambique and other Portuguese-speaking African countries. PMID:24976551

Consensus recommendations for essential vascular care in low- and middle-income countries.

PubMed

Stewart, Barclay T; Gyedu, Adam; Giannou, Christos; Mishra, Brijesh; Rich, Norman; Wren, Sherry M; Mock, Charles; Kushner, Adam L

2016-12-01

Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health as well as with experience in LMIC health care. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs, comprising primary health centers and first-level, referral, and tertiary hospitals. The recommendations include essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. The resources recommended have the potential to improve the ability of LMIC health care systems to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization, without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning prehospital and interhospital transport system, and vascular training for existing and future health care providers. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Costing of Paediatric Treatment alongside Clinical Trials under Low Resource Constraint Environments: Cotrimoxazole and Antiretroviral Medications in Children Living with HIV/AIDS

PubMed Central

2016-01-01

Introduction. Costing evidence is essential for policy makers for priority setting and resource allocation. It is in this context that the clinical trials of ARVs and cotrimoxazole provided a costing component to provide evidence for budgeting and resource needs alongside the clinical efficacy studies. Methods. A micro based costing approach was adopted, using case record forms for maintaining patient records. Costs for fixed assets were allocated based on the paediatric space. Medication and other resource costs were costed using the WHO/MSH Drug Price Indicators as well as procurement data where these were available. Results. The costs for cotrimoxazole and ARVs are significantly different. The average costs for human resources were US$22 and US$71 for physician costs and $1.3 and $16 for nursing costs while in-patient costs were $257 and $15 for the cotrimoxazole and ARV cohorts, respectively. Mean or average costs were $870 for the cotrimoxazole cohort and $218 for the ARV. The causal factors for the significant cost differences are attributable to the higher human resource time, higher infections of opportunistic conditions, and longer and higher frequency of hospitalisations, among others. PMID:28042479

Reducing streamflow forecast uncertainty: Application and qualitative assessment of the upper klamath river Basin, Oregon

USGS Publications Warehouse

Hay, L.E.; McCabe, G.J.; Clark, M.P.; Risley, J.C.

2009-01-01

The accuracy of streamflow forecasts depends on the uncertainty associated with future weather and the accuracy of the hydrologic model that is used to produce the forecasts. We present a method for streamflow forecasting where hydrologic model parameters are selected based on the climate state. Parameter sets for a hydrologic model are conditioned on an atmospheric pressure index defined using mean November through February (NDJF) 700-hectoPascal geopotential heights over northwestern North America [Pressure Index from Geopotential heights (PIG)]. The hydrologic model is applied in the Sprague River basin (SRB), a snowmelt-dominated basin located in the Upper Klamath basin in Oregon. In the SRB, the majority of streamflow occurs during March through May (MAM). Water years (WYs) 1980-2004 were divided into three groups based on their respective PIG values (high, medium, and low PIG). Low (high) PIG years tend to have higher (lower) than average MAM streamflow. Four parameter sets were calibrated for the SRB, each using a different set of WYs. The initial set used WYs 1995-2004 and the remaining three used WYs defined as high-, medium-, and low-PIG years. Two sets of March, April, and May streamflow volume forecasts were made using Ensemble Streamflow Prediction (ESP). The first set of ESP simulations used the initial parameter set. Because the PIG is defined using NDJF pressure heights, forecasts starting in March can be made using the PIG parameter set that corresponds with the year being forecasted. The second set of ESP simulations used the parameter set associated with the given PIG year. Comparison of the ESP sets indicates that more accuracy and less variability in volume forecasts may be possible when the ESP is conditioned using the PIG. This is especially true during the high-PIG years (low-flow years). ?? 2009 American Water Resources Association.

Task-Sharing Approaches to Improve Mental Health Care in Rural and Other Low-Resource Settings: A Systematic Review.

PubMed

Hoeft, Theresa J; Fortney, John C; Patel, Vikram; Unützer, Jürgen

2018-12-01

Rural areas persistently face a shortage of mental health specialists. Task shifting, or task sharing, is an approach in global mental health that may help address unmet mental health needs in rural and other low-resource areas. This review focuses on task-shifting approaches and highlights future directions for research in this area. Systematic review on task sharing of mental health care in rural areas of high-income countries included: (1) PubMed, (2) gray literature for innovations not yet published in peer-reviewed journals, and (3) outreach to experts for additional articles. We included English language articles published before August 31, 2013, on interventions sharing mental health care tasks across a team in rural settings. We excluded literature: (1) from low- and middle-income countries, (2) involving direct transfer of care to another provider, and (3) describing clinical guidelines and shared decision-making tools. The review identified approaches to task sharing focused mainly on community health workers and primary care providers. Technology was identified as a way to leverage mental health specialists to support care across settings both within primary care and out in the community. The review also highlighted how provider education, supervision, and partnerships with local communities can support task sharing. Challenges, such as confidentiality, are often not addressed in the literature. Approaches to task sharing may improve reach and effectiveness of mental health care in rural and other low-resource settings, though important questions remain. We recommend promising research directions to address these questions. © 2017 National Rural Health Association.

Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

PubMed Central

2011-01-01

Background The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. Aims This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. Methods Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. Results The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. Conclusions A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced. PMID:21320308

Optimizing Clinical Operations as part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low Resource Health Systems

PubMed Central

Carter, Patrick M.; Desmond, Jeffery S.; Akanbobnaab, Christopher; Oteng, Rockefeller A.; Rominski, Sarah; Barsan, William G.; Cunningham, Rebecca

2012-01-01

Background Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems; but use of Lean in low to middle income countries with developing emergency medicine systems has not been well characterized. Objectives To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital in Ghana and to identify key lessons learned to aid future global EM initiatives. Methods A three-week Lean improvement program focused on the hospital admissions process at Komfo Anokye Teaching Hospital was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. Results The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem solving techniques worked well in a low resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; 8) despite different levels of resources, root causes of system inefficiencies are often similar across health care systems, but require unique solutions appropriate to the clinical setting. Conclusions Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low to middle income countries. PMID:22435868

Internet Use among Ugandan Adolescents: Implications for HIV Intervention

PubMed Central

Ybarra, Michele L; Kiwanuka, Julius; Emenyonu, Nneka; Bangsberg, David R

2006-01-01

Background The Internet is fast gaining recognition as a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. The feasibility and accessibility of Internet-based health interventions in resource-limited settings, where cost-effective interventions are most needed, is unknown. To determine the utility of developing technology-based interventions in resource-limited settings, availability and patterns of usage of the Internet first need to be assessed. Methods and Findings The Uganda Media and You Survey was a cross-sectional survey of Internet use among adolescents (ages 12–18 years) in Mbarara, Uganda, a municipality mainly serving a rural population in sub-Saharan Africa. Participants were randomly selected among eligible students attending one of five participating secondary day and boarding schools in Mbarara, Uganda. Of a total of 538 students selected, 93% (500) participated. Of the total respondents, 45% (223) reported ever having used the Internet, 78% (175) of whom reported going online in the previous week. As maternal education increased, so too did the odds of adolescent Internet use. Almost two in five respondents (38% [189]) reported already having used a computer or the Internet to search for health information. Over one-third (35% [173]) had used the computer or Internet to find information about HIV/AIDS, and 20% (102) had looked for sexual health information. Among Internet users, searching for HIV/AIDS information on a computer or online was significantly related to using the Internet weekly, emailing, visiting chat rooms, and playing online games. In contrast, going online at school was inversely related to looking for HIV/AIDS information via technology. If Internet access were free, 66% (330) reported that they would search for information about HIV/AIDS prevention online. Conclusions Both the desire to use, and the actual use of, the Internet to seek sexual health and HIV/AIDS information is high among secondary school students in Mbarara. The Internet may be a promising strategy to deliver low-cost HIV/AIDS risk reduction interventions in resource-limited settings with expanding Internet access. PMID:17090211

Ground-Cover Measurements: Assessing Correlation Among Aerial and Ground-Based Methods

NASA Astrophysics Data System (ADS)

Booth, D. Terrance; Cox, Samuel E.; Meikle, Tim; Zuuring, Hans R.

2008-12-01

Wyoming’s Green Mountain Common Allotment is public land providing livestock forage, wildlife habitat, and unfenced solitude, amid other ecological services. It is also the center of ongoing debate over USDI Bureau of Land Management’s (BLM) adjudication of land uses. Monitoring resource use is a BLM responsibility, but conventional monitoring is inadequate for the vast areas encompassed in this and other public-land units. New monitoring methods are needed that will reduce monitoring costs. An understanding of data-set relationships among old and new methods is also needed. This study compared two conventional methods with two remote sensing methods using images captured from two meters and 100 meters above ground level from a camera stand (a ground, image-based method) and a light airplane (an aerial, image-based method). Image analysis used SamplePoint or VegMeasure software. Aerial methods allowed for increased sampling intensity at low cost relative to the time and travel required by ground methods. Costs to acquire the aerial imagery and measure ground cover on 162 aerial samples representing 9000 ha were less than 3000. The four highest correlations among data sets for bare ground—the ground-cover characteristic yielding the highest correlations (r)—ranged from 0.76 to 0.85 and included ground with ground, ground with aerial, and aerial with aerial data-set associations. We conclude that our aerial surveys are a cost-effective monitoring method, that ground with aerial data-set correlations can be equal to, or greater than those among ground-based data sets, and that bare ground should continue to be investigated and tested for use as a key indicator of rangeland health.

Dilution testing using rapid diagnostic tests in a HIV diagnostic algorithm: a novel alternative for confirmation testing in resource limited settings.

PubMed

Shanks, Leslie; Siddiqui, M Ruby; Abebe, Almaz; Piriou, Erwan; Pearce, Neil; Ariti, Cono; Masiga, Johnson; Muluneh, Libsework; Wazome, Joseph; Ritmeijer, Koert; Klarkowski, Derryck

2015-05-14

Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results. Participants were recruited from two testing centres in Ethiopia where a tiebreaker algorithm using 3 different RDTs in series is used to diagnose HIV. All samples positive on the initial screening RDT and every 10th negative sample underwent testing with the gold standard and dilution test. Dilution testing was performed using Determine™ rapid diagnostic test at 6 different dilutions. Results were compared to the gold standard of Western Blot; where Western Blot was indeterminate, PCR testing determined the final result. 2895 samples were recruited to the study. 247 were positive for a prevalence of 8.5 % (247/2895). A total of 495 samples underwent dilution testing. The RDT diagnostic algorithm misclassified 18 samples as positive. Dilution at the level of 1/160 was able to correctly identify all these 18 false positives, but at a cost of a single false negative result (sensitivity 99.6 %, 95 % CI 97.8-100; specificity 100 %, 95 % CI: 98.5-100). Concordance between the gold standard and the 1/160 dilution strength was 99.8 %. This study provides proof of concept for a new, low cost method of confirming HIV diagnosis in resource-limited settings. It has potential for use as a supplementary test in a confirmatory algorithm, whereby double positive RDT results undergo dilution testing, with positive results confirming HIV infection. Negative results require nucleic acid testing to rule out false negative results due to seroconversion or misclassification by the lower sensitivity dilution test. Further research is needed to determine if these results can be replicated in other settings. ClinicalTrials.gov, NCT01716299 .

Well water quality in rural Nicaragua using a low-cost bacterial test and microbial source tracking.

PubMed

Weiss, Patricia; Aw, Tiong Gim; Urquhart, Gerald R; Galeano, Miguel Ruiz; Rose, Joan B

2016-04-01

Water-related diseases, particularly diarrhea, are major contributors to morbidity and mortality in developing countries. Monitoring water quality on a global scale is crucial to making progress in terms of population health. Traditional analytical methods are difficult to use in many regions of the world in low-resource settings that face severe water quality issues due to the inaccessibility of laboratories. This study aimed to evaluate a new low-cost method (the compartment bag test (CBT)) in rural Nicaragua. The CBT was used to quantify the presence of Escherichia coli in drinking water wells and aimed to determine the source(s) of any microbial contamination. Results indicate that the CBT is a viable method for use in remote rural regions. The overall quality of well water in Pueblo Nuevo, Nicaragua was deemed unsafe, and results led to the conclusion that animal fecal wastes may be one of the leading causes of well contamination. Elevation and depth of wells were not found to impact overall water quality. However rope-pump wells had a 64.1% reduction in contamination when compared with simple wells.

Diagnostic and treatment difficulties of pyelonephritis in pregnancy in resource-limited settings.

PubMed

McGready, Rose; Wuthiekanun, Vanaporn; Ashley, Elizabeth A; Tan, Saw Oo; Pimanpanarak, Mupawjay; Viladpai-Nguen, Samuel Jacher; Jesadapanpong, Wilarat; Blacksell, Stuart D; Proux, Stephane; Day, Nicholas P; Singhasivanon, Pratap; White, Nicholas J; Nosten, François; Peacock, Sharon J

2010-12-01

Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7-19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings.

Field-friendly techniques for assessment of biomarkers of nutrition for development1234

PubMed Central

Garrett, Dean A; Sangha, Jasbir K; Kothari, Monica T; Boyle, David

2011-01-01

Whereas cost-effective interventions exist for the control of micronutrient malnutrition (MN), in low-resource settings field-friendly tools to assess the effect of these interventions are underutilized or not readily available where they are most needed. Conventional approaches for MN measurement are expensive and require relatively sophisticated laboratory instrumentation, skilled technicians, good infrastructure, and reliable sources of clean water and electricity. Consequently, there is a need to develop and introduce innovative tools that are appropriate for MN assessment in low-resource settings. These diagnostics should be cost-effective, simple to perform, robust, accurate, and capable of being performed with basic laboratory equipment. Currently, such technologies either do not exist or have been applied to the assessment of a few micronutrients. In the Demographic and Health Surveys (DHS), a few such examples for which “biomarkers” of nutrition development have been assessed in low-resource settings using field-friendly approaches are hemoglobin (anemia), retinol-binding protein (vitamin A), and iron (transferrin receptor). In all of these examples, samples were collected mainly by nonmedical staff and analyses were conducted in the survey country by technicians from the local health or research facilities. This article provides information on how the DHS has been able to successfully adapt field-friendly techniques in challenging environments in population-based surveys for the assessment of micronutrient deficiencies. Special emphasis is placed on sample collection, processing, and testing in relation to the availability of local technology, resources, and capacity. PMID:21677055

42 CFR 436.3 - Definitions and use of terms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Medicaid under this part because their income and resources are within limits set by the State under its Medicaid plan (including persons whose income and resources fall within these limits after their incurred.... Optional targeted low-income child means a child under age 19 who meets the financial and categorical...

42 CFR 436.3 - Definitions and use of terms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Medicaid under this part because their income and resources are within limits set by the State under its Medicaid plan (including persons whose income and resources fall within these limits after their incurred.... Optional targeted low-income child means a child under age 19 who meets the financial and categorical...

42 CFR 436.3 - Definitions and use of terms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Medicaid under this part because their income and resources are within limits set by the State under its Medicaid plan (including persons whose income and resources fall within these limits after their incurred.... Optional targeted low-income child means a child under age 19 who meets the financial and categorical...

Critical evaluation of the PALM-COEIN classification system among women with abnormal uterine bleeding in low-resource settings.

PubMed

Shubham, Divya; Kawthalkar, Anjali S

2018-05-01

To assess the feasibility of the PALM-COEIN system for the classification of abnormal uterine bleeding (AUB) in low-resource settings and to suggest modifications. A prospective study was conducted among women with AUB who were admitted to the gynecology ward of a tertiary care hospital and research center in central India between November 2014 and October 2016. All patients were managed as per department protocols. The causes of AUB were classified before treatment using the PALM-COEIN system (classification I) and on the basis of the histopathology reports of the hysterectomy specimens (classification II); the results were compared using classification II as the gold standard. The study included 200 women with AUB; hysterectomy was performed in 174 women. Preoperative classification of AUB per the PALM-COEIN system was correct in 130 (65.0%) women. Adenomyosis (evaluated by transvaginal ultrasonography) and endometrial hyperplasia (evaluated by endometrial curettage) were underdiagnosed. The PALM-COEIN classification system helps in deciding the best treatment modality for women with AUB on a case-by-case basis. The incorporation of suggested modifications will further strengthen its utility as a pretreatment classification system in low-resource settings. © 2017 International Federation of Gynecology and Obstetrics.

Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials.

PubMed

Vogel, Joshua P; Oladapo, Olufemi T; Pileggi-Castro, Cynthia; Adejuyigbe, Ebunoluwa A; Althabe, Fernando; Ariff, Shabina; Ayede, Adejumoke Idowu; Baqui, Abdullah H; Costello, Anthony; Chikamata, Davy M; Crowther, Caroline; Fawole, Bukola; Gibbons, Luz; Jobe, Alan H; Kapasa, Monica Lulu; Kinuthia, John; Kriplani, Alka; Kuti, Oluwafemi; Neilson, James; Patterson, Janna; Piaggio, Gilda; Qureshi, Rahat; Qureshi, Zahida; Sankar, Mari Jeeva; Stringer, Jeffrey S A; Temmerman, Marleen; Yunis, Khalid; Bahl, Rajiv; Metin Gülmezoglu, A

2017-01-01

The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials-the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial-have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns. In this article, we briefly present an appraisal of the current evidence around ACS, how these findings informed WHO's current recommendations on ACS use, and the knowledge gaps that have emerged in the light of new trial evidence. Critical considerations in the generalisability of the available evidence demonstrate that a true state of clinical equipoise exists for this treatment option in low-resource settings. An expert group convened by WHO concluded that there is a clear need for more efficacy trials of ACS in these settings to inform clinical practice.

Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting.

PubMed

Kandil, Mohamed; Sanad, Zakaria; Gaber, Wael

2014-04-01

To determine the best time to administer prophylactic antibiotics at Cesarean delivery in order to reduce the postoperative maternal infectious morbidity in a low resource setting. One hundred term primigravidae with singleton pregnancy were recruited and randomly allocated to two equal groups. Each woman received 2 g intravenous Cefazoline. Women in Group I received it prior to skin incision while those in Group II had it immediately after cord clamping. We measured the following outcome parameters: (1) Surgical site wound infection; (2) Endometritis and (3) Urinary tract infection. There was no significant difference in any of the patients' characteristics between both groups. In Group I, three cases developed surgical site infections but four in Group II (p > 0.05). In Group I, the infected cases had Cesarean because of malpresentations while in Group II, two cases had Cesarean because of patients' request, one because of maternal heart disease and one due to intra-uterine growth restriction. Seven and nine cases had urinary tract infection in Groups I and II, respectively, (p > 0.05). Prophylactic antibiotic administration either prior to surgery or after cord clamping is probably equally effective in reducing the postoperative infectious morbidity after Cesarean in low resource settings.

Critical control points for avian influenza A H5N1 in live bird markets in low resource settings.

PubMed

Samaan, Gina; Gultom, Anita; Indriani, Risa; Lokuge, Kamalini; Kelly, Paul M

2011-06-01

Live bird markets can become contaminated with and become a source of transmission for avian influenza viruses including the highly pathogenic H5N1 strain. Many countries affected by the H5N1-virus have limited resources for programs in environmental health, sanitation and disease control in live bird markets. This study proposes five critical control points (CCPs) to reduce the risk of H5N1-virus contamination in markets in low resource settings. The CCPs were developed based on three surveys conducted in Indonesia: a cross-sectional survey in 119 markets, a knowledge, attitudes and practice survey in 3 markets and a microbiological survey in 83 markets. These surveys assessed poultry workflow, market infrastructure, hygiene and regulatory practices and microbiological contamination with the H5N1-virus. The five CCPs identified were (1) reducing risk of receiving infected birds into the market, (2) reducing the risk of virus spread between different bird flocks in holding cages, (3) reducing surface contamination by isolating slaughter processes from other poultry-related processes, (4) minimizing the potential for contamination during evisceration of carcasses and (5) reducing the risk of surface contamination in the sale zone of the market. To be relevant for low resource settings, the CCPs do not necessitate large infrastructure changes. The CCPs are suited for markets that slaughter poultry and have capacity for daily disposal and removal of solid waste from the market. However, it is envisaged that the CCPs can be adapted for the development of risk-based programs in various settings. Copyright © 2011 Elsevier B.V. All rights reserved.

Challenges and Opportunities for the implementation of interventions to prevent and control CVD in low resource settings in Argentina

PubMed Central

Rubinstein, Adolfo; Irazola, Vilma E.; Poggio, Rosana; Gulayin, Pablo; Nejamis, Analía; Beratarrechea, Andrea

2015-01-01

In Argentina, Cardiovascular diseases are estimated to cause about 100,000 deaths and more than 250,000 coronary heart disease and stroke events annually, at a cost of more than one billion international dollars. Despite progress in the implementation of several programs to combat non-communicable diseases in Argentina over the last years, most health resources are still dedicated to infectious disease and maternal and child health. The Institute for Clinical Effectiveness and Health Policy, an independent academic institution affiliated to the University of Buenos Aires medical school, runs CESCAS (South American Centre of Excellence in Cardiovascular Health), a center devoted to epidemiological, implementation and policy research. At CESCAS there are three ongoing randomized clinical trials focused on implementation science: 1) A Mobile health intervention to prevent progression of pre-hypertension in poor urban settings in Argentina, Guatemala and Peru; 2) A Comprehensive Approach for Hypertension Prevention and Control in low-resource settings in Argentina; and 3) An Educational Approach to Improve Physician Effectiveness in the Detection, Treatment and Control for patients with Hypercholesterolemia and high Cardiovascular Disease (CVD) risk in low-resource settings in Argentina. All these studies involve the design and implementation of complex interventions to change behaviors of providers and patients. The rationale of each of the three studies, the design of the interventions and the evaluation of processes and outcomes are described in this article together with the barriers and enabling factors associated with implementation research studies. There is a strong need in Argentina and the region at large to build the health research capacity and infrastructure necessary to undertake implementation studies to translate evidence from research findings into improvements in health policy and practice to address CVD and their risk factors. PMID:25754563

Thyroid Surgery in a Resource-Limited Setting.

PubMed

Jafari, Aria; Campbell, David; Campbell, Bruce H; Ngoitsi, Henry Nono; Sisenda, Titus M; Denge, Makaya; James, Benjamin C; Cordes, Susan R

2017-03-01

Objective The present study reviews a series of patients who underwent thyroid surgery in Eldoret, Kenya, to demonstrate the feasibility of conducting long-term (>1 year) outcomes research in a resource-limited setting, impact on the quality of life of the recipient population, and inform future humanitarian collaborations. Study Design Case series with chart review. Setting Tertiary public referral hospital in Eldoret, Kenya. Subjects and Methods Twenty-one patients were enrolled during the study period. A retrospective chart review was performed for all adult patients who underwent thyroid surgery during humanitarian trips (2010-2015). Patients were contacted by mobile telephone. Medical history and physical examination, including laryngoscopy, were performed, and the SF-36 was administered (a quality-of-life questionnaire). Laboratory measurements of thyroid function and neck ultrasound were obtained. Results The mean follow-up was 33.6 ± 20.2 months after surgery: 37.5% of subtotal thyroidectomy patients and 15.4% of lobectomy patients were hypothyroid postoperatively according to serologic studies. There were no cases of goiter recurrence or malignancy. All patients reported postoperative symptomatic improvement and collectively showed positive pre- and postoperative score differences on the SF-36. Conclusion Although limited by a small sample size and the retrospective nature, our study demonstrates the feasibility of long-term surgical and quality-of-life outcomes research in a resource-limited setting. The low complication rates suggest minimal adverse effects of performing surgery in this context. Despite a considerable rate of postoperative hypothyroidism, it is in accordance with prior studies and emphasizes the need for individualized, longitudinal, and multidisciplinary care. Quality-of-life score improvements suggest benefit to the recipient population.

Dissemination of Health-Related Research among Scientists in Three Countries: Access to Resources and Current Practices

PubMed Central

2015-01-01

Objectives. In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. Methods. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. Findings. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Conclusion. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap. PMID:26495287

The challenge of assessing infant vaccine responses in resource-poor settings

PubMed Central

Flanagan, Katie L; Burl, Sarah; Lohman-Payne, Barbara L; Plebanski, Magdalena

2010-01-01

Newborns and infants are highly susceptible to infectious diseases, resulting in high mortality and morbidity, particularly in resource-poor settings. Many vaccines require several booster doses, resulting in an extensive vaccine schedule, and yet there is still inadequate protection from some of these diseases. This is partly due to the immaturity of the neonate and infant immune system. Little is known about the specific modifications to immunological assessment protocols in early life but increasing knowledge of infant immunology has helped provide better recommendations for assessing these responses. Since most new vaccines will eventually be deployed in low-income settings such as Africa, the logistics and resources of assessing immunity in such settings also need to be understood. In this article, we will review immunity to vaccines in early life, discuss the many challenges associated with assessing immunogenicity and provide practical tips. PMID:20518720

Neurodevelopmental outcomes for high-risk neonates in a low-resource setting.

PubMed

Milner, Kate M; Duke, Trevor; Steer, Andrew C; Kado, Joseph H; Koyamaibole, Lanieta; Kaarira, Rakei; Namudu, Kelera; Woolfenden, Susan; Miller, Anne E; O'Heir, Kathryn E; Neal, Eleanor F G; Roberts, Gehan

2017-11-01

Worldwide, most neonates who survive prematurity and serious illness reside in low-resource settings where developmental outcome data and follow-up care are limited. This study aimed to assess in Fiji, a low-resource Pacific setting, prevalence and risk factors for moderate to severe neurodevelopmental impairment (NDI) in early childhood among high-risk neonates compared with controls. Retrospective cohort study comparing long-term outcomes for high-risk neonatal intensive care unit patients (n=149) compared with matched term, normal birth weight neonates (n=147) discharged from Colonial War Memorial Hospital between November 2008 and April 2010. NDI was defined as one or more of cerebral palsy, moderate to severe hearing or visual impairment, or global developmental delay using Bayley Scales of Infant and Toddler Development Third Edition (ie, score <70 in ≥1 of cognitive, language or motor domains). At median (IQR) age 36.1 (28.3, 38.0) months, prevalence of moderate to severe NDI % (95% CI, n) in high-risk and control groups was 12 (5 to 17, n=13) and 5 (2 to 12, n=5), respectively, an increased risk ratio (95% CI) of 2.7 (0.8 to 8.9). Median gestational age (weeks (median, IQR)) in the high-risk group was 37.5 (34-40) weeks. Among high-risk neonates, gestational age, birth weight, asphyxia, meningitis and/or respiratory distress were significantly associated with risk of NDI. Prevalence of NDI was high among this predominantly term high-risk neonatal cohort compared with controls. Results, including identified risk factors, inform efforts to strengthen quality of care and models of follow-up for high-risk neonates in this low-resource setting. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study

PubMed Central

Amour, Caroline; Gratz, Jean; Mduma, Estomih; Svensen, Erling; Rogawski, Elizabeth T.; McGrath, Monica; Seidman, Jessica C.; McCormick, Benjamin J. J.; Shrestha, Sanjaya; Samie, Amidou; Mahfuz, Mustafa; Qureshi, Shahida; Hotwani, Aneeta; Babji, Sudhir; Trigoso, Dixner Rengifo; Lima, Aldo A. M.; Bodhidatta, Ladaporn; Bessong, Pascal; Ahmed, Tahmeed; Shakoor, Sadia; Kang, Gagandeep; Kosek, Margaret; Guerrant, Richard L.; Lang, Dennis; Gottlieb, Michael; Houpt, Eric R.; Platts-Mills, James A.; Acosta, Angel Mendez; de Burga, Rosa Rios; Chavez, Cesar Banda; Flores, Julian Torres; Olotegui, Maribel Paredes; Pinedo, Silvia Rengifo; Salas, Mery Siguas; Trigoso, Dixner Rengifo; Vasquez, Angel Orbe; Ahmed, Imran; Alam, Didar; Ali, Asad; Bhutta, Zulfiqar A.; Qureshi, Shahida; Rasheed, Muneera; Soofi, Sajid; Turab, Ali; Zaidi, Anita K.M.; Bodhidatta, Ladaporn; Mason, Carl J.; Babji, Sudhir; Bose, Anuradha; George, Ajila T.; Hariraju, Dinesh; Jennifer, M. Steffi; John, Sushil; Kaki, Shiny; Kang, Gagandeep; Karunakaran, Priyadarshani; Koshy, Beena; Lazarus, Robin P.; Muliyil, Jayaprakash; Raghava, Mohan Venkata; Raju, Sophy; Ramachandran, Anup; Ramadas, Rakhi; Ramanujam, Karthikeyan; Rose, Anuradha; Roshan, Reeba; Sharma, Srujan L.; Sundaram, Shanmuga; Thomas, Rahul J.; Pan, William K.; Ambikapathi, Ramya; Carreon, J. Daniel; Charu, Vivek; Doan, Viyada; Graham, Jhanelle; Hoest, Christel; Knobler, Stacey; Lang, Dennis R.; McCormick, Benjamin J.J.; McGrath, Monica; Miller, Mark A.; Mohale, Archana; Nayyar, Gaurvika; Psaki, Stephanie; Rasmussen, Zeba; Richard, Stephanie A.; Seidman, Jessica C.; Wang, Vivian; Blank, Rebecca; Gottlieb, Michael; Tountas, Karen H.; Amour, Caroline; Bayyo, Eliwaza; Mduma, Estomih R.; Mvungi, Regisiana; Nshama, Rosemary; Pascal, John; Swema, Buliga Mujaga; Yarrot, Ladislaus; Ahmed, Tahmeed; Ahmed, A.M. Shamsir; Haque, Rashidul; Hossain, Iqbal; Islam, Munirul; Mahfuz, Mustafa; Mondal, Dinesh; Tofail, Fahmida; Chandyo, Ram Krishna; Shrestha, Prakash Sunder; Shrestha, Rita; Ulak, Manjeswori; Bauck, Aubrey; Black, Robert; Caulfield, Laura; Checkley, William; Kosek, Margaret N.; Lee, Gwenyth; Schulze, Kerry; Yori, Pablo Peñataro; Murray-Kolb, Laura E.; Ross, A. Catharine; Schaefer, Barbara; Simons, Suzanne; Pendergast, Laura; Abreu, Cláudia B.; Costa, Hilda; Di Moura, Alessandra; Filho, José Quirino; Havt, Alexandre; Leite, Álvaro M.; Lima, Aldo A.M.; Lima, Noélia L.; Lima, Ila F.; Maciel, Bruna L.L.; Medeiros, Pedro H.Q.S.; Moraes, Milena; Mota, Francisco S.; Oriá, Reinaldo B.; Quetz, Josiane; Soares, Alberto M.; Mota, Rosa M.S.; Patil, Crystal L.; Bessong, Pascal; Mahopo, Cloupas; Maphula, Angelina; Nyathi, Emanuel; Samie, Amidou; Barrett, Leah; Dillingham, Rebecca; Gratz, Jean; Guerrant, Richard L.; Houpt, Eric; Petri, William A.; Platts-Mills, James; Scharf, Rebecca; Shrestha, Binob; Shrestha, Sanjaya Kumar; Strand, Tor; Svensen, Erling

2016-01-01

Abstract Background. Enteropathogen infections have been associated with enteric dysfunction and impaired growth in children in low-resource settings. In a multisite birth cohort study (MAL-ED), we describe the epidemiology and impact of Campylobacter infection in the first 2 years of life. Methods. Children were actively followed up until 24 months of age. Diarrheal and nondiarrheal stool samples were collected and tested by enzyme immunoassay for Campylobacter. Stool and blood samples were assayed for markers of intestinal permeability and inflammation. Results. A total of 1892 children had 7601 diarrheal and 26 267 nondiarrheal stool samples tested for Campylobacter. We describe a high prevalence of infection, with most children (n = 1606; 84.9%) having a Campylobacter-positive stool sample by 1 year of age. Factors associated with a reduced risk of Campylobacter detection included exclusive breastfeeding (risk ratio, 0.57; 95% confidence interval, .47–.67), treatment of drinking water (0.76; 0.70–0.83), access to an improved latrine (0.89; 0.82–0.97), and recent macrolide antibiotic use (0.68; 0.63–0.74). A high Campylobacter burden was associated with a lower length-for-age Z score at 24 months (−1.82; 95% confidence interval, −1.94 to −1.70) compared with a low burden (−1.49; −1.60 to −1.38). This association was robust to confounders and consistent across sites. Campylobacter infection was also associated with increased intestinal permeability and intestinal and systemic inflammation. Conclusions. Campylobacter was prevalent across diverse settings and associated with growth shortfalls. Promotion of exclusive breastfeeding, drinking water treatment, improved latrines, and targeted antibiotic treatment may reduce the burden of Campylobacter infection and improve growth in children in these settings. PMID:27501842

Analysis of the Environmental Impact of Insulin Infusion Sets Based on Loss of Resources with Waste

PubMed Central

Pfützner, Andreas; Musholt, Petra B; Malmgren-Hansen, Bjoern; Nilsson, Nils H; Forst, Thomas

2011-01-01

Insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] requires regular change of infusion sets every 2-3 days in order to minimize the risk of skin irritations or other adverse events. This has been discussed to be a potential burden to the environment. The purpose of this analysis was to perform an environmental assessment of insulin pump infusion sets based on loss of resources occurring during incineration of the discarded products and by means of a lifecycle concept used to weight a material in relation to its rareness on earth and its consumption. In addition to five infusion sets (Inset30, InsetII, Comfort, Quick-set, and Cleo), a patch pump (Omnipod) was also included in this analysis. The annual loss in waste of the so called “person reserve” of 3 days of catheter use was compared with daily consumption of a cup of coffee in a disposable paper cup and to a soft drink in an aluminum can. The weight-based loss in resources through waste for the infusion sets (except for Cleo) corresponded to 70-200% of the loss of resources for a coffee cup (Cleo, 320%; Omnipod, 1,821,600%) and to 1-3% of the loss from an aluminum soft drink can (Cleo, 5%; Omnipod, 31,200%). The loss or resources by use of infusion sets used in insulin pump therapy appears to be low and is similar to the burden induced by the uptake of one cup of coffee per day. The loss or resources with regular CSII is considerably lower than the loss or resources induced by patch pumps. PMID:21880223

Exploring personalized searches using tag-based user profiles and resource profiles in folksonomy.

PubMed

Cai, Yi; Li, Qing; Xie, Haoran; Min, Huaqin

2014-10-01

With the increase in resource-sharing websites such as YouTube and Flickr, many shared resources have arisen on the Web. Personalized searches have become more important and challenging since users demand higher retrieval quality. To achieve this goal, personalized searches need to take users' personalized profiles and information needs into consideration. Collaborative tagging (also known as folksonomy) systems allow users to annotate resources with their own tags, which provides a simple but powerful way for organizing, retrieving and sharing different types of social resources. In this article, we examine the limitations of previous tag-based personalized searches. To handle these limitations, we propose a new method to model user profiles and resource profiles in collaborative tagging systems. We use a normalized term frequency to indicate the preference degree of a user on a tag. A novel search method using such profiles of users and resources is proposed to facilitate the desired personalization in resource searches. In our framework, instead of the keyword matching or similarity measurement used in previous works, the relevance measurement between a resource and a user query (termed the query relevance) is treated as a fuzzy satisfaction problem of a user's query requirements. We implement a prototype system called the Folksonomy-based Multimedia Retrieval System (FMRS). Experiments using the FMRS data set and the MovieLens data set show that our proposed method outperforms baseline methods. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation of a cardiopulmonary resuscitation curriculum in a low resource environment.

PubMed

Chang, Mary P; Lyon, Camila B; Janiszewski, David; Aksamit, Deborah; Kateh, Francis; Sampson, John

2015-11-07

To evaluate whether a 2-day International Liaison Committee on Resuscitation (ILCOR) Universal Algorithm-based curriculum taught in a tertiary care hospital in Liberia increases local health care provider knowledge and skill comfort level. A combined basic and advanced cardiopulmonary resuscitation (CPR) curriculum was developed for low-resource settings that included lectures and low-fidelity manikin-based simulations. In March 2014, the curriculum was taught to healthcare providers in a tertiary care hospital in Liberia. In a quality assurance review, participants were evaluated for knowledge and comfort levels with resuscitation before and after the workshop. They were also videotaped during simulation sessions and evaluated on standardized performance metrics. Fifty-two hospital staff completed both pre-and post-curriculum surveys. The median score was 45% pre-curriculum and 82% post-curriculum (p<0.00001). The median provider comfort level score was 4 of 5 pre-curriculum and 5 of 5 post-curriculum (p<0.00001). During simulations, 93.2% of participants performed the pulse check within 10 seconds, and 97.7% performed defibrillation within 180 seconds. Clinician knowledge of and comfort level with CPR increased significantly after participating in our curriculum. A CPR curriculum based on lectures and low-fidelity manikin simulations may be an effective way to teach resuscitation in this low-resource setting.

Open-source mobile digital platform for clinical trial data collection in low-resource settings.

PubMed

van Dam, Joris; Omondi Onyango, Kevin; Midamba, Brian; Groosman, Nele; Hooper, Norman; Spector, Jonathan; Pillai, Goonaseelan Colin; Ogutu, Bernhards

2017-02-01

Governments, universities and pan-African research networks are building durable infrastructure and capabilities for biomedical research in Africa. This offers the opportunity to adopt from the outset innovative approaches and technologies that would be challenging to retrofit into fully established research infrastructures such as those regularly found in high-income countries. In this context we piloted the use of a novel mobile digital health platform, designed specifically for low-resource environments, to support high-quality data collection in a clinical research study. Our primary aim was to assess the feasibility of a using a mobile digital platform for clinical trial data collection in a low-resource setting. Secondarily, we sought to explore the potential benefits of such an approach. The investigative site was a research institute in Nairobi, Kenya. We integrated an open-source platform for mobile data collection commonly used in the developing world with an open-source, standard platform for electronic data capture in clinical trials. The integration was developed using common data standards (Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model), maximising the potential to extend the approach to other platforms. The system was deployed in a pharmacokinetic study involving healthy human volunteers. The electronic data collection platform successfully supported conduct of the study. Multidisciplinary users reported high levels of satisfaction with the mobile application and highlighted substantial advantages when compared with traditional paper record systems. The new system also demonstrated a potential for expediting data quality review. This pilot study demonstrated the feasibility of using a mobile digital platform for clinical research data collection in low-resource settings. Sustainable scientific capabilities and infrastructure are essential to attract and support clinical research studies. Since many research structures in Africa are being developed anew, stakeholders should consider implementing innovative technologies and approaches.

Factors for success in mental health advocacy

PubMed Central

Hann, Katrina; Pearson, Heather; Campbell, Doris; Sesay, Daniel; Eaton, Julian

2015-01-01

Background Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition – Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. Design The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. Results Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. Conclusions The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings. PMID:26689456

Factors for success in mental health advocacy.

PubMed

Hann, Katrina; Pearson, Heather; Campbell, Doris; Sesay, Daniel; Eaton, Julian

2015-01-01

Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition - Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings.

Streptococcal Pharyngitis in Schoolchildren in Bamako, Mali

PubMed Central

Tapia, Milagritos D.; Sow, Samba O.; Tamboura, Boubou; Keita, Mahamadou M.; Berthe, Abdoulaye; Samake, Mariam; Nataro, James P.; Onwuchekwa, Uma O.; Penfound, Thomas A.; Blackwelder, William; Dale, James B.; Kotloff, Karen L.

2014-01-01

Background Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease (RHD) in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. Methods Surveillance for pharyngitis was conducted among children 5 to 16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. Results GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy identified 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus non-vaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren. Conclusions Two promising strategies could reduce RHD in low resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development. PMID:25356953

A systematic review of innovative diabetes care models in low-and middle-income countries (LMICs).

PubMed

Esterson, Yonah B; Carey, Michelle; Piette, John D; Thomas, Nihal; Hawkins, Meredith

2014-02-01

Over 70% of the world's patients with diabetes reside in low-and middle-income countries (LMICs), where adequate infrastructure and resources for diabetes care are often lacking. Therefore, academic institutions, health care organizations, and governments from Western nations and LMICs have worked together to develop a variety of effective diabetes care models for resource-poor settings. A focused search of PubMed was conducted with the goal of identifying reports that addressed the implementation of diabetes care models or initiatives to improve clinical and/or biochemical outcomes in patients with diabetes mellitus. A total of 15 published manuscripts comprising nine diabetes care models in 16 locations in sub-Saharan Africa, Latin America, and Asia identified by the above approach were systematically reviewed. The reviewed models shared a number of principles including collaboration, education, standardization, resource optimization, and technological innovation. The most comprehensive models used a number of these principles, which contributed to their success. Reviewing the principles shared by these successful programs may help guide the development of effective future models for diabetes care in low-income settings.

Citation searches are more sensitive than keyword searches to identify studies using specific measurement instruments

PubMed Central

Linder, Suzanne K.; Kamath, Geetanjali R.; Pratt, Gregory F.; Saraykar, Smita S.; Volk, Robert J.

2015-01-01

Objective To compare the effectiveness of two search methods in identifying studies that used the Control Preferences Scale (CPS), a healthcare decision-making instrument commonly used in clinical settings. Study Design & Setting We searched the literature using two methods: 1) keyword searching using variations of “control preferences scale” and 2) cited reference searching using two seminal CPS publications. We searched three bibliographic databases [PubMed, Scopus, Web of Science (WOS)] and one full-text database (Google Scholar). We report precision and sensitivity as measures of effectiveness. Results Keyword searches in bibliographic databases yielded high average precision (90%), but low average sensitivity (16%). PubMed was the most precise, followed closely by Scopus and WOS. The Google Scholar keyword search had low precision (54%) but provided the highest sensitivity (70%). Cited reference searches in all databases yielded moderate sensitivity (45–54%), but precision ranged from 35–75% with Scopus being the most precise. Conclusion Cited reference searches were more sensitive than keyword searches, making it a more comprehensive strategy to identify all studies that use a particular instrument. Keyword searches provide a quick way of finding some but not all relevant articles. Goals, time and resources should dictate the combination of which methods and databases are used. PMID:25554521

Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

PubMed

Schultz, Marcus J; Dunser, Martin W; Dondorp, Arjen M; Adhikari, Neill K J; Iyer, Shivakumar; Kwizera, Arthur; Lubell, Yoel; Papali, Alfred; Pisani, Luigi; Riviello, Beth D; Angus, Derek C; Azevedo, Luciano C; Baker, Tim; Diaz, Janet V; Festic, Emir; Haniffa, Rashan; Jawa, Randeep; Jacob, Shevin T; Kissoon, Niranjan; Lodha, Rakesh; Martin-Loeches, Ignacio; Lundeg, Ganbold; Misango, David; Mer, Mervyn; Mohanty, Sanjib; Murthy, Srinivas; Musa, Ndidiamaka; Nakibuuka, Jane; Serpa Neto, Ary; Nguyen Thi Hoang, Mai; Nguyen Thien, Binh; Pattnaik, Rajyabardhan; Phua, Jason; Preller, Jacobus; Povoa, Pedro; Ranjit, Suchitra; Talmor, Daniel; Thevanayagam, Jonarthan; Thwaites, C Louise

2017-05-01

Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

Health care worker hand hygiene in the pediatric special care unit at Mulago National Referral Hospital in Uganda: a best practice implementation project.

PubMed

Muhumuza, Christine; Gomersall, Judith Streak; Fredrick, Makumbi E; Atuyambe, Lynn; Okiira, Christopher; Mukose, Aggrey; Ssempebwa, John

2015-03-01

The hands of a health care worker are a common vehicle of pathogen transmission in hospital settings. Health care worker hand hygiene is therefore critical for patients' well being. Whilst failure of health care workers to comply with the best hand hygiene practice is a problem in all health care settings, issues of lack of access to adequate cleaning equipment and in some cases even running water make practicing good hand hygiene particularly difficult in low-resource developing country settings. This study reports an audit and feedback project that focused on the hand hygiene of the health care worker in the pediatric special care unit of the Mulago National Referral Hospital, which is a low-resource setting in Uganda. To improve hand hygiene among health care workers in the pediatric special care unit and thereby contribute to reducing transmission of health care worker-associated pathogens. The Joanna Briggs Institute three-phase Practical Application of Clinical Evidence System audit and feedback tool for promoting evidence utilization and change in health care was used. In phase one of the project, stakeholders were engaged and seven evidence-based audit criteria were developed. A baseline audit was then conducted. In phase two, barriers underpinning areas of noncompliance found in the baseline audit were identified and three strategies - education, reminders and provision of hand cleaning equipment - were implemented to overcome them. In phase three, a follow-up audit was conducted. Compliance with best practice hygiene was found to be poor in the baseline audit for all but one of the audit criteria. Following the implementation of the strategies, hand hygiene improved. The compliance rate increased substantially across all criteria. Staff education achieved 100%, whilst criterion 4 increased to 70%. However, use of alcohol-based hand-rub for hand hygiene only improved to 66%, and for six of the seven audit criteria, compliance remained below 74%. The project provides another example of how audit can be used as a tool to improve health practice, even in a low-resource setting. At the same time, it showed how difficult it is to achieve compliance with best hand hygiene practice in a low-resource hospital. The project highlights the importance of continued education/awareness raising on the importance of good hand hygiene practice as well as investment in infrastructure and cleaning supplies for achieving and sustaining good hand hygiene among workers in a low-resource hospital setting. A key contribution of the project was the legacy it left in the form of knowledge about how to use audit and feedback as a tool to promote the best practice. A similar project has been implemented in the maternity ward at the hospital and further audits are planned.

A Case-Study of the Resources and Functioning of Two Research Ethics Committees in Western India.

PubMed

Chenneville, Tiffany; Menezes, Lynette; Kosambiya, Jayendrakumar; Baxi, Rajendra

2016-12-01

Assessing the resources and functioning of research ethics committees (RECs) in low-resource settings poses many challenges. We conducted a case study of two medical college RECs (A and B) in Western India utilizing the Research Ethics Committee Quality Assurance Self-Assessment Tool (RECQASAT) as well as in-depth interviews with representative members to evaluate REC effectiveness. REC A and B obtained 62% and 67% of allowable points on the RECQASAT. These scores together with findings from the in-depth interviews suggest the need for significant improvement in REC effectiveness particularly in the areas of membership and educational training, organizational aspects, recording minutes, communicating decisions, and REC resources. Developing evidence-based best practices and strengthening infrastructure are essential to enhancing REC efficacy in low-resource countries.

Dimensions of Learning Organizations Questionnaire (DLOQ) in a low-resource health care setting in Nepal.

PubMed

Leufvén, Mia; Vitrakoti, Ravi; Bergström, Anna; Ashish, K C; Målqvist, Mats

2015-01-22

Knowledge-based organizations, such as health care systems, need to be adaptive to change and able to facilitate uptake of new evidence. To be able to assess organizational capability to learn is therefore an important part of health systems strengthening. The aim of the present study is to assess context using the Dimensions of the Learning Organization Questionnaire (DLOQ) in a low-resource health setting in Nepal. DLOQ was translated and administered to 230 employees at all levels of the hospital. Data was analyzed using non-parametric tests. The DLOQ was able to detect variations across employee's perceptions of the organizational context. Nurses scored significantly lower than doctors on the dimension "Empowerment" while doctors scored lower than nurses on "Strategic leadership". These results suggest that the hospital's organization carries attributes of a centralized, hierarchical structure that might hinder a progress towards a learning organization. This study demonstrates that, despite the designing and developing of the DLOQ in the USA and its main utilization in company settings, it can be used and applied in hospital settings in low-income countries. The application of DLOQ provides valuable insights and understanding when designing and evaluating efforts for healthcare improvement.

An innovative system for 3D clinical photography in the resource-limited settings

PubMed Central

2014-01-01

Background Kaposi’s sarcoma (KS) is the most frequently occurring cancer in Mozambique among men and the second most frequently occurring cancer among women. Effective therapeutic treatments for KS are poorly understood in this area. There is an unmet need to develop a simple but accurate tool for improved monitoring and diagnosis in a resource-limited setting. Standardized clinical photographs have been considered to be an essential part of the evaluation. Methods When a therapeutic response is achieved, nodular KS often exhibits a reduction of the thickness without a change in the base area of the lesion. To evaluate the vertical space along with other characters of a KS lesion, we have created an innovative imaging system with a consumer light-field camera attached to a miniature “photography studio” adaptor. The image file can be further processed by computational methods for quantification. Results With this novel imaging system, each high-quality 3D image was consistently obtained with a single camera shot at bedside by minimally trained personnel. After computational processing, all-focused photos and measurable 3D parameters were obtained. More than 80 KS image sets were processed in a semi-automated fashion. Conclusions In this proof-of-concept study, the feasibility to use a simple, low-cost and user-friendly system has been established for future clinical study to monitor KS therapeutic response. This 3D imaging system can be also applied to obtain standardized clinical photographs for other diseases. PMID:24929434

Comprehensive Yet Scalable Health Information Systems for Low Resource Settings: A Collaborative Effort in Sierra Leone

PubMed Central

Braa, Jørn; Kanter, Andrew S.; Lesh, Neal; Crichton, Ryan; Jolliffe, Bob; Sæbø, Johan; Kossi, Edem; Seebregts, Christopher J.

2010-01-01

We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone. PMID:21347003

From unseen to seen: tackling the global burden of uncorrected refractive errors.

PubMed

Durr, Nicholas J; Dave, Shivang R; Lage, Eduardo; Marcos, Susana; Thorn, Frank; Lim, Daryl

2014-07-11

Worldwide, more than one billion people suffer from poor vision because they do not have the eyeglasses they need. Their uncorrected refractive errors are a major cause of global disability and drastically reduce productivity, educational opportunities, and overall quality of life. The problem persists most prevalently in low-resource settings, even though prescription eyeglasses serve as a simple, effective, and largely affordable solution. In this review, we discuss barriers to obtaining, and approaches for providing, refractive eye care. We also highlight emerging technologies that are being developed to increase the accessibility of eye care. Finally, we describe opportunities that exist for engineers to develop new solutions to positively impact the diagnosis and treatment of correctable refractive errors in low-resource settings.

saltPAD: A New Analytical Tool for Monitoring Salt Iodization in Low Resource Settings

PubMed Central

Myers, Nicholas M.; Strydom, Emmerentia Elza; Sweet, James; Sweet, Christopher; Spohrer, Rebecca; Dhansay, Muhammad Ali; Lieberman, Marya

2016-01-01

We created a paper test card that measures a common iodizing agent, iodate, in salt. To test the analytical metrics, usability, and robustness of the paper test card when it is used in low resource settings, the South African Medical Research Council and GroundWork performed independent validation studies of the device. The accuracy and precision metrics from both studies were comparable. In the SAMRC study, more than 90% of the test results (n=1704) were correctly classified as corresponding to adequately or inadequately iodized salt. The cards are suitable for market and household surveys to determine whether salt is adequately iodized. Further development of the cards will improve their utility for monitoring salt iodization during production. PMID:29942380

Testing hypotheses for excess flower production and low fruit-to-flower ratios in a pollinating seed-consuming mutualism

USGS Publications Warehouse

Holland, J. Nathaniel; Bronstein, Judith L.; DeAngelis, Donald L.

2004-01-01

Pollinator attraction, pollen limitation, resource limitation, pollen donation and selective fruit abortion have all been proposed as processes explaining why hermaphroditic plants commonly produce many more flowers than mature fruit. We conducted a series of experiments in Arizona to investigate low fruit-to-flower ratios in senita cacti, which rely exclusively on pollinating seed-consumers. Selective abortion of fruit based on seed predators is of particular interest in this case because plants relying on pollinating seed-consumers are predicted to have such a mechanism to minimize seed loss. Pollinator attraction and pollen dispersal increased with flower number, but fruit set did not, refuting the hypothesis that excess flowers increase fruit set by attracting more pollinators. Fruit set of natural- and hand-pollinated flowers were not different, supporting the resource, rather than pollen, limitation hypothesis. Senita did abort fruit, but not selectively based on pollen quantity, pollen donors, or seed predators. Collectively, these results are consistent with sex allocation theory in that resource allocation to excess flower production can increase pollen dispersal and the male fitness function of flowers, but consequently results in reduced resources available for fruit set. Inconsistent with sex allocation theory, however, fruit production and the female fitness function of flowers may actually increase with flower production. This is because excess flower production lowers pollinator-to-flower ratios and results in fruit abortion, both of which limit the abundance and hence oviposition rates, of pre-dispersal seed predators.

42 CFR 423.773 - Requirements for eligibility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 150 percent of the FPL applicable to the individual's family size. (2) Has resources at or below the resource thresholds set forth in § 423.773(b)(2) or (d)(2). (b) Full subsidy eligible individual. A full...-Sharing Subsidies for Low-Income Individuals § 423.773 Requirements for eligibility. (a) Subsidy eligible...

42 CFR 423.773 - Requirements for eligibility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 150 percent of the FPL applicable to the individual's family size. (2) Has resources at or below the resource thresholds set forth in § 423.773(b)(2) or (d)(2). (b) Full subsidy eligible individual. A full...-Sharing Subsidies for Low-Income Individuals § 423.773 Requirements for eligibility. (a) Subsidy eligible...

42 CFR 423.773 - Requirements for eligibility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 150 percent of the FPL applicable to the individual's family size. (2) Has resources at or below the resource thresholds set forth in § 423.773(b)(2) or (d)(2). (b) Full subsidy eligible individual. A full...-Sharing Subsidies for Low-Income Individuals § 423.773 Requirements for eligibility. (a) Subsidy eligible...

Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings.

PubMed

Koethe, John R; Chi, Benjamin H; Megazzini, Karen M; Heimburger, Douglas C; Stringer, Jeffrey S A

2009-09-01

Access to antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to the success of ART programs. Protein-calorie malnutrition (a common form of malnutrition in the region) hastens HIV disease progression, and food insecurity is a barrier to medication adherence. Analyses of patient outcomes have identified a low body mass index after the start of ART as an independent predictor of early mortality, but the causes of a low body mass index are multifactorial (eg, normal anthropometric variation, chronic inadequate food intake, and/or wasting associated with HIV infection and other infectious diseases). Although there is much information on population-level humanitarian food assistance, few data exist to measure the effectiveness of macronutrient supplementation or to identify individuals most likely to benefit. In this report, we review the current evidence supporting macronutrient supplementation for HIV-infected adults, we report on clinical trials in resource-adequate and resource-constrained settings, and we highlight priority areas for future research.

Cloud-based processing of multi-spectral imaging data

NASA Astrophysics Data System (ADS)

Bernat, Amir S.; Bolton, Frank J.; Weiser, Reuven; Levitz, David

2017-03-01

Multispectral imaging holds great promise as a non-contact tool for the assessment of tissue composition. Performing multi - spectral imaging on a hand held mobile device would allow to bring this technology and with it knowledge to low resource settings to provide a state of the art classification of tissue health. This modality however produces considerably larger data sets than white light imaging and requires preliminary image analysis for it to be used. The data then needs to be analyzed and logged, while not requiring too much of the system resource or a long computation time and battery use by the end point device. Cloud environments were designed to allow offloading of those problems by allowing end point devices (smartphones) to offload computationally hard tasks. For this end we present a method where the a hand held device based around a smartphone captures a multi - spectral dataset in a movie file format (mp4) and compare it to other image format in size, noise and correctness. We present the cloud configuration used for segmenting images to frames where they can later be used for further analysis.

Radiation Oncology Quality and Safety Considerations in Low-Resource Settings: A Medical Physics Perspective.

PubMed

Van Dyk, Jacob; Meghzifene, Ahmed

2017-04-01

The past few years have seen a significant growth of interest in the global radiation therapy (RT) crisis. Various organizations have quantified the need and are providing aid in support of addressing the shortfalls existing in many low-to-middle income countries. With the tremendous demand for new facilities, equipment, and personnel, it is very important to recognize the quality and safety challenges and to address them directly. An examination of publications on quality and safety in RT indicates a consistency in a number of the recommendations; however, these authoritative reports were generally based on input from high-resourced contexts. Here, we review these recommendations with a special emphasis on issues that are significant in low-to-middle income countries. Although multidimensional, training, and staffing are top priorities, any support provided to lower-resourced settings must address the numerous facets associated with quality and safety indicators. Strong partnerships between high income and other countries will enhance the development of safe and resource-appropriate strategies for advancing the radiation treatment process. The real challenge is the engagement of a strong spirit of cooperation, collaboration, and communication among the multiple organizations in support of reducing the cancer divide and improving the provision of safe and effective RT. Copyright © 2017 Elsevier Inc. All rights reserved.

Low prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in urban and rural community settings in Bolivia and Peru.

PubMed

Bartoloni, Alessandro; Pallecchi, Lucia; Fernandez, Connie; Mantella, Antonia; Riccobono, Eleonora; Magnelli, Donata; Mannini, Dario; Strohmeyer, Marianne; Bartalesi, Filippo; Segundo, Higinio; Monasterio, Joaquin; Rodriguez, Hugo; Cabezas, César; Gotuzzo, Eduardo; Rossolini, Gian Maria

2013-05-01

To investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in rural and urban community settings of Bolivia and Peru. MRSA nasal carriage was investigated in 585 individuals living in rural and urban areas of Bolivia and Peru (one urban area, one small rural village, and two native communities, one of which was highly isolated). MRSA isolates were subjected to molecular analysis for the detection of virulence genes, characterization of the staphylococcal cassette chromosome mec (SCCmec), and genotyping (multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE)). An overall very low prevalence of MRSA nasal carriage was observed (0.5%), with MRSA carriers being detected only in a small rural village of the Bolivian Chaco. The three MRSA isolates showed the characteristics of community-associated MRSA (being susceptible to all non-beta-lactam antibiotics and harboring the SCCmec type IV), were clonally related, and belonged to ST1649. This study provides an insight into the epidemiology of MRSA in community settings of Bolivia and Peru. Reliable, time-saving, and low-cost methods should be implemented to encourage continued surveillance of MRSA dissemination in resource-limited countries. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Review of sampling hard-to-reach and hidden populations for HIV surveillance.

PubMed

Magnani, Robert; Sabin, Keith; Saidel, Tobi; Heckathorn, Douglas

2005-05-01

Adequate surveillance of hard-to-reach and 'hidden' subpopulations is crucial to containing the HIV epidemic in low prevalence settings and in slowing the rate of transmission in high prevalence settings. For a variety of reasons, however, conventional facility and survey-based surveillance data collection strategies are ineffective for a number of key subpopulations, particularly those whose behaviors are illegal or illicit. This paper critically reviews alternative sampling strategies for undertaking behavioral or biological surveillance surveys of such groups. Non-probability sampling approaches such as facility-based sentinel surveillance and snowball sampling are the simplest to carry out, but are subject to a high risk of sampling/selection bias. Most of the probability sampling methods considered are limited in that they are adequate only under certain circumstances and for some groups. One relatively new method, respondent-driven sampling, an adaptation of chain-referral sampling, appears to be the most promising for general applications. However, as its applicability to HIV surveillance in resource-poor settings has yet to be established, further field trials are needed before a firm conclusion can be reached.

Using evaluation theory in priority setting and resource allocation.

PubMed

Smith, Neale; Mitton, Craig; Cornelissen, Evelyn; Gibson, Jennifer; Peacock, Stuart

2012-01-01

Public sector interest in methods for priority setting and program or policy evaluation has grown considerably over the last several decades, given increased expectations for accountable and efficient use of resources and emphasis on evidence-based decision making as a component of good management practice. While there has been some occasional effort to conduct evaluation of priority setting projects, the literatures around priority setting and evaluation have largely evolved separately. In this paper, the aim is to bring them together. The contention is that evaluation theory is a means by which evaluators reflect upon what it is they are doing when they do evaluation work. Theories help to organize thinking, sort out relevant from irrelevant information, provide transparent grounds for particular implementation choices, and can help resolve problematic issues which may arise in the conduct of an evaluation project. A detailed review of three major branches of evaluation theory--methods, utilization, and valuing--identifies how such theories can guide the development of efforts to evaluate priority setting and resource allocation initiatives. Evaluation theories differ in terms of their guiding question, anticipated setting or context, evaluation foci, perspective from which benefits are calculated, and typical methods endorsed. Choosing a particular theoretical approach will structure the way in which any priority setting process is evaluated. The paper suggests that explicitly considering evaluation theory makes key aspects of the evaluation process more visible to all stakeholders, and can assist in the design of effective evaluation of priority setting processes; this should iteratively serve to improve the understanding of priority setting practices themselves.

Successful Deployment of High Flow Nasal Cannula in a Peruvian Pediatric Intensive Care Unit Using Implementation Science-Lessons Learned.

PubMed

Nielsen, Katie R; Becerra, Rosario; Mallma, Gabriela; Tantaleán da Fieno, José

2018-01-01

Acute lower respiratory infections are the leading cause of death outside the neonatal period for children less than 5 years of age. Widespread availability of invasive and non-invasive mechanical ventilation in resource-rich settings has reduced mortality rates; however, these technologies are not always available in many low- and middle-income countries due to the high cost and trained personnel required to implement and sustain their use. High flow nasal cannula (HFNC) is a form of non-invasive respiratory support with growing evidence for use in pediatric respiratory failure. Its simple interface makes utilization in resource-limited settings appealing, although widespread implementation in these settings lags behind resource-rich settings. Implementation science is an emerging field dedicated to closing the know-do gap by incorporating evidence-based interventions into routine care, and its principles have guided the scaling up of many global health interventions. In 2016, we introduced HFNC use for respiratory failure in a pediatric intensive care unit in Lima, Peru using implementation science methodology. Here, we review our experience in the context of the principles of implementation science to serve as a guide for others considering HFNC implementation in resource-limited settings.

Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review.

PubMed

Scarf, Vanessa; Catling, Christine; Viney, Rosalie; Homer, Caroline

2016-01-01

There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications. Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data. Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care. There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.

Efficacy of a Low-Cost Bubble CPAP System in Treatment of Respiratory Distress in a Neonatal Ward in Malawi

PubMed Central

Kawaza, Kondwani; Machen, Heather E.; Brown, Jocelyn; Mwanza, Zondiwe; Iniguez, Suzanne; Gest, Al; Smith, E. O'Brian; Oden, Maria; Richards-Kortum, Rebecca R.; Molyneux, Elizabeth

2014-01-01

Background Respiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP) is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care. Methods We conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups. Findings 87 neonates (62 bCPAP, 25 controls) were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62) compared with 44.0% (11/25) for controls. 65.5% (19/29) of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13) of controls. 64.6% (31/48) of neonates with respiratory distress syndrome (RDS) receiving bCPAP survived to discharge, compared to 23.5% (4/17) of controls. 61.5% (16/26) of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived. Interpretation Use of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries. PMID:24489715

Plastic Bags for Prevention of Hypothermia in Preterm and Low Birth Weight Infants

PubMed Central

Leadford, Alicia E.; Warren, Jamie B.; Manasyan, Albert; Chomba, Elwyn; Salas, Ariel A.; Schelonka, Robert

2013-01-01

BACKGROUND AND OBJECTIVES: Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia. METHODS: Infants at 26 to 36 weeks’ gestational age and/or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at birth. The primary outcome measure was axillary temperature in the World Health Organization–defined normal range (36.5–37.5°C) at 1 hour after birth. RESULTS: A total of 104 infants were randomized. At 1 hour after birth, infants randomized to plastic bag (n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16–2.81; P = .007). The temperature at 1 hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P < .001). Hyperthermia (>38.0°C) did not occur in any infant. CONCLUSIONS: Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings. PMID:23733796

Preventing conflicts among bid curves used with transactive controllers in a market-based resource allocation system

DOEpatents

Fuller, Jason C.; Chassin, David P.; Pratt, Robert G.; Hauer, Matthew; Tuffner, Francis K.

2017-03-07

Disclosed herein are representative embodiments of methods, apparatus, and systems for distributing a resource (such as electricity) using a resource allocation system. One of the disclosed embodiments is a method for operating a transactive thermostatic controller configured to submit bids to a market-based resource allocation system. According to the exemplary method, a first bid curve is determined, the first bid curve indicating a first set of bid prices for corresponding temperatures and being associated with a cooling mode of operation for a heating and cooling system. A second bid curve is also determined, the second bid curve indicating a second set of bid prices for corresponding temperatures and being associated with a heating mode of operation for a heating and cooling system. In this embodiment, the first bid curve, the second bid curve, or both the first bid curve and the second bid curve are modified to prevent overlap of any portion of the first bid curve and the second bid curve.

Pandemic influenza and health system resource gaps in Bali: an analysis through a resource transmission dynamics model.

PubMed

Adisasmito, Wiku; Hunter, Benjamin M; Krumkamp, Ralf; Latief, Kamal; Rudge, James W; Hanvoravongchai, Piya; Coker, Richard J

2015-03-01

The failure to contain pandemic influenza A(H1N1) 2009 in Mexico has shifted global attention from containment to mitigation. Limited surveillance and reporting have, however, prevented detailed assessment of mitigation during the pandemic, particularly in low- and middle-income countries. To assess pandemic influenza case management capabilities in a resource-limited setting, the authors used a health system questionnaire and density-dependent, deterministic transmission model for Bali, Indonesia, determining resource gaps. The majority of health resources were focused in and around the provincial capital, Denpasar; however, gaps are found in every district for nursing staff, surgical masks, and N95 masks. A relatively low pathogenicity pandemic influenza virus would see an overall surplus for physicians, antivirals, and antimicrobials; however, a more pathogenic virus would lead to gaps in every resource except antimicrobials. Resources could be allocated more evenly across Bali. These, however, are in short supply universally and therefore redistribution would not fill resource gaps. © 2011 APJPH.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Ramsey, Wayne; King, Richard; Green, Sally

2018-05-30

This is the final paper in a thematic series reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was established to explore a systematic, integrated, evidence-based organisation-wide approach to disinvestment in a large Australian health service network. This paper summarises the findings, discusses the contribution of the SHARE Program to the body of knowledge and understanding of disinvestment in the local healthcare setting, and considers implications for policy, practice and research. The SHARE program was conducted in three phases. Phase One was undertaken to understand concepts and practices related to disinvestment and the implications for a local health service and, based on this information, to identify potential settings and methods for decision-making about disinvestment. The aim of Phase Two was to implement and evaluate the proposed methods to determine which were sustainable, effective and appropriate in a local health service. A review of the current literature incorporating the SHARE findings was conducted in Phase Three to contribute to the understanding of systematic approaches to disinvestment in the local healthcare context. SHARE differed from many other published examples of disinvestment in several ways: by seeking to identify and implement disinvestment opportunities within organisational infrastructure rather than as standalone projects; considering disinvestment in the context of all resource allocation decisions rather than in isolation; including allocation of non-monetary resources as well as financial decisions; and focusing on effective use of limited resources to optimise healthcare outcomes. The SHARE findings provide a rich source of new information about local health service decision-making, in a level of detail not previously reported, to inform others in similar situations. Multiple innovations related to disinvestment were found to be acceptable and feasible in the local setting. Factors influencing decision-making, implementation processes and final outcomes were identified; and methods for further exploration, or avoidance, in attempting disinvestment in this context are proposed based on these findings. The settings, frameworks, models, methods and tools arising from the SHARE findings have potential to enhance health care and patient outcomes.

Feeding neonates by cup: A systematic review of the literature

PubMed Central

McKinney, Christy M.; Glass, Robin P.; Coffey, Patricia; Rue, Tessa; Vaughn, Matthew G.; Cunningham, Michael

2016-01-01

Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed. PMID:27016350

Feeding Neonates by Cup: A Systematic Review of the Literature.

PubMed

McKinney, Christy M; Glass, Robin P; Coffey, Patricia; Rue, Tessa; Vaughn, Matthew G; Cunningham, Michael

2016-08-01

Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed.

The "global surgeon": is it time for modifications in the American surgical training paradigm?

PubMed

Ginwalla, Rashna F; Rustin, Rudolph B

2015-01-01

"Global surgery" is becoming an increasingly popular concept not only for new trainees, but also for established surgeons. The need to provide surgical care in low-resource settings is laudable, but the American surgical training system currently does not impart the breadth of skills required to provide quality care. We propose one possible model for a surgical fellowship program that provides those trainees who desire to practice in these settings a comprehensive experience that encompasses not only broad technical skills but also the opportunity to engage in policy and programmatic development and implementation. This is a descriptive commentary based on personal experience and a review of the literature. The proposed model is 2 years long, and can either be done after general surgery training as an additional "global surgery" fellowship or as part of a 3 + 2 general surgery + global surgery system. It would incorporate training in general surgery as well as orthopedics, urology, obstetrics & gynecology, neurosurgery, plastics & reconstructive surgery, as well as dedicated time for health systems training. Incorporating such training in a low-resource setting would be a requirement of such a program, in order to obtain field experience. Global surgery is a key word these days in attracting young trainees to academic surgical residency programs, yet they are subsequently inadequately trained to provide the required surgical services in these low-resource settings. Dedicated programmatic changes are required to allow those who choose to practice in these settings to obtain the full breadth of training needed to become safe, competent surgeons in such environments. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Feasibility of the hydrogen sulfide test for the assessment of drinking water quality in post-earthquake Haiti.

PubMed

Weppelmann, Thomas A; Alam, Meer T; Widmer, Jocelyn; Morrissey, David; Rashid, Mohammed H; De Rochars, Valery M Beau; Morris, J Glenn; Ali, Afsar; Johnson, Judith A

2014-12-01

In 2010, a magnitude 7.0 earthquake struck Haiti, severely damaging the drinking and wastewater infrastructure and leaving millions homeless. Compounding this problem, the introduction of Vibrio cholerae resulted in a massive cholera outbreak that infected over 700,000 people and threatened the safety of Haiti's drinking water. To mitigate this public health crisis, non-government organizations installed thousands of wells to provide communities with safe drinking water. However, despite increased access, Haiti currently lacks the monitoring capacity to assure the microbial safety of any of its water resources. For these reasons, this study was designed to assess the feasibility of using a simple, low-cost method to detect indicators of fecal contamination of drinking water that could be implemented at the community level. Water samples from 358 sources of drinking water in the Léogâne flood basin were screened with a commercially available hydrogen sulfide test and a standard membrane method for the enumeration of thermotolerant coliforms. When compared with the gold standard method, the hydrogen sulfide test had a sensitivity of 65 % and a specificity of 93 %. While the sensitivity of the assay increased at higher fecal coliform concentrations, it never exceeded 88 %, even with fecal coliform concentrations greater than 100 colony-forming units per 100 ml. While its simplicity makes the hydrogen sulfide test attractive for assessing water quality in low-resource settings, the low sensitivity raises concerns about its use as the sole indicator of the presence or absence of fecal coliforms in individual or community water sources.

Feasibility of the Hydrogen Sulfide Test for the Assessment of Drinking Water Quality in Post-Earthquake Haiti

PubMed Central

Weppelmann, Thomas A.; Alam, Meer T.; Widmer, Jocelyn; Morrissey, David; Rashid, Mohammed H.; Beau De Rochars, Valery M.; Morris, J. Glenn; Ali, Afsar; Johnson, Judith A.

2014-01-01

In 2010 a magnitude 7.0 earthquake struck Haiti, severely damaging the drinking and waste water infrastructure and leaving millions homeless. Compounding this problem, the introduction of Vibrio cholera resulted in a massive cholera outbreak that infected over 700,000 people and threatened the safety of Haiti’s drinking water. To mitigate this public health crisis, non-government organizations installed thousands of wells to provide communities with safe drinking water. However, despite increased access, Haiti currently lacks the monitoring capacity to assure the microbial safety of any of its water resources. For these reasons, this study was designed to assess the feasibility of using a simple, low cost method to detect indicators of fecal contamination of drinking water that could be implemented at the community level. Water samples from 358 sources of drinking water in the Léogâne flood basin were screened with a commercially available hydrogen sulfide test and a standard membrane method for the enumeration of thermotolerant coliforms. When compared with the gold standard method, the hydrogen sulfide test had a sensitivity of 65% and a specificity of 93%. While the sensitivity of the assay increased at higher fecal coliform concentrations, it never exceeded 88%, even with fecal coliform concentrations greater than 100 colony forming units per 100 milliliters. While its simplicity makes the hydrogen sulfide test attractive for assessing water quality in low resource settings, the low sensitivity raises concerns about its use as the sole indicator of the presence or absence of fecal coliforms in individual or community water sources. PMID:25182685

Feasibility of Tuberculosis Treatment Monitoring by Video Directly Observed Therapy: A Binational Pilot Study

PubMed Central

Garfein, Richard S.; Collins, Kelly; Muñoz, Fátima; Moser, Kathleen; Cerecer-Callu, Paris; Raab, Fredrick; Rios, Phillip; Flick, Allison; Zúñiga, María Luisa; Cuevas-Mota, Jazmine; Liang, Krystal; Rangel, Gudelia; Burgos, José Luis; Rodwell, Timothy; Patrick, Kevin

2017-01-01

Objective Directly observed therapy is recommended worldwide for monitoring tuberculosis (TB) treatment; yet transportation and personnel requirements limit its use. We evaluated the feasibility and acceptability of “Video DOT” (VDOT), which allowed patients to record and transmit medication ingestion videos that were watched remotely by healthcare providers to document adherence. Methods We conducted a single-arm trial among TB patients in San Diego, CA (n=43) and Tijuana, B.C., Mexico (n=9) to represent high- and low-resources settings. Pre/post treatment interviews assessed participant characteristics and experiences. Adherence was defined as the proportion of observed doses to expected doses. Results Mean age was 34 years (range: 18–86), 54% were male, and 77% were non-Caucasian. Mean duration of VDOT use was 5.5 months (range: 1–11). Adherence was similar in San Diego (93%) and Tijuana (96%). Compared to time on in-person DOT, 92% preferred VDOT; 81% thought VDOT was more confidential; 89% never/rarely had problems recording videos; and 100% would recommend VDOT to others. Overall, 7 (13%) participants were returned to in-person DOT and 6 (12%) separate participants had their phone lost, broken or stolen. Conclusions VDOT was feasible and acceptable with high adherence in high- and low-resource settings. Efficacy and cost-effectiveness studies are needed. PMID:26260824

A paper/polymer hybrid microfluidic microplate for rapid quantitative detection of multiple disease biomarkers.

PubMed

Sanjay, Sharma T; Dou, Maowei; Sun, Jianjun; Li, XiuJun

2016-07-26

Enzyme linked immunosorbent assay (ELISA) is one of the most widely used laboratory disease diagnosis methods. However, performing ELISA in low-resource settings is limited by long incubation time, large volumes of precious reagents, and well-equipped laboratories. Herein, we developed a simple, miniaturized paper/PMMA (poly(methyl methacrylate)) hybrid microfluidic microplate for low-cost, high throughput, and point-of-care (POC) infectious disease diagnosis. The novel use of porous paper in flow-through microwells facilitates rapid antibody/antigen immobilization and efficient washing, avoiding complicated surface modifications. The top reagent delivery channels can simply transfer reagents to multiple microwells thus avoiding repeated manual pipetting and costly robots. Results of colorimetric ELISA can be observed within an hour by the naked eye. Quantitative analysis was achieved by calculating the brightness of images scanned by an office scanner. Immunoglobulin G (IgG) and Hepatitis B surface Antigen (HBsAg) were quantitatively analyzed with good reliability in human serum samples. Without using any specialized equipment, the limits of detection of 1.6 ng/mL for IgG and 1.3 ng/mL for HBsAg were achieved, which were comparable to commercial ELISA kits using specialized equipment. We envisage that this simple POC hybrid microplate can have broad applications in various bioassays, especially in resource-limited settings.

A paper/polymer hybrid microfluidic microplate for rapid quantitative detection of multiple disease biomarkers

PubMed Central

Sanjay, Sharma T.; Dou, Maowei; Sun, Jianjun; Li, XiuJun

2016-01-01

Enzyme linked immunosorbent assay (ELISA) is one of the most widely used laboratory disease diagnosis methods. However, performing ELISA in low-resource settings is limited by long incubation time, large volumes of precious reagents, and well-equipped laboratories. Herein, we developed a simple, miniaturized paper/PMMA (poly(methyl methacrylate)) hybrid microfluidic microplate for low-cost, high throughput, and point-of-care (POC) infectious disease diagnosis. The novel use of porous paper in flow-through microwells facilitates rapid antibody/antigen immobilization and efficient washing, avoiding complicated surface modifications. The top reagent delivery channels can simply transfer reagents to multiple microwells thus avoiding repeated manual pipetting and costly robots. Results of colorimetric ELISA can be observed within an hour by the naked eye. Quantitative analysis was achieved by calculating the brightness of images scanned by an office scanner. Immunoglobulin G (IgG) and Hepatitis B surface Antigen (HBsAg) were quantitatively analyzed with good reliability in human serum samples. Without using any specialized equipment, the limits of detection of 1.6 ng/mL for IgG and 1.3 ng/mL for HBsAg were achieved, which were comparable to commercial ELISA kits using specialized equipment. We envisage that this simple POC hybrid microplate can have broad applications in various bioassays, especially in resource-limited settings. PMID:27456979

Using a service design model to develop the "Passport to Safer Birth" in Nigeria and Uganda.

PubMed

Salgado, Mariana; Wendland, Melanie; Rodriguez, Damaris; Bohren, Meghan A; Oladapo, Olufemi T; Ojelade, Olubunmi A; Olalere, Adebimpe A; Luwangula, Ronald; Mugerwa, Kidza; Fawole, Bukola

2017-12-01

To demonstrate how a human-centered service design approach can generate practical tools for good-quality childbirth care in low-resource settings. As part of the WHO "Better Outcomes in Labour Difficulty" (BOLD) project, a service design approach was used in eight Ugandan and Nigerian health facilities and communities to develop the "Passport to Safer Birth." There are three phases: Research for Design, Concept Design, and Detail Design. These generated design principles, design archetype personas, and Passport prototypes. Data collection methods included desk research, interviews, group discussions, and journey mapping to identify touchpoints where the woman interacts with the health system. A total of 90 interviews, 12 observation hours, and 15 group discussions were undertaken. The resulting design principles were: a shared and deeper understanding of pregnancy and childbirth among family and community; family readiness for decision-making and action; and the woman's sense of being in control and being cared for. Four archetype personas of women emerged: Vulnerable; Passive; Empowered; Accepter. Subsequent development of the Passport to Safer Birth tools addressed three domains: Care Mediator; Expectation Manager; and Pregnancy Assistant. The service design approach can create innovative, human-centered service solutions to improve maternity care experiences and outcomes in low-resource settings. © 2017 International Federation of Gynecology and Obstetrics The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

A paper/polymer hybrid microfluidic microplate for rapid quantitative detection of multiple disease biomarkers

NASA Astrophysics Data System (ADS)

Sanjay, Sharma T.; Dou, Maowei; Sun, Jianjun; Li, Xiujun

2016-07-01

Enzyme linked immunosorbent assay (ELISA) is one of the most widely used laboratory disease diagnosis methods. However, performing ELISA in low-resource settings is limited by long incubation time, large volumes of precious reagents, and well-equipped laboratories. Herein, we developed a simple, miniaturized paper/PMMA (poly(methyl methacrylate)) hybrid microfluidic microplate for low-cost, high throughput, and point-of-care (POC) infectious disease diagnosis. The novel use of porous paper in flow-through microwells facilitates rapid antibody/antigen immobilization and efficient washing, avoiding complicated surface modifications. The top reagent delivery channels can simply transfer reagents to multiple microwells thus avoiding repeated manual pipetting and costly robots. Results of colorimetric ELISA can be observed within an hour by the naked eye. Quantitative analysis was achieved by calculating the brightness of images scanned by an office scanner. Immunoglobulin G (IgG) and Hepatitis B surface Antigen (HBsAg) were quantitatively analyzed with good reliability in human serum samples. Without using any specialized equipment, the limits of detection of 1.6 ng/mL for IgG and 1.3 ng/mL for HBsAg were achieved, which were comparable to commercial ELISA kits using specialized equipment. We envisage that this simple POC hybrid microplate can have broad applications in various bioassays, especially in resource-limited settings.

Using survival analysis to determine association between maternal pelvis height and antenatal fetal head descent in Ugandan mothers

PubMed Central

Munabi, Ian Guyton; Luboga, Samuel Abilemech; Mirembe, Florence

2015-01-01

Introduction Fetal head descent is used to demonstrate the maternal pelvis capacity to accommodate the fetal head. This is especially important in low resource settings that have high rates of childbirth related maternal deaths and morbidity. This study looked at maternal height and an additional measure, maternal pelvis height, from automotive engineering. The objective of the study was to determine the associations between maternal: height and pelvis height with the rate of fetal head descent in expectant Ugandan mothers. Methods This was a cross sectional study on 1265 singleton mothers attending antenatal clinics at five hospitals in various parts of Uganda. In addition to the routine antenatal examination, each mother had their pelvis height recorded following informed consent. Survival analysis was done using STATA 12. Results It was found that 27% of mothers had fetal head descent with an incident rate of 0.028 per week after the 25th week of pregnancy. Significant associations were observed between the rate of fetal head descent with: maternal height (Adj Haz ratio 0.93 P < 0.01) and maternal pelvis height (Adj Haz ratio 1.15 P < 0.01). Conclusion The significant associations observed between maternal: height and pelvis height with rate of fetal head descent, demonstrate a need for further study of maternal pelvis height as an additional decision support tool for screening mothers in low resource settings. PMID:26918071

SPANISH PEAKS PRIMITIVE AREA, MONTANA.

USGS Publications Warehouse

Calkins, James A.; Pattee, Eldon C.

1984-01-01

A mineral survey of the Spanish Peaks Primitive Area, Montana, disclosed a small low-grade deposit of demonstrated chromite and asbestos resources. The chances for discovery of additional chrome resources are uncertain and the area has little promise for the occurrence of other mineral or energy resources. A reevaluation, sampling at depth, and testing for possible extensions of the Table Mountain asbestos and chromium deposit should be undertaken in the light of recent interpretations regarding its geologic setting.

Exploration of Mechanisms behind Changes after Participation in a Parenting Intervention: A Qualitative Study in a Low-Resource Setting.

PubMed

Mejia, Anilena; Ulph, Fiona; Calam, Rachel

2016-03-01

Parenting interventions are effective for preventing psychological difficulties in children. However, their active ingredients have not been comprehensively explored. How do they work? What are the mechanisms operating behind changes? In 2012, a randomized controlled trial of a parenting intervention was conducted in low-resource communities of Panama. Effects on child behavioral difficulties, parental stress, and parenting practices were large in the short and long term. This was an ideal opportunity to explore potential mechanisms operating behind effects found in this low-resource setting. Twenty-five parents were interviewed. Data were analyzed through an inductive semantic thematic analysis. Three themes emerged from the data: (a) psychological mechanisms behind changes, (b) behavioral changes in parent, and (c) changes in the children. Parents described that the intervention triggered changes in emotion regulation, self-efficacy, and problem solving. Parents also reported behavioral changes such as praising their children more often, who in turn seemed more responsible and better at following instructions. The study offers participant-driven insight into potential pathways of change after participation in this parenting intervention, pathways that are often overlooked in quantitative studies. Future studies should further explore these pathways, through mediator and moderator analyses, and determine how much is shared across interventions and across different cultural settings. © Society for Community Research and Action 2016.

A Shipping Container-Based Sterile Processing Unit for Low Resources Settings

PubMed Central

2016-01-01

Deficiencies in the sterile processing of medical instruments contribute to poor outcomes for patients, such as surgical site infections, longer hospital stays, and deaths. In low resources settings, such as some rural and semi-rural areas and secondary and tertiary cities of developing countries, deficiencies in sterile processing are accentuated due to the lack of access to sterilization equipment, improperly maintained and malfunctioning equipment, lack of power to operate equipment, poor protocols, and inadequate quality control over inventory. Inspired by our sterile processing fieldwork at a district hospital in Sierra Leone in 2013, we built an autonomous, shipping-container-based sterile processing unit to address these deficiencies. The sterile processing unit, dubbed “the sterile box,” is a full suite capable of handling instruments from the moment they leave the operating room to the point they are sterile and ready to be reused for the next surgery. The sterile processing unit is self-sufficient in power and water and features an intake for contaminated instruments, decontamination, sterilization via non-electric steam sterilizers, and secure inventory storage. To validate efficacy, we ran tests of decontamination and sterilization performance. Results of 61 trials validate convincingly that our sterile processing unit achieves satisfactory outcomes for decontamination and sterilization and as such holds promise to support healthcare facilities in low resources settings. PMID:27007568

Evaporative concentration on a paper-based device to concentrate analytes in a biological fluid.

PubMed

Wong, Sharon Y; Cabodi, Mario; Rolland, Jason; Klapperich, Catherine M

2014-12-16

We report the first demonstration of using heat on a paper device to rapidly concentrate a clinically relevant analyte of interest from a biological fluid. Our technology relies on the application of localized heat to a paper strip to evaporate off hundreds of microliters of liquid to concentrate the target analyte. This method can be used to enrich for a target analyte that is present at low concentrations within a biological fluid to enhance the sensitivity of downstream detection methods. We demonstrate our method by concentrating the tuberculosis-specific glycolipid, lipoarabinomannan (LAM), a promising urinary biomarker for the detection and diagnosis of tuberculosis. We show that the heat does not compromise the subsequent immunodetectability of LAM, and in 20 min, the tuberculosis biomarker was concentrated by nearly 20-fold in simulated urine. Our method requires only 500 mW of power, and sample flow is self-driven via capillary action. As such, our technology can be readily integrated into portable, battery-powered, instrument-free diagnostic devices intended for use in low-resource settings.

Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh.

PubMed

Ao, Trong T; Rahman, Mahmudur; Haque, Farhana; Chakraborty, Apurba; Hossain, M Jahangir; Haider, Sabbir; Alamgir, A S M; Sobel, Jeremy; Luby, Stephen P; Gurley, Emily S

2016-04-01

We assessed a media-based public health surveillance system in Bangladesh during 2010-2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005.

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement.

PubMed

Chan, Alexandre; Abdullah, Matin M; Ishak, Wan Zamaniah B Wan; Ong-Cornel, Annielyn B; Villalon, Antonio H; Kanesvaran, Ravindran

2017-12-01

A meeting of regional experts was convened in Manila, Philippines, to develop a resource-stratified chemotherapy-induced nausea and vomiting (CINV) management guideline. In patients treated with highly emetogenic chemotherapy in general clinical settings, triple therapy with a serotonin (5-hydroxytryptamine-3 [5-HT 3 ]) antagonist (preferably palonosetron), dexamethasone, and aprepitant is recommended for acute CINV prevention. In resource-restricted settings, triple therapy is still recommended, although a 5-HT 3 antagonist other than palonosetron may be used. In both general and resource-restricted settings, dual therapy with dexamethasone (days 2 to 4) and aprepitant (days 2 to 3) is recommended to prevent delayed CINV. In patients treated with moderately emetogenic chemotherapy, dual therapy with a 5-HT 3 antagonist, preferably palonosetron, and dexamethasone is recommended for acute CINV prevention in general settings; any 5-HT 3 antagonist can be combined with dexamethasone in resource-restricted environments. In general settings, for the prevention of delayed CINV associated with moderately emetogenic chemotherapy, corticosteroid monotherapy on days 2 and 3 is recommended. If aprepitant is used on day 1, it should be continued on days 2 and 3. Prevention of delayed CINV with corticosteroids is preferred in resource-restricted settings. The expert panel also developed CINV management guidelines for anthracycline plus cyclophosphamide combination schedules, multiday cisplatin, and chemotherapy with low or minimal emetogenic potential, and its recommendations are detailed in this review. Overall, these regional guidelines provide definitive guidance for CINV management in general and resource-restricted settings. These consensus recommendations are anticipated to contribute to collaborative efforts to improve CINV management in Southeast Asia.

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement

PubMed Central

Abdullah, Matin M.; Ishak, Wan Zamaniah B. Wan; Ong-Cornel, Annielyn B.; Villalon, Antonio H.; Kanesvaran, Ravindran

2017-01-01

A meeting of regional experts was convened in Manila, Philippines, to develop a resource-stratified chemotherapy-induced nausea and vomiting (CINV) management guideline. In patients treated with highly emetogenic chemotherapy in general clinical settings, triple therapy with a serotonin (5-hydroxytryptamine-3 [5-HT3]) antagonist (preferably palonosetron), dexamethasone, and aprepitant is recommended for acute CINV prevention. In resource-restricted settings, triple therapy is still recommended, although a 5-HT3 antagonist other than palonosetron may be used. In both general and resource-restricted settings, dual therapy with dexamethasone (days 2 to 4) and aprepitant (days 2 to 3) is recommended to prevent delayed CINV. In patients treated with moderately emetogenic chemotherapy, dual therapy with a 5-HT3 antagonist, preferably palonosetron, and dexamethasone is recommended for acute CINV prevention in general settings; any 5-HT3 antagonist can be combined with dexamethasone in resource-restricted environments. In general settings, for the prevention of delayed CINV associated with moderately emetogenic chemotherapy, corticosteroid monotherapy on days 2 and 3 is recommended. If aprepitant is used on day 1, it should be continued on days 2 and 3. Prevention of delayed CINV with corticosteroids is preferred in resource-restricted settings. The expert panel also developed CINV management guidelines for anthracycline plus cyclophosphamide combination schedules, multiday cisplatin, and chemotherapy with low or minimal emetogenic potential, and its recommendations are detailed in this review. Overall, these regional guidelines provide definitive guidance for CINV management in general and resource-restricted settings. These consensus recommendations are anticipated to contribute to collaborative efforts to improve CINV management in Southeast Asia. PMID:29244998

Mining semantic networks of bioinformatics e-resources from the literature

PubMed Central

2011-01-01

Background There have been a number of recent efforts (e.g. BioCatalogue, BioMoby) to systematically catalogue bioinformatics tools, services and datasets. These efforts rely on manual curation, making it difficult to cope with the huge influx of various electronic resources that have been provided by the bioinformatics community. We present a text mining approach that utilises the literature to automatically extract descriptions and semantically profile bioinformatics resources to make them available for resource discovery and exploration through semantic networks that contain related resources. Results The method identifies the mentions of resources in the literature and assigns a set of co-occurring terminological entities (descriptors) to represent them. We have processed 2,691 full-text bioinformatics articles and extracted profiles of 12,452 resources containing associated descriptors with binary and tf*idf weights. Since such representations are typically sparse (on average 13.77 features per resource), we used lexical kernel metrics to identify semantically related resources via descriptor smoothing. Resources are then clustered or linked into semantic networks, providing the users (bioinformaticians, curators and service/tool crawlers) with a possibility to explore algorithms, tools, services and datasets based on their relatedness. Manual exploration of links between a set of 18 well-known bioinformatics resources suggests that the method was able to identify and group semantically related entities. Conclusions The results have shown that the method can reconstruct interesting functional links between resources (e.g. linking data types and algorithms), in particular when tf*idf-like weights are used for profiling. This demonstrates the potential of combining literature mining and simple lexical kernel methods to model relatedness between resource descriptors in particular when there are few features, thus potentially improving the resource description, discovery and exploration process. The resource profiles are available at http://gnode1.mib.man.ac.uk/bioinf/semnets.html PMID:21388573

Human resources for mental health care: current situation and strategies for action.

PubMed

Kakuma, Ritsuko; Minas, Harry; van Ginneken, Nadja; Dal Poz, Mario R; Desiraju, Keshav; Morris, Jodi E; Saxena, Shekhar; Scheffler, Richard M

2011-11-05

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

Surviving spinal cord injury in low income countries

PubMed Central

2014-01-01

Background Mortality rates from injuries are higher for people from poorer economic backgrounds than those with higher incomes (according to the World Health Organization [WHO]), and health care professionals and organisations dealing with people with disabilities experience that individuals with spinal cord injury (SCI) in low income countries face serious challenges in their daily lives. Objectives The aims of this study were to explore life expectancy (life expectancy is the average remaining years of life of an individual) and the situation of persons living with SCI in low income settings. Method Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals. Results There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges. Conclusion The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences. PMID:28730012

7 CFR 3550.51 - Program objectives.

Code of Federal Regulations, 2012 CFR

2012-01-01

... financing to help low- and very low-income persons who cannot obtain credit from other sources obtain adequate housing in rural areas. Resources for the section 502 program are limited, and therefore..., if feasible. Sections 3550.52 through 3550.73 set forth the requirements for originating loans on...

7 CFR 3550.51 - Program objectives.

Code of Federal Regulations, 2013 CFR

2013-01-01

... financing to help low- and very low-income persons who cannot obtain credit from other sources obtain adequate housing in rural areas. Resources for the section 502 program are limited, and therefore..., if feasible. Sections 3550.52 through 3550.73 set forth the requirements for originating loans on...

7 CFR 3550.51 - Program objectives.

Code of Federal Regulations, 2014 CFR

2014-01-01

... financing to help low- and very low-income persons who cannot obtain credit from other sources obtain adequate housing in rural areas. Resources for the section 502 program are limited, and therefore..., if feasible. Sections 3550.52 through 3550.73 set forth the requirements for originating loans on...

7 CFR 3550.51 - Program objectives.

Code of Federal Regulations, 2011 CFR

2011-01-01

... financing to help low- and very low-income persons who cannot obtain credit from other sources obtain adequate housing in rural areas. Resources for the section 502 program are limited, and therefore..., if feasible. Sections 3550.52 through 3550.73 set forth the requirements for originating loans on...

Sankofa pediatric HIV disclosure intervention cyber data management: building capacity in a resource-limited setting and ensuring data quality

PubMed Central

Catlin, Ann Christine; Fernando, Sumudinie; Gamage, Ruwan; Renner, Lorna; Antwi, Sampson; Tettey, Jonas Kusah; Amisah, Kofi Aikins; Kyriakides, Tassos; Cong, Xiangyu; Reynolds, Nancy R.; Paintsil, Elijah

2015-01-01

Prevalence of pediatric HIV disclosure is low in resource-limited settings. Innovative, culturally sensitive, and patient-centered disclosure approaches are needed. Conducting such studies in resource-limited settings is not trivial considering the challenges of capturing, cleaning, and storing clinical research data. To overcome some of these challenges, the Sankofa pediatric disclosure intervention adopted an interactive cyber infrastructure for data capture and analysis. The Sankofa Project database system is built on the HUBzero cyber infrastructure (https://hubzero.org), an open source software platform. The hub database components support: (1) data management – the “databases” component creates, configures, and manages database access, backup, repositories, applications, and access control; (2) data collection – the “forms” component is used to build customized web case report forms that incorporate common data elements and include tailored form submit processing to handle error checking, data validation, and data linkage as the data are stored to the database; and (3) data exploration – the “dataviewer” component provides powerful methods for users to view, search, sort, navigate, explore, map, graph, visualize, aggregate, drill-down, compute, and export data from the database. The Sankofa cyber data management tool supports a user-friendly, secure, and systematic collection of all data. We have screened more than 400 child–caregiver dyads and enrolled nearly 300 dyads, with tens of thousands of data elements. The dataviews have successfully supported all data exploration and analysis needs of the Sankofa Project. Moreover, the ability of the sites to query and view data summaries has proven to be an incentive for collecting complete and accurate data. The data system has all the desirable attributes of an electronic data capture tool. It also provides an added advantage of building data management capacity in resource-limited settings due to its innovative data query and summary views and availability of real-time support by the data management team. PMID:26616131

Sankofa pediatric HIV disclosure intervention cyber data management: building capacity in a resource-limited setting and ensuring data quality.

PubMed

Catlin, Ann Christine; Fernando, Sumudinie; Gamage, Ruwan; Renner, Lorna; Antwi, Sampson; Tettey, Jonas Kusah; Amisah, Kofi Aikins; Kyriakides, Tassos; Cong, Xiangyu; Reynolds, Nancy R; Paintsil, Elijah

2015-01-01

Prevalence of pediatric HIV disclosure is low in resource-limited settings. Innovative, culturally sensitive, and patient-centered disclosure approaches are needed. Conducting such studies in resource-limited settings is not trivial considering the challenges of capturing, cleaning, and storing clinical research data. To overcome some of these challenges, the Sankofa pediatric disclosure intervention adopted an interactive cyber infrastructure for data capture and analysis. The Sankofa Project database system is built on the HUBzero cyber infrastructure ( https://hubzero.org ), an open source software platform. The hub database components support: (1) data management - the "databases" component creates, configures, and manages database access, backup, repositories, applications, and access control; (2) data collection - the "forms" component is used to build customized web case report forms that incorporate common data elements and include tailored form submit processing to handle error checking, data validation, and data linkage as the data are stored to the database; and (3) data exploration - the "dataviewer" component provides powerful methods for users to view, search, sort, navigate, explore, map, graph, visualize, aggregate, drill-down, compute, and export data from the database. The Sankofa cyber data management tool supports a user-friendly, secure, and systematic collection of all data. We have screened more than 400 child-caregiver dyads and enrolled nearly 300 dyads, with tens of thousands of data elements. The dataviews have successfully supported all data exploration and analysis needs of the Sankofa Project. Moreover, the ability of the sites to query and view data summaries has proven to be an incentive for collecting complete and accurate data. The data system has all the desirable attributes of an electronic data capture tool. It also provides an added advantage of building data management capacity in resource-limited settings due to its innovative data query and summary views and availability of real-time support by the data management team.

The Application of LT-Table in TRIZ Contradiction Resolving Process

NASA Astrophysics Data System (ADS)

Wei, Zihui; Li, Qinghai; Wang, Donglin; Tian, Yumei

TRIZ is used to resolve invention problems. ARIZ is the most powerful systematic method which integrates all of TRIZ heuristics. Definition of ideal final result (IFR), identification of contradictions and resource utilization are main lines of ARIZ. But resource searching of ARIZ has fault of blindness. Alexandr sets up mathematical model of transformation of the hereditary information in an invention problem using the theory of catastrophes, and provides method of resource searching using LT-table. The application of LT-table on contradiction resolving is introduced. Resource utilization using LT-table is joined into ARIZ step as an addition of TRIZ, apply this method in separator paper punching machine design.

Moving toward rapid and low-cost point-of-care molecular diagnostics with a repurposed 3D printer and RPA.

PubMed

Chan, Kamfai; Wong, Pui-Yan; Parikh, Chaitanya; Wong, Season

2018-03-15

Traditionally, the majority of nucleic acid amplification-based molecular diagnostic tests are done in centralized settings. In recent years, point-of-care tests have been developed for use in low-resource settings away from central laboratories. While most experts agree that point-of-care molecular tests are greatly needed, their availability as cost-effective and easy-to-operate tests remains an unmet goal. In this article, we discuss our efforts to develop a recombinase polymerase amplification reaction-based test that will meet these criteria. First, we describe our efforts in repurposing a low-cost 3D printer as a platform that can carry out medium-throughput, rapid, and high-performing nucleic acid extraction. Next, we address how these purified templates can be rapidly amplified and analyzed using the 3D printer's heated bed or the deconstructed, low-cost thermal cycler we have developed. In both approaches, real-time isothermal amplification and detection of template DNA or RNA can be accomplished using a low-cost portable detector or smartphone camera. Last, we demonstrate the capability of our technologies using foodborne pathogens and the Zika virus. Our low-cost approach does not employ complicated and high-cost components, making it suitable for resource-limited settings. When integrated and commercialized, it will offer simple sample-to-answer molecular diagnostics. Copyright © 2018 Elsevier Inc. All rights reserved.

Establishing an academic biobank in a resource-challenged environment.

PubMed

Soo, Cassandra Claire; Mukomana, Freedom; Hazelhurst, Scott; Ramsay, Michele

2017-05-24

Past practices of informal sample collections and spreadsheets for data and sample management fall short of best-practice models for biobanking, and are neither cost effective nor efficient to adequately serve the needs of large research studies. The biobank of the Sydney Brenner Institute for Molecular Bioscience serves as a bioresource for institutional, national and international research collaborations. It provides high-quality human biospecimens from African populations, secure data and sample curation and storage, as well as monitored sample handling and management processes, to promote both non-communicable and infectious-disease research. Best-practice guidelines have been adapted to align with a low-resource setting and have been instrumental in the development of a quality-management system, including standard operating procedures and a quality-control regimen. Here, we provide a summary of 10 important considerations for initiating and establishing an academic research biobank in a low-resource setting. These include addressing ethical, legal, technical, accreditation and/or certification concerns and financial sustainability.

Establishing an academic biobank in a resource-challenged environment

PubMed Central

Soo, C C; Mukomana, F; Hazelhurst, S; Ramsay, M

2018-01-01

Past practices of informal sample collections and spreadsheets for data and sample management fall short of best-practice models for biobanking, and are neither cost effective nor efficient to adequately serve the needs of large research studies. The biobank of the Sydney Brenner Institute for Molecular Bioscience serves as a bioresource for institutional, national and international research collaborations. It provides high-quality human biospecimens from African populations, secure data and sample curation and storage, as well as monitored sample handling and management processes, to promote both non-communicable and infectious-disease research. Best-practice guidelines have been adapted to align with a low-resource setting and have been instrumental in the development of a quality-management system, including standard operating procedures and a quality-control regimen. Here, we provide a summary of 10 important considerations for initiating and establishing an academic research biobank in a low-resource setting. These include addressing ethical, legal, technical, accreditation and/or certification concerns and financial sustainability. PMID:28604319

Frugal innovation in medicine for low resource settings.

PubMed

Tran, Viet-Thi; Ravaud, Philippe

2016-07-07

Whilst it is clear that technology is crucial to advance healthcare: innovation in medicine is not just about high-tech tools, new procedures or genome discoveries. In constrained environments, healthcare providers often create unexpected solutions to provide adequate healthcare to patients. These inexpensive but effective frugal innovations may be imperfect, but they have the power to ensure that health is within reach of everyone. Frugal innovations are not limited to low-resource settings: ingenuous ideas can be adapted to offer simpler and disruptive alternatives to usual care all around the world, representing the concept of "reverse innovation". In this article, we discuss the different types of frugal innovations, illustrated with examples from the literature, and argue for the need to give voice to this neglected type of innovation in medicine.

Outcomes of people with psychotic disorders in a community-based rehabilitation programme in rural India

PubMed Central

Chatterjee, Sudipto; Pillai, Aravind; Jain, Sumeet; Cohen, Alex; Patel, Vikram

2009-01-01

Background There is little evidence of the feasibility, acceptability and impact of services for the care of people with psychotic disorders in low- and middle-income countries. Aims To describe the scaling up and impact of a community-based rehabilitation programme for people with psychotic disorders in a very-low-resource setting. Methods Longitudinal study of people with psychotic disorders who had been ill for an average of 8 years in a rural Indian community. All individuals received a community-based intervention package comprising psychotropic medications, psychoeducation, adherence management, psychosocial rehabilitation and support for livelihoods. The primary outcome was change in disability scores. Results The cohort consisted of 256 people with psychotic disorders (schizophrenia, bipolar affective disorder and other psychosis) of whom 236 people completed the end-point assessments (92%), with a median follow-up of 46 months. There were significant reductions (P<0.05) in the levels of disability for the cohort, the vast majority (83.5%) of whom engaged with the programme. On multivariate analyses, lower baseline disability scores, family engagement with the programme, medication adherence and being a member of a self-help group were independent determinants of good outcomes. Lack of formal education, a diagnosis of schizophrenia and dropping out of the programme were independent determinants of poor outcomes. Conclusions Community-based rehabilitation is a feasible and acceptable intervention with a beneficial impact on disability for the majority of people with psychotic disorders in low-resource settings. The impact on disability is influenced by a combination of clinical, programme and social determinants. PMID:19880934

Community Perspectives on Access to and Availability of Healthy Food in Rural, Low-Resource, Latino Communities.

PubMed

Valdez, Zulema; Ramírez, A Susana; Estrada, Erendira; Grassi, Kathleen; Nathan, Stephanie

2016-12-15

Attention has focused on the food environment as a result of the growing concern with obesity rates among Latinos in rural areas. Researchers have observed associations between a lack of physical access to affordable produce in areas where supermarkets and grocery stores are limited and poor dietary intake and obesity; these associations are high in rural, low-resource neighborhoods with a high population of Latino residents. We aimed to engage residents of low-resource, Latino-majority neighborhoods in discussions of food access in a rural yet agricultural community setting, which is typically described as a "food desert." We used a mixed-methods approach and conducted 3 focus groups (n = 20) and in-depth interviews (n = 59) and surveys (n = 79) with residents of a rural yet agricultural community. We used thematic analysis to explore residents' perceptions of access to healthy foods. Residents (n = 79; mean age, 41.6 y; 72% female; 79% Latino; 53% Spanish-speaking) reported that dollar and discount stores in this agricultural area provided access to produce; however, produce at retail stores was less affordable than produce at nonretail outlets such as fruit and vegetable stands. Gifts and trades of fruits and vegetables from neighbors and community organizations supplied no-cost or low-cost healthy foods. Residents' suggestions to improve food access centered on lowering the cost of produce in existing retail outlets and seeking out nonretail outlets. Our findings contribute to understanding of the food environment in low-resource, rural yet agricultural areas. Although such areas are characterized as "food deserts," residents identified nonretail outlets as a viable source of affordable produce, while indicating that the cost of retail produce was a concern. Innovative policy solutions to increase healthy food consumption must focus on affordability as well as accessibility, and consider alternate, nonretail food outlets in agricultural areas.

The legacy of the Child Health and Nutrition Research Initiative (CHNRI).

PubMed

Black, Robert E

2016-06-01

Under the Global Forum for Health Research, the Child Health and Nutrition Research Initiative (CHNRI) began its operations in 1999 and became a Swiss foundation in 2006. The vision of CHNRI was to improve child health and nutrition of all children in low- and middle-income countries (LMIC) through research that informs health policy and practice. Specific objectives included expanding global knowledge on childhood disease burden and cost-effectiveness of interventions, promoting priority setting in research, ensuring inclusion of institutions and scientists in LMIC in setting priorities, promoting capacity development in LMIC and stimulating donors and countries to increase resources for research. CHNRI created a knowledge network, funded research through multiple rounds of a global competitive process and published research papers and policy briefs. A signature effort was to develop a systematic methodology for prioritizing health and nutrition research investments. The "CHNRI method" has been extensively applied to global health problems and is now the most commonly used method for prioritizing health research questions.

Methods and tools to simulate the effect of economic instruments in complex water resources systems. Application to the Jucar river basin.

NASA Astrophysics Data System (ADS)

Lopez-Nicolas, Antonio; Pulido-Velazquez, Manuel

2014-05-01

The main challenge of the BLUEPRINT to safeguard Europe's water resources (EC, 2012) is to guarantee that enough good quality water is available for people's needs, the economy and the environment. In this sense, economic policy instruments such as water pricing policies and water markets can be applied to enhance efficient use of water. This paper presents a method based on hydro-economic tools to assess the effect of economic instruments on water resource systems. Hydro-economic models allow integrated analysis of water supply, demand and infrastructure operation at the river basin scale, by simultaneously combining engineering, hydrologic and economic aspects of water resources management. The method made use of the simulation and optimization hydroeconomic tools SIMGAMS and OPTIGAMS. The simulation tool SIMGAMS allocates water resources among the users according to priorities and operating rules, and evaluate economic scarcity costs of the system by using economic demand functions. The model's objective function is designed so that the system aims to meet the operational targets (ranked according to priorities) at each month while following the system operating rules. The optimization tool OPTIGAMS allocates water resources based on an economic efficiency criterion: maximize net benefits, or alternatively, minimizing the total water scarcity and operating cost of water use. SIMGAS allows to simulate incentive water pricing policies based on marginal resource opportunity costs (MROC; Pulido-Velazquez et al., 2013). Storage-dependent step pricing functions are derived from the time series of MROC values at a certain reservoir in the system. These water pricing policies are defined based on water availability in the system (scarcity pricing), so that when water storage is high, the MROC is low, while low storage (drought periods) will be associated to high MROC and therefore, high prices. We also illustrate the use of OPTIGAMS to simulate the effect of ideal water markets by economic optimization, without considering the potential effect of transaction costs. These methods and tools have been applied to the Jucar River basin (Spain). The results show the potential of economic instruments in setting incentives for a more efficient management of water resources systems. Acknowledgments: The study has been partially supported by the European Community 7th Framework Project (GENESIS project, n. 226536), SAWARES (Plan Nacional I+D+i 2008-2011, CGL2009-13238-C02-01 and C02-02), SCARCE (Consolider-Ingenio 2010 CSD2009-00065) of the Spanish Ministry of Economy and Competitiveness; and EC 7th Framework Project ENHANCE (n. 308438) Reference: Pulido-Velazquez, M., Alvarez-Mendiola, E., and Andreu, J., 2013. Design of Efficient Water Pricing Policies Integrating Basinwide Resource Opportunity Costs. J. Water Resour. Plann. Manage., 139(5): 583-592.

Common Data Model for Neuroscience Data and Data Model Exchange

PubMed Central

Gardner, Daniel; Knuth, Kevin H.; Abato, Michael; Erde, Steven M.; White, Thomas; DeBellis, Robert; Gardner, Esther P.

2001-01-01

Objective: Generalizing the data models underlying two prototype neurophysiology databases, the authors describe and propose the Common Data Model (CDM) as a framework for federating a broad spectrum of disparate neuroscience information resources. Design: Each component of the CDM derives from one of five superclasses—data, site, method, model, and reference—or from relations defined between them. A hierarchic attribute-value scheme for metadata enables interoperability with variable tree depth to serve specific intra- or broad inter-domain queries. To mediate data exchange between disparate systems, the authors propose a set of XML-derived schema for describing not only data sets but data models. These include biophysical description markup language (BDML), which mediates interoperability between data resources by providing a meta-description for the CDM. Results: The set of superclasses potentially spans data needs of contemporary neuroscience. Data elements abstracted from neurophysiology time series and histogram data represent data sets that differ in dimension and concordance. Site elements transcend neurons to describe subcellular compartments, circuits, regions, or slices; non-neuroanatomic sites include sequences to patients. Methods and models are highly domain-dependent. Conclusions: True federation of data resources requires explicit public description, in a metalanguage, of the contents, query methods, data formats, and data models of each data resource. Any data model that can be derived from the defined superclasses is potentially conformant and interoperability can be enabled by recognition of BDML-described compatibilities. Such metadescriptions can buffer technologic changes. PMID:11141510

Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control.

PubMed

Bobrow, Kirsten; Farmer, Andrew; Cishe, Nomazizi; Nwagi, Ntobeko; Namane, Mosedi; Brennan, Thomas P; Springer, David; Tarassenko, Lionel; Levitt, Naomi

2018-01-23

Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description. We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials.gov ( NCT02019823 ; 24/12/2013).

A comparison of clinicians' access to online knowledge resources using two types of information retrieval applications in an academic hospital setting

PubMed Central

Hunt, Sevgin; Cimino, James J.; Koziol, Deloris E.

2013-01-01

Objective: The research studied whether a clinician's preference for online health knowledge resources varied with the use of two applications that were designed for information retrieval in an academic hospital setting. Methods: The researchers analyzed a year's worth of computer log files to study differences in the ways that four clinician groups (attending physicians, housestaff physicians, nurse practitioners, and nurses) sought information using two types of information retrieval applications (health resource links or Infobutton icons) across nine resources while they reviewed patients' laboratory results. Results: From a set of 14,979 observations, the authors found statistically significant differences among the 4 clinician groups for accessing resources using the health resources application (P<0.001) but not for the Infobuttons application (P = 0.31). For the health resources application, the preferences of the 4 clinical groups varied according to the specific resources examined (all P≤0.02). Conclusion: The information-seeking behavior of clinicians may vary in relation to their role and the way in which the information is presented. Studying these behaviors can provide valuable insights to those tasked with maintaining information retrieval systems' links to appropriate online knowledge resources. PMID:23405044

Development of concepts for the management of shallow geothermal resources in urban areas - Experience gained from the Basel and Zaragoza case studies

NASA Astrophysics Data System (ADS)

García-Gil, Alejandro; Epting, Jannis; Mueller, Matthias H.; Huggenberger, Peter; Vázquez-Suñé, Enric

2015-04-01

In urban areas the shallow subsurface often is used as a heat resource (shallow geothermal energy), i.e. for the installation and operation of a broad variety of geothermal systems. Increasingly, groundwater is used as a low-cost heat sink, e.g. for building acclimatization. Together with other shallow geothermal exploitation systems significantly increased groundwater temperatures have been observed in many urban areas (urban heat island effect). The experience obtained from two selected case study cities in Basel (CH) and Zaragoza (ES) has allowed developing concepts and methods for the management of thermal resources in urban areas. Both case study cities already have a comprehensive monitoring network operating (hydraulics and temperature) as well as calibrated high-resolution numerical groundwater flow and heat-transport models. The existing datasets and models have allowed to compile and compare the different hydraulic and thermal boundary conditions for both groundwater bodies, including: (1) River boundaries (River Rhine and Ebro), (2) Regional hydraulic and thermal settings, (3) Interaction with the atmosphere under consideration of urbanization and (4) Anthropogenic quantitative and thermal groundwater use. The potential natural states of the considered groundwater bodies also have been investigated for different urban settings and varying processes concerning groundwater flow and thermal regimes. Moreover, concepts for the management of thermal resources in urban areas and the transferability of the applied methods to other urban areas are discussed. The methods used provide an appropriate selection of parameters (spatiotemporal resolution) that have to be measured for representative interpretations of groundwater flow and thermal regimes of specific groundwater bodies. From the experience acquired from the case studies it is shown that understanding the variable influences of the specific geological and hydrogeological as well as hydraulic and thermal boundary conditions in urban settings is crucial. It also could be shown that good quality data are necessary to appropriately define and investigate thermal boundary conditions and the temperature development in urban systems. Groundwater temperatures in both investigated groundwater bodies are already over-heated and essentially impede further thermal groundwater use for cooling purposes. Current legislation approaches are not suitable to evaluate new concessions for thermal exploitation. Therefore, novel approaches for the assessment of new concessions which take into account the complex interaction of natural boundaries as well as existing shallow geothermal systems have to be developed.

Medical device procurement in low- and middle-income settings: protocol for a systematic review

PubMed Central

2014-01-01

Background Medical device procurement processes for low- and middle-income countries (LMICs) are a poorly understood and researched topic. To support LMIC policy formulation in this area, international public health organizations and research institutions issue a large body of predominantly grey literature including guidelines, manuals and recommendations. We propose to undertake a systematic review to identify and explore the medical device procurement methodologies suggested within this and further literature. Procurement facilitators and barriers will be identified, and methodologies for medical device prioritization under resource constraints will be discussed. Methods/design Searches of both bibliographic and grey literature will be conducted to identify documents relating to the procurement of medical devices in LMICs. Data will be extracted according to protocol on a number of pre-specified issues and variables. First, data relating to the specific settings described within the literature will be noted. Second, information relating to medical device procurement methodologies will be extracted, including prioritization of procurement under resource constraints, the use of evidence (e.g. cost-effectiveness evaluations, burden of disease data) as well as stakeholders participating in procurement processes. Information relating to prioritization methodologies will be extracted in the form of quotes or keywords, and analysis will include qualitative meta-summary. Narrative synthesis will be employed to analyse data otherwise extracted. The PRISMA guidelines for reporting will be followed. Discussion The current review will identify recommended medical device procurement methodologies for LMICs. Prioritization methods for medical device acquisition will be explored. Relevant stakeholders, facilitators and barriers will be discussed. The review is aimed at both LMIC decision makers and the international research community and hopes to offer a first holistic conceptualization of this topic. PMID:25336161

Resource Isolation Method for Program’S Performance on CMP

NASA Astrophysics Data System (ADS)

Guan, Ti; Liu, Chunxiu; Xu, Zheng; Li, Huicong; Ma, Qiang

2017-10-01

Data center and cloud computing are more popular, which make more benefits for customers and the providers. However, in data center or clusters, commonly there is more than one program running on one server, but programs may interference with each other. The interference may take a little effect, however, the interference may cause serious drop down of performance. In order to avoid the performance interference problem, the mechanism of isolate resource for different programs is a better choice. In this paper we propose a light cost resource isolation method to improve program’s performance. This method uses Cgroups to set the dedicated CPU and memory resource for a program, aiming at to guarantee the program’s performance. There are three engines to realize this method: Program Monitor Engine top program’s resource usage of CPU and memory and transfer the information to Resource Assignment Engine; Resource Assignment Engine calculates the size of CPU and memory resource should be applied for the program; Cgroups Control Engine divide resource by Linux tool Cgroups, and drag program in control group for execution. The experiment result show that making use of the resource isolation method proposed by our paper, program’s performance can be improved.

[Methods for the costing process in the field of economic evaluation of a rehabilitation program for patients with chronic obstructive lung diseases].

PubMed

Hessel, F P; Wittmann, M; Petro, W; Wasem, J

2000-07-01

Studies in health economics especially economic evaluations of health care technologies and programmes are getting more and more important. However, in Germany there are no established, validated and commonly used instruments for the costing process. For the economic evaluation of a rehabilitation programme for patients with chronic lung diseases such as asthma and chronic bronchitis we developed methods for identification, measurement and validation of resource use during the inpatient rehabilitation programme and during the outpatient follow-up period. These methods are based on methodological considerations as well as on practical experience from conducting a pilot study. With regard to the inpatient setting all relevant diagnostic and therapeutic resource uses could be measured basing on routine clinical documentation and validated by using the cost accounting of the clinic. For measuring the use of resources during the follow-up period in an outpatient setting no reliable administrative data are accessible. Hence, we compared a standardised retrospective patient questionnaire used in a 20-minute interview (n = 50) and a cost diary for the continuing documentation by the patient over a period of 4 weeks (n = 50). Both tools were useful for measuring all relevant resource uses in sufficient detail, but because of higher participation rates and lower dropouts the structured interview appears to be more suitable. Average total costs per month were 1591 DM (interview), respectively 1867 DM (cost diary). Besides productivity loss, costs for medication and GP visits caused the relatively highest resource uses. Practicable instruments were developed for the costing process as part of an economic evaluation in a German rehabilitation setting for pulmonary diseases. After individual modification, these could also be used for different indications and in other institutional settings.

Applying under-sampling techniques and cost-sensitive learning methods on risk assessment of breast cancer.

PubMed

Hsu, Jia-Lien; Hung, Ping-Cheng; Lin, Hung-Yen; Hsieh, Chung-Ho

2015-04-01

Breast cancer is one of the most common cause of cancer mortality. Early detection through mammography screening could significantly reduce mortality from breast cancer. However, most of screening methods may consume large amount of resources. We propose a computational model, which is solely based on personal health information, for breast cancer risk assessment. Our model can be served as a pre-screening program in the low-cost setting. In our study, the data set, consisting of 3976 records, is collected from Taipei City Hospital starting from 2008.1.1 to 2008.12.31. Based on the dataset, we first apply the sampling techniques and dimension reduction method to preprocess the testing data. Then, we construct various kinds of classifiers (including basic classifiers, ensemble methods, and cost-sensitive methods) to predict the risk. The cost-sensitive method with random forest classifier is able to achieve recall (or sensitivity) as 100 %. At the recall of 100 %, the precision (positive predictive value, PPV), and specificity of cost-sensitive method with random forest classifier was 2.9 % and 14.87 %, respectively. In our study, we build a breast cancer risk assessment model by using the data mining techniques. Our model has the potential to be served as an assisting tool in the breast cancer screening.

The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

PubMed

Gebreyes, Wondwossen A; Dupouy-Camet, Jean; Newport, Melanie J; Oliveira, Celso J B; Schlesinger, Larry S; Saif, Yehia M; Kariuki, Samuel; Saif, Linda J; Saville, William; Wittum, Thomas; Hoet, Armando; Quessy, Sylvain; Kazwala, Rudovick; Tekola, Berhe; Shryock, Thomas; Bisesi, Michael; Patchanee, Prapas; Boonmar, Sumalee; King, Lonnie J

2014-01-01

Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight advances in key zoonotic disease areas and the One Health capacity needs.

The Global One Health Paradigm: Challenges and Opportunities for Tackling Infectious Diseases at the Human, Animal, and Environment Interface in Low-Resource Settings

PubMed Central

Gebreyes, Wondwossen A.; Dupouy-Camet, Jean; Newport, Melanie J.; Oliveira, Celso J. B.; Schlesinger, Larry S.; Saif, Yehia M.; Kariuki, Samuel; Saif, Linda J.; Saville, William; Wittum, Thomas; Hoet, Armando; Quessy, Sylvain; Kazwala, Rudovick; Tekola, Berhe; Shryock, Thomas; Bisesi, Michael; Patchanee, Prapas; Boonmar, Sumalee; King, Lonnie J.

2014-01-01

Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight advances in key zoonotic disease areas and the One Health capacity needs. PMID:25393303

Are we prepared to help low-resource communities cope with a severe influenza pandemic?

PubMed

Starbuck, Eric S; von Bernuth, Rudolph; Bolles, Kathryn; Koepsell, Jeanne

2013-11-01

Recent research involving lab-modified H5N1 influenza viruses with increased transmissibility and the ongoing evolution of the virus in nature should remind us of the continuing importance of preparedness for a severe influenza pandemic. Current vaccine technology and antiviral supply remain inadequate, and in a severe pandemic, most low-resource communities will fail to receive adequate medical supplies. However, with suitable guidance, these communities can take appropriate actions without substantial outside resources to reduce influenza transmission and care for the ill. Such guidance should be completed, and support provided to developing countries to adapt it for their settings and prepare for implementation. © 2012 John Wiley & Sons Ltd.

Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh

PubMed Central

Ao, Trong T.; Rahman, Mahmudur; Haque, Farhana; Chakraborty, Apurba; Hossain, M. Jahangir; Haider, Sabbir; Alamgir, A.S.M.; Sobel, Jeremy; Luby, Stephen P.

2016-01-01

We assessed a media-based public health surveillance system in Bangladesh during 2010–2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005. PMID:26981877

A three operator split-step method covering a larger set of non-linear partial differential equations

NASA Astrophysics Data System (ADS)

Zia, Haider

2017-06-01

This paper describes an updated exponential Fourier based split-step method that can be applied to a greater class of partial differential equations than previous methods would allow. These equations arise in physics and engineering, a notable example being the generalized derivative non-linear Schrödinger equation that arises in non-linear optics with self-steepening terms. These differential equations feature terms that were previously inaccessible to model accurately with low computational resources. The new method maintains a 3rd order error even with these additional terms and models the equation in all three spatial dimensions and time. The class of non-linear differential equations that this method applies to is shown. The method is fully derived and implementation of the method in the split-step architecture is shown. This paper lays the mathematical ground work for an upcoming paper employing this method in white-light generation simulations in bulk material.

Current Technologies and Recent Developments for Screening of HPV-Associated Cervical and Oropharyngeal Cancers

PubMed Central

Shah, Sunny S.; Senapati, Satyajyoti; Klacsmann, Flora; Miller, Daniel L.; Johnson, Jeff J.; Chang, Hsueh-Chia; Stack, M. Sharon

2016-01-01

Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, predominantly represented by cervical cancer and oropharyngeal squamous cell carcinoma. Because of the prevalence of the virus, persistence of infection, and long latency period, novel and low-cost methods are needed for effective population level screening and monitoring. We review established methods for screening of cervical and oral cancer as well as commercially-available techniques for detection of HPV DNA. We then describe the ongoing development of microfluidic nucleic acid-based biosensors to evaluate circulating host microRNAs that are produced in response to an oncogenic HPV infection. The goal is to develop an ideal screening platform that is low-cost, portable, and easy to use, with appropriate signal stability, sensitivity and specificity. Advances in technologies for sample lysis, pre-treatment and concentration, and multiplexed nucleic acid detection are provided. Continued development of these devices provides opportunities for cancer screening in low resource settings, for point-of-care diagnostics and self-screening, and for monitoring response to vaccination or surgical treatment. PMID:27618102

Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study.

PubMed

Janet, Sophie; Carrara, Verena I; Simpson, Julie A; Thin, Nant War War; Say, Wah Wah; Paw, Naw Ta Mlar; Chotivanich, Kesinee; Turner, Claudia; Crawley, Jane; McGready, Rose

2018-01-01

Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable. Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border. From 21,225 newbonrs delivered, 15,073 (71%) met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU). Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced) cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06). Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442), and 6.32 (95%CI 3.01-13.26; p<0.001) respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001). Neurodevelopmental follow-up to one year was performed in 1,608 (10.5%) of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565) versus 63 (n = 41); p = 0.732), while advanced resuscitation scores were significantly lower (56 (n = 5); p = 0.017). Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery) associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews.

PubMed

Elliott, Iain S; Sonshine, Daniel B; Akhavan, Sina; Slade Shantz, Angelique; Caldwell, Amber; Slade Shantz, Jesse; Gosselin, Richard A; Coughlin, R Richard

2015-06-01

Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries. We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research. The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process barriers. Drivers to be fostered included a desire to effect change, collaboration with colleagues, and mentorship opportunities. The identified barriers and drivers of research in East Africa provide a targeted framework for interventions and collaborations with surgeons and organizations from high-resource settings looking to be involved in global health.

A microfluidic paper-based analytical device for the assay of albumin-corrected fructosamine values from whole blood samples.

PubMed

Boonyasit, Yuwadee; Laiwattanapaisal, Wanida

2015-01-01

A method for acquiring albumin-corrected fructosamine values from whole blood using a microfluidic paper-based analytical system that offers substantial improvement over previous methods is proposed. The time required to quantify both serum albumin and fructosamine is shortened to 10 min with detection limits of 0.50 g dl(-1) and 0.58 mM, respectively (S/N = 3). The proposed system also exhibited good within-run and run-to-run reproducibility. The results of the interference study revealed that the acceptable recoveries ranged from 95.1 to 106.2%. The system was compared with currently used large-scale methods (n = 15), and the results demonstrated good agreement among the techniques. The microfluidic paper-based system has the potential to continuously monitor glycemic levels in low resource settings.

42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... set forth in paragraph (a)(1) in unusual cases, such as low volume items and services, but may not... and in terms of resource use into APC groups. Except as specified in paragraph (a)(2) of this section, items and services within a group are not comparable with respect to the use of resources if the highest...

42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... set forth in paragraph (a)(1) in unusual cases, such as low volume items and services, but may not... and in terms of resource use into APC groups. Except as specified in paragraph (a)(2) of this section, items and services within a group are not comparable with respect to the use of resources if the highest...

Legal barriers

Treesearch

Anita E. Ruud

1995-01-01

The law is a strict master regarding any kind of deliberately set fires. The value of natural resources and resource management is low on the list of priorities for this state’s lawmakers. BEWARE is the key word for those who dare to challenge the traditional notion that all fires must be extinguished immediately, except those within the safe confines of your fireplace...

Systems and methods for automatically identifying and linking names in digital resources

DOEpatents

Parker, Charles T.; Lyons, Catherine M.; Roston, Gerald P.; Garrity, George M.

2017-06-06

The present invention provides systems and methods for automatically identifying name-like-strings in digital resources, matching these name-like-string against a set of names held in an expertly curated database, and for those name-like-strings found in said database, enhancing the content by associating additional matter with the name, wherein said matter includes information about the names that is held within said database and pointers to other digital resources which include the same name and it synonyms.

Cumulative exergy extraction from the natural environment (CEENE): a comprehensive life cycle impact assessment method for resource accounting.

PubMed

Dewulf, J; Bösch, M E; De Meester, B; Van der Vorst, G; Van Langenhove, H; Hellweg, S; Huijbregts, M A J

2007-12-15

The objective of the paper is to establish a comprehensive resource-based life cycle impact assessment (LCIA) method which is scientifically sound and that enables to assess all kinds of resources that are deprived from the natural ecosystem, all quantified on one single scale, free of weighting factors. The method is based on the exergy concept. Consistent exergy data on fossils, nuclear and metal ores, minerals, air, water, land occupation, and renewable energy sources were elaborated, with well defined system boundaries. Based on these data, the method quantifies the exergy "taken away" from natural ecosystems, and is thus called the cumulative exergy extraction from the natural environment (CEENE). The acquired data set was coupled with a state-of-the art life cycle inventory database, ecoinvent. In this way, the method is able to quantitatively distinguish eight categories of resources withdrawn from the natural environment: renewable resources, fossil fuels, nuclear energy, metal ores, minerals, water resources, land resources, and atmospheric resources. Third, the CEENE method is illustrated for a number of products that are available in ecoinvent, and results are compared with common resource oriented LCIA methods. The application to the materials in the ecoinvent database showed that fossil resources and land use are of particular importance with regard to the total CEENE score, although the other resource categories may also be significant.

Utility of the urine reagent strip leucocyte esterase assay for the diagnosis of meningitis in resource-limited settings: meta-analysis

PubMed Central

Bortcosh, William; Siedner, Mark; Carroll, Ryan W.

2018-01-01

OBJECTIVE Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource settings (LRS) often lack the capacity to perform these studies. We sought to determine whether the presence of white blood cells in CSF detected by commercially available urine reagent strips could aid in the diagnosis of bacterial meningitis. METHODS We searched PubMed for studies published between 1980 and 2016 that investigated the use of urine reagent strips to identify cerebrospinal fluid (CSF) pleocytosis. We assessed studies in any language that enrolled subjects who underwent lumbar puncture and had cerebrospinal fluid testing by both standard laboratory assays and urine reagent strips. We abstracted true-positive, false-negative, false-positive and true-negative counts for each study using a diagnostic threshold of ≥10 white blood cells per microlitre for suspected bacterial meningitis and performed mixed regression modelling with random effects to estimate pooled diagnostic accuracy across studies. RESULTS Our search returned 13 studies including 2235 participants. Urine reagent strips detected CSF pleocytosis with a pooled sensitivity of 92% (95% CI: 84–96), a pooled specificity of 98% (95% CI: 94–99) and a negative predictive value of 99% when the bacterial meningitis prevalence is 10%. CONCLUSIONS Urine reagent strips could provide a rapid and accurate tool to detect CSF pleocytosis, which, if negative, can be used to exclude diagnosis of bacterial meningitis in settings without laboratory infrastructure. Further investigation of the diagnostic value of using protein, glucose and bacteria components of these strips is warranted. PMID:28627004

Anesthetic management of placenta accreta in a low-resource setting: a case series.

PubMed

Muñoz, L A; Mendoza, G J; Gomez, M; Reyes, L E; Arevalo, J J

2015-11-01

Current recommendations for the anesthetic management of placenta accreta support a conservative approach with neuraxial anesthesia and uterine artery embolization. These are based on case series from experienced centers in developed countries. The aim of this study was to describe the anesthetic management of placenta accreta in a low-resource setting. A retrospective case note review was performed. From 1 August 2006 to 31 July 2011 placentas from cases of suspected placenta accreta were reassessed histologically to confirm the diagnosis. Patient charts were reviewed and information on anesthetic technique, monitoring, blood transfusion, maternal and fetal outcomes was extracted. Thirty-nine cases were identified. Mean (± SD) maternal age was 33 ± 5.4 years. Hysterectomy was performed at the time of cesarean section in all cases. Thirty-four patients received neuraxial anesthesia, of whom 15 required conversion to general anesthesia. Invasive blood pressure monitoring was used in all patients and a central venous catheter was inserted in 33 cases. Complications associated with monitoring occurred in five patients. Median [IQR] blood loss was 2000 [1100-2700] mL and the median [IQR] number of units of red blood cell transfused was 2 [0-6]. Vasoactive medication was used in 14 patients and 15 patients were transferred to the intensive care unit postoperatively. No maternal or newborn deaths occurred. A multidisciplinary approach can prove valuable when placenta accreta is suspected before delivery. In low-resource settings, lack of interventional radiology services and prenatal diagnostic capability may have an impact on anesthetic management in patients with placenta accreta. However, other than greater blood loss, our study demonstrated that good maternal and neonatal outcomes are possible in spite of limited resources. Copyright © 2015 Elsevier Ltd. All rights reserved.

Management of neglected open extremity fractures in low-resource settings: Experience of the French Army Medical Service in Chad.

PubMed

Mathieu, L; Mottier, F; Bertani, A; Danis, J; Rongiéras, F; Chauvin, F

2014-11-01

The purpose of this study was to report the experience of the French Army Medical Service in the management of neglected open extremity fractures and related-complications in Chad. Delayed treatment of open extremity fractures is possible in a low-resource setting. An observational prospective study was performed in a French Forward Surgical Team deployed in N'Djamena for six months. Twenty-seven patients, 24 men and three women, mean age 30 years old with an open fracture that was managed more than 24 hours after it occurred were included. The mean treatment delay was 83 days. Fractures were located in the tibia in 20 cases. There were 15 non-infected and twelve infected fractures. The number of cases of debridement, flap coverage, and the overall number of procedures were higher in the group with infection, but the difference was not significant. Treatment of infected fractures was complicated by six early recurrent infections, while there were no complications in the group without infection. The mean follow-up was 4.4 months. Infection was controlled in eleven cases, however evaluation of fracture healing was limited because of the short follow-up in the group with infection. Functional outcome of the lower extremities was often complicated by knee stiffness. Delayed management of open fractures depends on the available resources. In low-resource settings, the goals of surgery should be modest. Treatment of non-infected injuries and osteomyelitis is possible. On the other hand, treatment of infected fractures and septic nonunions should be undertaken with caution if all the necessary aspects of treatment, in particular extended antibiotic treatment and sequential procedures are not possible. level IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A MODIFIED LOW COST COLOURIMETRIC METHOD FOR PARACETAMOL (ACETAMINOPHEN) MEASUREMENT IN PLASMA

PubMed Central

Shihana, Fathima; Dissanayake, Dhammika Menike; Dargan, Paul Ivor; Dawson, Andrew Hamilton

2011-01-01

Background Despite a significant increase in the number of patients with paracetamol poisoning in the developing world, plasma paracetamol assays are not widely available. The purpose of this study was to assess a low cost modified colorimetric paracetamol assay that has the potential to be performed in small laboratories with restricted resources. Methods The paracetamol assay used in this study was based on the Glynn and Kendal colorimetric method with a few modifications in order to decrease the production of nitrous gas and thereby reduce infrastructure costs. Preliminary validation studies were performed using spiked aqueous samples with known concentrations of paracetamol. Subsequently, the results from the colorimetric method for 114 stored clinical samples from patients with paracetamol poisoning were compared with those from the current gold-standard high-performance liquid chromatography (HPLC) method. A prospective survey, assessing the clinical use of the paracetamol assay, was performed on all patients with paracetamol poisoning attending the Peradeniya General Hospital, Sri Lanka over a ten-month period. Results The recovery study showed an excellent correlation (r2 >0.998) for paracetamol concentrations from 25- 400 mg/l. The final yellow colour was stable for at least 10 minutes at room temperature. There was also excellent correlation with the HPLC method (r2=0.9758). In the clinical cohort study, use of the antidote N-acetylcysteine was avoided in over a third of patients who had a plasma paracetamol concentration measured. The cost of consumables used per assay was $0.50 (US). Conclusions This colorimetric paracetamol assay is reliable and accurate and can be performed rapidly, easily and economically. Use of this assay in resource poor clinical settings has the potential to have a significant clinical and economic impact on the management of paracetamol poisoning. PMID:20095813

Mobile Phone–based Infectious Disease Surveillance System, Sri Lanka

PubMed Central

Sawford, Kate; Daniel, Samson L.A.; Nelson, Trisalyn A.; Stephen, Craig

2010-01-01

Because many infectious diseases are emerging in animals in low-income and middle-income countries, surveillance of animal health in these areas may be needed for forecasting disease risks to humans. We present an overview of a mobile phone–based frontline surveillance system developed and implemented in Sri Lanka. Field veterinarians reported animal health information by using mobile phones. Submissions increased steadily over 9 months, with ≈4,000 interactions between field veterinarians and reports on the animal population received by the system. Development of human resources and increased communication between local stakeholders (groups and persons whose actions are affected by emerging infectious diseases and animal health) were instrumental for successful implementation. The primary lesson learned was that mobile phone–based surveillance of animal populations is acceptable and feasible in lower-resource settings. However, any system implementation plan must consider the time needed to garner support for novel surveillance methods among users and stakeholders. PMID:20875276

Development of a technical assistance framework for building organizational capacity of health programs in resource-limited settings.

PubMed

Reyes, E Michael; Sharma, Anjali; Thomas, Kate K; Kuehn, Chuck; Morales, José Rafael

2014-09-17

Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs. Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation. Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework. A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs.

The user cost of energy resource and its reasonable tax rate-A case of oil

NASA Astrophysics Data System (ADS)

Lifan, Liu

2017-12-01

The development and use of natural resources bring about the externality of resources depletion, especially for non-renewable resources. This paper takes oil as an example to analyze the user cost of energy resource with EI Serafy User cost method, and discusses the rationality of the resource tax. Meanwhile, this paper determines oil resource tax rate in consideration of resource sustainable development. The results show that, the user cost of oil isn’t compensated fully, it is too low to make compensation to the environment and the profit of future generation, and the resource tax is a little low. At last of the paper, some conclusions and policy suggestions on resource tax reform are given.

Understanding and mitigating HIV-related resource-based stigma in the era of antiretroviral therapy.

PubMed

Holmes, Kathleen; Winskell, Kate

2013-01-01

The perception in low-resource settings that investment of resources in people living with HIV (PLHIV) is wasted because AIDS is both an incurable and deadly disease is known as resource-based stigma. In this paper, we draw on in-depth interviews (IDI), focus group discussions (FGD), and key informant interviews (KII) with 77 HIV-positive microfinance participants and nongovernmental organization leaders to examine resource-based stigma in the context of increased access to antiretroviral therapy (ART) at an individual, household, and community level in Côte d'Ivoire. The purpose of this exploratory paper is to examine: (1) resource-based stigmatization in the era of ART and (2) the relationship among microfinance, a poverty-reduction intervention, and HIV stigmatization. The frequency with which resource-based stigma was discussed by respondents suggests that it is an important component of HIV-related stigma in this setting. It affected PLHIV's access to material as well as social resources, leading to economic discrimination and social devaluation. Participation in village savings and loans groups, however, mitigated resource-based HIV stigma, suggesting that in the era of increased access to antiretroviral therapy, economic programs should be considered as one possible HIV stigma-reduction intervention.

Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.

PubMed

Borracci, Raul A; Arribalzaga, Eduardo B; Couto, Juan L; Dvorkin, Mario; Ahuad Guerrero, Rodolfo A; Fernandez, Carmen; Ferreira, Luis N; Cerezo, Leticia

2015-01-01

Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation. A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies. Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts. One-third of students expressed high altruistic motivations and should therefore be encouraged during their careers. Better remuneration and the assurance of a position at an urban hospital in the future may tip the choice in favor of underprivileged regions. Since most respondents said that neither government nor medical schools sufficiently encourage the practice of medicine in poor deprived regions, government policy-makers should recommend changes in resource allocation to better promote official proposals and opportunities to work.

mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review

PubMed Central

Goudge, Jane; Gómez-Olivé, Francesc Xavier; Huxley, Caroline; Dodd, Katherine; Griffiths, Frances

2018-01-01

Background Routine monitoring by patients and healthcare providers to manage chronic disease is vital, though this can be challenging in low-resourced health systems. Mobile health (mHealth) has been proposed as one way to improve management of chronic diseases. Past mHealth reviews have proposed the need for a greater understanding around how the theoretical constructs in mHealth interventions actually work. In response, we synthesised evidence from primary studies on monitoring of chronic diseases using two-way digital text or voice communication between a patient and health worker. We did this in order to understand the important considerations for the design of mHealth interventions. Method Articles retrieved were systematically screened and analysed to elicit explanations of mHealth monitoring interventions. These explanations were consolidated into programme theory and compared with existing theory and frameworks. We identified variation in outcomes to understand how context moderates the outcome. Results Four articles were identified—monitoring of hypertension and HIV/AIDS from: Kenya, Pakistan, Honduras and Mexico and South Africa. Six components were found in all four interventions: reminders, patient observation of health state, motivational education/advice, provision of support communication, targeted actions and praise and encouragement. Intervention components were mapped to existing frameworks and theory. Variation in outcome identified in subgroup analysis suggests greater impact is achieved with certain patient groups, such as those with low literacy, those with stressful life events or those early in the disease trajectory. There was no other evidence in the included studies of the effect of context on the intervention and outcome. Conclusion mHealth interventions for monitoring chronic disease in low-resource settings, based on existing frameworks and theory, can be effective. A match between what the intervention provides and the needs or social factors relevant to specific patient group increases the effect. It was not possible to understand the impact of context on intervention and outcome beyond these patient-level measures as no evidence was provided in the study reports. PMID:29527356

Instrument-free exothermic heating with phase change temperature control for paper microfluidic devices

NASA Astrophysics Data System (ADS)

Singleton, Jered; Zentner, Chris; Buser, Josh; Yager, Paul; LaBarre, Paul; Weigl, Bernhard H.

2013-03-01

Many infectious diseases, as well as some cancers, that affect global health are most accurately diagnosed through nucleic acid amplification and detection. There is a great need to simplify nucleic acid-based assay systems for use in global health in low-resource settings as well as in settings that do not have convenient access to laboratory staff and equipment such as doctors' offices and home care settings. In developing countries, unreliable electric power, inadequate supply chains, and lack of maintenance for complex diagnostic instruments are all common infrastructure shortfalls. Many elements of instrument-free, disposable, nucleic acid amplification assays have been demonstrated in recent years. However, the problem of instrument-free,1 low-cost, temperature-controlled chemical heating remains unsolved. In this paper we present the current status and results of work towards developing disposable, low-cost, temperature-controlled heaters designed to support isothermal nucleic acid amplification assays that are integrated with a two-dimensional paper network. Our approach utilizes the heat generated through exothermic chemical reactions and controls the heat through use of engineered phase change materials to enable sustained temperatures required for nucleic acid amplification. By selecting appropriate exothermic and phase change materials, temperatures can be controlled over a wide range, suitable for various isothermal amplification methods, and maintained for over an hour at an accuracy of +/- 1°C.

Instrument-free exothermic heating with phase change temperature control for paper microfluidic devices.

PubMed

Singleton, Jered; Zentner, Chris; Buser, Josh; Yager, Paul; LaBarre, Paul; Weigl, Bernhard H

2013-03-09

Many infectious diseases, as well as some cancers, that affect global health are most accurately diagnosed through nucleic acid amplification and detection. There is a great need to simplify nucleic acid-based assay systems for use in global health in low-resource settings as well as in settings that do not have convenient access to laboratory staff and equipment such as doctors' offices and home care settings. In developing countries, unreliable electric power, inadequate supply chains, and lack of maintenance for complex diagnostic instruments are all common infrastructure shortfalls. Many elements of instrument-free, disposable, nucleic acid amplification assays have been demonstrated in recent years. However, the problem of instrument-free, low-cost, temperature-controlled chemical heating remains unsolved. In this paper we present the current status and results of work towards developing disposable, low-cost, temperature-controlled heaters designed to support isothermal nucleic acid amplification assays that are integrated with a two-dimensional paper network. Our approach utilizes the heat generated through exothermic chemical reactions and controls the heat through use of engineered phase change materials to enable sustained temperatures required for nucleic acid amplification. By selecting appropriate exothermic and phase change materials, temperatures can be controlled over a wide range, suitable for various isothermal amplification methods, and maintained for over an hour at an accuracy of +/- 1°C.

Instrument-free exothermic heating with phase change temperature control for paper microfluidic devices

PubMed Central

Singleton, Jered; Zentner, Chris; Buser, Josh; Yager, Paul; LaBarre, Paul; Weigl, Bernhard H.

2014-01-01

Many infectious diseases, as well as some cancers, that affect global health are most accurately diagnosed through nucleic acid amplification and detection. There is a great need to simplify nucleic acid-based assay systems for use in global health in low-resource settings as well as in settings that do not have convenient access to laboratory staff and equipment such as doctors' offices and home care settings. In developing countries, unreliable electric power, inadequate supply chains, and lack of maintenance for complex diagnostic instruments are all common infrastructure shortfalls. Many elements of instrument-free, disposable, nucleic acid amplification assays have been demonstrated in recent years. However, the problem of instrument-free,1 low-cost, temperature-controlled chemical heating remains unsolved. In this paper we present the current status and results of work towards developing disposable, low-cost, temperature-controlled heaters designed to support isothermal nucleic acid amplification assays that are integrated with a two-dimensional paper network. Our approach utilizes the heat generated through exothermic chemical reactions and controls the heat through use of engineered phase change materials to enable sustained temperatures required for nucleic acid amplification. By selecting appropriate exothermic and phase change materials, temperatures can be controlled over a wide range, suitable for various isothermal amplification methods, and maintained for over an hour at an accuracy of +/- 1°C. PMID:25426269

The National Institutes of Health Affordable Cancer Technologies Program: Improving Access to Resource-Appropriate Technologies for Cancer Detection, Diagnosis, Monitoring, and Treatment in Low- and Middle-Income Countries

PubMed Central

Divi, Rao; Gwede, Michael; Tandon, Pushpa; Sorg, Brian S.; Ossandon, Miguel R.; Agrawal, Lokesh; Pai, Vinay; Baker, Houston; Lash, Tiffani Bailey

2016-01-01

Point-of-care (POC) technologies have proved valuable in cancer detection, diagnosis, monitoring, and treatment in the developed world, and have shown promise in low-and-middle-income countries (LMIC) as well. Despite this promise, the unique design constraints presented in low-resource settings, coupled with the variety of country-specific regulatory and institutional dynamics, have made it difficult for investigators to translate successful POC cancer interventions to the LMIC markets. In response to this need, the National Cancer Institute has partnered with the National Institute of Biomedical Imaging and Bioengineering to create the National Institutes of Health Affordable Cancer Technologies (ACTs) program. This program seeks to simplify the pathway to market by funding multidisciplinary investigative teams to adapt and validate the existing technologies for cancer detection, diagnosis, and treatment in LMIC settings. The various projects under ACTs range from microfluidic cancer diagnostic tools to novel treatment devices, each geared for successful clinical adaptation to LMIC settings. Via progression through this program, each POC innovation will be uniquely leveraged for successful clinical translation to LMICs in a way not before seen in this arena. PMID:27730015

Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

PubMed

Trevisanuto, Daniele; Bertuola, Federica; Lanzoni, Paolo; Cavallin, Francesco; Matediana, Eduardo; Manzungu, Olivier Wingi; Gomez, Ermelinda; Da Dalt, Liviana; Putoto, Giovanni

2015-01-01

We assessed the effect of an adapted neonatal resuscitation program (NRP) course on healthcare providers' performances in a low-resource setting through the use of video recording. A video recorder, mounted to the radiant warmers in the delivery rooms at Beira Central Hospital, Mozambique, was used to record all resuscitations. One-hundred resuscitations (50 before and 50 after participation in an adapted NRP course) were collected and assessed based on a previously published score. All 100 neonates received initial steps; from these, 77 and 32 needed bag-mask ventilation (BMV) and chest compressions (CC), respectively. There was a significant improvement in resuscitation scores in all levels of resuscitation from before to after the course: for "initial steps", the score increased from 33% (IQR 28-39) to 44% (IQR 39-56), p<0.0001; for BMV, from 20% (20-40) to 40% (40-60), p = 0.001; and for CC, from 0% (0-10) to 20% (0-50), p = 0.01. Times of resuscitative interventions after the course were improved in comparison to those obtained before the course, but remained non-compliant with the recommended algorithm. Although resuscitations remained below the recommended standards in terms of quality and time of execution, clinical practice of healthcare providers improved after participation in an adapted NRP course. Video recording was well-accepted by the staff, useful for objective assessment of performance during resuscitation, and can be used as an educational tool in a low-resource setting.

Making Safe Surgery Affordable: Design of a Surgical Drill Cover System for Scale.

PubMed

Buchan, Lawrence L; Black, Marianne S; Cancilla, Michael A; Huisman, Elise S; Kooyman, Jeremy J R; Nelson, Scott C; OʼHara, Nathan N; OʼBrien, Peter J; Blachut, Piotr A

2015-10-01

Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to nonsterile hardware drills because they are affordable, robust, and efficient, but they are impossible to sterilize using steam. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a nonsterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on 3 main aspects. First, the design included a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. Second, the selected hardware drill had a maximum speed of 1050 rpm to match common surgical drills and reduce risk of necrosis. Third, the fabric cover was optimized for ease of assembly while maintaining a sterile technique. Furthermore, with the Drill Cover approach, multiple Drill Covers can be provided with a single battery-powered drill in a "kit," so that the drill can be used in back-to-back surgeries without requiring immediate sterilization. The Drill Cover design presented here provides a proof-of-concept for a product that can be commercialized, produced at scale, and used in low-resource settings globally to improve access to safe surgery.

Predictors of asymptomatic bacteriuria among pregnant women in a low-resource setting.

PubMed

Awoleke, J O; Adanikin, A I; Ajayi, D D; Ayosanmi, O S

2015-01-01

This study aims at identifying predictors of asymptomatic bacteriuria (AB) among pregnant women in a low-resource setting, with the intent of recommending a guideline for screening during antenatal care. A total of 266 healthy pregnant women were antenatally recruited after informed consent. They had routine antenatal investigations, a 1 h 50-g oral glucose tolerance test and quantitative urine culture and sensitivity. The data collected were analysed using statistical software package SPSS v. 17. Prevalence of AB was 23 (8.6%). Escherichia coli was the commonest isolate (6, 26.1%), closely followed by Staphylococcus aureus (5, 21.7%). AB was commoner among patients aged 25-34 years, of low parity and higher education. Blood group B- rhesus-positive significantly predicts the likelihood of developing AB in pregnancy (adjusted OR: 0.36; 95% CI: 0.14-0.96). We conclude that blood group B-rhesus-positive in association with other patients' characteristics, such as age 25-34 years, low parity and higher education could form guidelines for a screening algorithm in our environment.

Development and validation of an early childhood development scale for use in low-resourced settings.

PubMed

McCoy, Dana Charles; Sudfeld, Christopher R; Bellinger, David C; Muhihi, Alfa; Ashery, Geofrey; Weary, Taylor E; Fawzi, Wafaie; Fink, Günther

2017-02-09

Low-cost, cross-culturally comparable measures of the motor, cognitive, and socioemotional skills of children under 3 years remain scarce. In the present paper, we aim to develop a new caregiver-reported early childhood development (ECD) scale designed to be implemented as part of household surveys in low-resourced settings. We evaluate the acceptability, test-retest reliability, internal consistency, and discriminant validity of the new ECD items, subscales, and full scale in a sample of 2481 18- to 36-month-old children from peri-urban and rural Tanzania. We also compare total and subscale scores with performance on the Bayley Scales of Infant Development (BSID-III) in a subsample of 1036 children. Qualitative interviews from 10 mothers and 10 field workers are used to inform quantitative data. Adequate levels of acceptability and internal consistency were found for the new scale and its motor, cognitive, and socioemotional subscales. Correlations between the new scale and the BSID-III were high (r > .50) for the motor and cognitive subscales, but low (r < .20) for the socioemotional subscale. The new scale discriminated between children's skills based on age, stunting status, caregiver-reported disability, and adult stimulation. Test-retest reliability scores were variable among a subset of items tested. Results of this study provide empirical support from a low-income country setting for the acceptability, reliability, and validity of a new caregiver-reported ECD scale. Additional research is needed to test these and other caregiver reported items in children in the full 0 to 3 year range across multiple cultural and linguistic settings.

A public database of macromolecular diffraction experiments.

PubMed

Grabowski, Marek; Langner, Karol M; Cymborowski, Marcin; Porebski, Przemyslaw J; Sroka, Piotr; Zheng, Heping; Cooper, David R; Zimmerman, Matthew D; Elsliger, Marc André; Burley, Stephen K; Minor, Wladek

2016-11-01

The low reproducibility of published experimental results in many scientific disciplines has recently garnered negative attention in scientific journals and the general media. Public transparency, including the availability of `raw' experimental data, will help to address growing concerns regarding scientific integrity. Macromolecular X-ray crystallography has led the way in requiring the public dissemination of atomic coordinates and a wealth of experimental data, making the field one of the most reproducible in the biological sciences. However, there remains no mandate for public disclosure of the original diffraction data. The Integrated Resource for Reproducibility in Macromolecular Crystallography (IRRMC) has been developed to archive raw data from diffraction experiments and, equally importantly, to provide related metadata. Currently, the database of our resource contains data from 2920 macromolecular diffraction experiments (5767 data sets), accounting for around 3% of all depositions in the Protein Data Bank (PDB), with their corresponding partially curated metadata. IRRMC utilizes distributed storage implemented using a federated architecture of many independent storage servers, which provides both scalability and sustainability. The resource, which is accessible via the web portal at http://www.proteindiffraction.org, can be searched using various criteria. All data are available for unrestricted access and download. The resource serves as a proof of concept and demonstrates the feasibility of archiving raw diffraction data and associated metadata from X-ray crystallographic studies of biological macromolecules. The goal is to expand this resource and include data sets that failed to yield X-ray structures in order to facilitate collaborative efforts that will improve protein structure-determination methods and to ensure the availability of `orphan' data left behind for various reasons by individual investigators and/or extinct structural genomics projects.

Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods.

PubMed

Odaga, John; Henriksson, Dorcus K; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K; Valadez, Joseph J

2016-01-01

Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.

Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

PubMed Central

Odaga, John; Henriksson, Dorcus K.; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K.; Valadez, Joseph J.

2016-01-01

Background Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Design Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. Results All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. Conclusions In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival. PMID:27225791

Design and development of a simple UV fluorescence multi-spectral imaging system

NASA Astrophysics Data System (ADS)

Tovar, Carlos; Coker, Zachary; Yakovlev, Vladislav V.

2018-02-01

Healthcare access in low-resource settings is compromised by the availability of affordable and accurate diagnostic equipment. The four primary poverty-related diseases - AIDS, pneumonia, malaria, and tuberculosis - account for approximately 400 million annual deaths worldwide as of 2016 estimates. Current diagnostic procedures for these diseases are prolonged and can become unreliable under various conditions. We present the development of a simple low-cost UV fluorescence multi-spectral imaging system geared towards low resource settings for a variety of biological and in-vitro applications. Fluorescence microscopy serves as a useful diagnostic indicator and imaging tool. The addition of a multi-spectral imaging modality allows for the detection of fluorophores within specific wavelength bands, as well as the distinction between fluorophores possessing overlapping spectra. The developed instrument has the potential for a very diverse range of diagnostic applications in basic biomedical science and biomedical diagnostics and imaging. Performance assessment of the microscope will be validated with a variety of samples ranging from organic compounds to biological samples.

An evaluation of the applicability of the telluric-electric and audio-magnetotelluric methods to mineral assessment on the Arabian Shield, Kingdom of Saudi Arabia

USGS Publications Warehouse

Flanigan, Vincent J.; Zablocki, Charles J.

1984-01-01

Feasibility studies of two electromagnetic methods were made in selected areas of the Jabal Hibshi (1:250,000) quadrangle, 26F, in the Kingdom of Saudi Arabia in March of 1983. The methods tested were the natural source-field telluricelectric and audio-magnetotelluric methods developed and extensively used in recent years by the U.S. Geological Survey in some of its domestic programs related to geothermal and mineral resource assessment. Results from limited studies in the Meshaheed district, the Jabal as Silsilah ring complex, and across a portion of the Raha fault zone clearly demonstrate the appropriateness of these sub-regional scale, reconnaissance-type studies to mineral resource assessment. The favorable results obtained are largely attributed to distinctive and large contrasts in the electrical resistivity of the major rock types encountered. It appears that the predominant controlling factor governing the rock resistivities is the amount of contained clay minerals. Accordingly, unaltered (specifically, non-argillic) igneous and metamorphic rocks have very high resistivities; metasedimentary rocks of the Murdama group that contain several percent clay minerals have intermediate values of resistivity; and highly altered rocks, containing abundant clay minerals, have very low values of resistivity. Water-filled fracture porosity may be a secondary, but important, factor in some settings. However, influences from variations in interstitial or intercrystalline, water-filled porosity are probably small because these types of porosity are generally low. It is reasonable to expect similar results in other areas within the Arabian Shield.

Planning and evaluating mental health services in low- and middle-income countries using theory of change

PubMed Central

Breuer, Erica; De Silva, Mary J.; Shidaye, Rahul; Petersen, Inge; Nakku, Juliet; Jordans, Mark J. D.; Fekadu, Abebaw; Lund, Crick

2016-01-01

Background There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings. Aims To describe how theory of change (ToC) was used to plan the development and evaluation of MHCPs as part of the PRogramme for Improving Mental health carE (PRIME). Method ToC development occurred in three stages: (a) development of a cross-country ToC by 15 PRIME consortium members; (b) development of country-specific ToCs in 13 workshops with a median of 15 (interquartile range 13–22) stakeholders per workshop; and (c) review and refinement of the cross-country ToC by 18 PRIME consortium members. Results One cross-country and five district ToCs were developed that outlined the steps required to improve outcomes for people with mental disorders in PRIME districts. Conclusions ToC is a valuable participatory method that can be used to develop MHCPs and plan their evaluation. PMID:26447178

Recent advances in tuberculosis diagnostics in resource-limited settings.

PubMed

Seki, Mitsuko; Kim, Chang-Ki; Hayakawa, Satoshi; Mitarai, Satoshi

2018-04-19

Smear-negative and drug-resistant cases of tuberculosis (TB) disease necessitate the development of new diagnostic methods, especially in resource-limited settings. To improve the current TB situations, sensitive and specific TB point-of-care tests (POCTs) should be developed. This review addresses the current status of TB, novel diagnostic methodologies for TB, and the impact of those new diagnostics on TB control in such situations. Moreover, the perspective of TB management based on laboratory examinations is described. Smear microscopy with sputum samples is the only laboratory examination available in many resource-limited settings and is still used globally. Several nucleic acid amplification tests (NATs) have been developed. The World Health Organization (WHO) endorsed novel diagnostics based on NATs and updated their definition of a bacteriologically confirmed case requiring the biological specimen to be positive by smear microscopy, culture, or the WHO-recommended rapid diagnostic protocols. The use of new diagnostics increased the number of bacteriologically confirmed TB cases. Novel diagnostics are now available, but their sensitivity is still lower than that of conventional liquid culture method. To address the increasing incidence of TB, more resources including novel diagnostics as POCTs with higher sensitivity must be allocated to healthcare systems.

WE-FG-201-02: Automated Treatment Planning for Low-Resource Settings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Court, L.

Many low- and middle-income countries lack the resources and services to manage cancer, from screening and diagnosis to radiation therapy planning, treatment and quality assurance. The challenges in upgrading or introducing the needed services are enormous, and include severe shortages in equipment and trained staff. In this symposium, we will describe examples of technology and scientific research that have the potential to impact all these areas. These include: (1) the development of high-quality/low-cost colposcopes for cervical cancer screening, (2) the application of automated radiotherapy treatment planning to reduce staffing shortages, (3) the development of a novel radiotherapy treatment unit, andmore » (4) utilizing a cloud-based infrastructure to facilitate collaboration and QA. Learning Objectives: Understand some of the issues in cancer care in low- resource environments, including shortages in staff and equipment, and inadequate physical infrastructure for advanced radiotherapy. Understand the challenges in developing and deploying diagnostic and treatment devices and services for low-resource environments. Understand some of the emerging technological solutions for cancer management in LMICs. NCI; L. Court, NIH, Varian, Elekta; I. Feain, Ilana Feain is founder and CTO of Nano-X Pty Ltd.« less

Effect of video server topology on contingency capacity requirements

NASA Astrophysics Data System (ADS)

Kienzle, Martin G.; Dan, Asit; Sitaram, Dinkar; Tetzlaff, William H.

1996-03-01

Video servers need to assign a fixed set of resources to each video stream in order to guarantee on-time delivery of the video data. If a server has insufficient resources to guarantee the delivery, it must reject the stream request rather than slowing down all existing streams. Large scale video servers are being built as clusters of smaller components, so as to be economical, scalable, and highly available. This paper uses a blocking model developed for telephone systems to evaluate video server cluster topologies. The goal is to achieve high utilization of the components and low per-stream cost combined with low blocking probability and high user satisfaction. The analysis shows substantial economies of scale achieved by larger server images. Simple distributed server architectures can result in partitioning of resources with low achievable resource utilization. By comparing achievable resource utilization of partitioned and monolithic servers, we quantify the cost of partitioning. Next, we present an architecture for a distributed server system that avoids resource partitioning and results in highly efficient server clusters. Finally, we show how, in these server clusters, further optimizations can be achieved through caching and batching of video streams.

Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting.

PubMed

Ngwenya, Solwayo

2016-01-01

Primary postpartum hemorrhage (PPH) is defined as blood loss from the genital tract of 500 mL or more following a normal vaginal delivery (NVD) or 1,000 mL or more following a cesarean section within 24 hours of birth. PPH contributes significantly to maternal morbidity and mortality worldwide. Women can rapidly hemorrhage and die soon after giving birth. It can be a devastating outcome to many young families. Women giving birth in low-resource settings are at a higher risk of death than their counterparts in resource-rich environments. PPH is a leading cause of maternal deaths globally, contributing to a quarter of the deaths annually. This study aims 1) to document the incidence, risk factors, and causes of PPH in a low-resource setting and 2) to document the maternal outcomes of PPH in low-resource setting. This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the labor ward birth registers for patients who had a diagnosis of PPH during the period from January 1, 2016 to June 30, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered. Blood loss was estimated postdelivery by the attending clinician - either a midwife or a doctor. At this maternity unit, blood loss is not measured but estimated owing to prevailing resource constraints. The SPSS Version 21 statistical tool was used to calculate the mean and standard deviation (SD) values. Simple statistical tests were used on absolute numbers to calculate percentages. There were 4,567 deliveries at the institution during the period from January 1, 2016 to June 30, 2016. There were 74 cases of PPH during the study period. The incidence of primary PPH was 1.6%. The mean age was 27.7 years (SD ±6.9), mean gestational age was 38.6 weeks gestation (SD ±2.2), and mean birth weight was 3.16 kg (SD ±0.65) for the studied group of patients. Three-quarters (75.7%) of the cases had NVD. The majority of the cases (77.0%) had an identifiable risk factor for developing primary PPH. The most identifiable risk factor for primary PPH was pregnancy-induced hypertension followed by prolonged labor. Uterine atony was the most common cause of postpartum hemorrhage (82.4%). The women who delivered by NVD, who were diagnosed with a PPH, and who lost an estimated 500-1,000 mL of blood were 73.2%; 25% lost 1,000-1,500 mL of blood, and 1.8% lost more than 1,500 mL of blood. The women who delivered by lower-segment cesarean section, who were diagnosed with a PPH, and who lost an estimated 1,000-1,500 mL of blood were 77.8%, and 22.2% bled an estimated 1,500 mL of blood or more. The majority of the cases of primary PPH (94.6%) survived the condition and 5.4% died. The incidence of PPH at Mpilo Central Hospital was 1.6% during the study period, lower than that reported elsewhere in similar setting in the literature. This study, therefore, is important as it documents for the first time for this maternity unit and for a Zimbabwean setting, the incidence of one of the most important causes of global maternal deaths. Future studies should involve the effect on maternal outcomes of PPH following widespread introduction of misoprostol therapy into practice. This data can help in mobilizing global efforts to improve women's health.

A field-based characterization of conductivity in areas of minimal alteration: A case example in the Cascades of northwestern United States.

PubMed

Cormier, Susan M; Zheng, Lei; Hayslip, Gretchen; Flaherty, Colleen M

2018-08-15

The concentration of salts in streams is increasing world-wide making freshwater a declining resource. Developing thresholds for freshwater with low specific conductivity (SC), a measure of dissolved ions in water, may protect high quality resources that are refugia for aquatic life and that dilute downstream waters. In this case example, methods are illustrated for estimating protective levels for streams with low SC. The Cascades in the Pacific Northwest of the United States of America was selected for the case study because a geophysical model indicated that the SC of freshwater streams was likely to be very low. Also, there was an insufficient range in the SC data to accurately derive a criterion using the 2011, US Environmental Protection Agency field-based extirpation concentration distribution method. Instead, background and a regression model was used to estimate chronic and acute SC levels that could extirpate 5% of benthic invertebrate genera. Background SC was estimated at the 25th centile (33μS/cm) of the measured data and used as the independent variable in a least squares empirical background-to-criteria (B-C) model. Because no comparison could be made with effect levels estimated from a paired SC and biological data set from the Cascades, the lower 50% prediction limit (PL) was identified as an example chronic water quality criterion (97μS/cm). The maximum exposure threshold was estimated at the 90th centile SC of streams meeting the chronic SC level. The example acute SC level was 190μS/cm. Because paired aquatic life and SC data are often sparse, the B-C method is useful for developing SC criteria for other systems with limited data. Published by Elsevier B.V.

Effect of Pre-operative Anaemia on Post-operative Complications in Low-Resource Settings.

PubMed

White, Michelle C; Longstaff, Lydia; Lai, Peggy S

2017-03-01

In high-resource settings, even mild anaemia is associated with an increased risk of post-operative complications. Whether this is true in low-resource settings is unclear. We aimed to evaluate the effect of anaemia on surgical outcomes in the Republic of Congo and Madagascar. It is a retrospective chart review of 2064 non-pregnant patients undergoing elective surgery with Mercy Ships. Logistic regression was used to determine the association between pre-operative anaemia and pre-defined surgical complications, adjusted for age, gender, surgical specialty, and country. The average age of patients was 27.2 years; 56.7% were male. Sixty-two percent of patients were not anaemic, and 22.7, 13.9 and 1.4% met sex-related criteria for mild, moderate and severe anaemia, respectively. In adjusted analyses, the severe anaemia group had an 8.58 [3.65, 19.49] higher odds of experiencing any surgical complication (p < 0.001) compared to non-anaemic patients. Analysis of each complication showed a 33.13 [9.57, 110.39] higher odds of unexpected ICU admission (p < 0.001); a 7.29 [1.98, 21.45] higher odds of surgical site infection (p < 0.001); and 7.48 [1.79, 25.78] higher odds of requiring hospital readmission (p < 0.001). Evaluating other anaemia categories, only those with moderate anaemia had a higher risk of requiring ICU admission (odds ratio 2.75 [1.00, 7.04], p = 0.04) compared to those without anaemia. Our results indicate that in low-income settings, severe anaemia is associated with an increased risk of post-operative complications including unexpected ICU admission, surgical site infection and hospital readmission, whereas mild anaemia was not associated with increased post-operative complications.

Plant disease severity assessment - How rater bias, assessment method and experimental design affect hypothesis testing and resource use efficiency

USDA-ARS?s Scientific Manuscript database

The impact of rater bias and assessment method on hypothesis testing was studied for different experimental designs for plant disease assessment using balanced and unbalanced data sets. Data sets with the same number of replicate estimates for each of two treatments are termed ‘balanced’, and those ...

Management of multiple myeloma in resource-constrained settings.

PubMed

Kumar, Lalit; Kumar Sahoo, Ranjit

2016-12-01

The prognosis of patients with multiple myeloma (MM) has improved significantly in the past two decades. This is attributed to use of novel agents for induction, high-dose chemotherapy and autologous stem cell transplantation (ASCT), maintenance therapy, and improved supportive care. Currently, evidence-based management guidelines/recommendations developed by International societies/groups are being followed partially in low-resource settings. Lack of quality diagnostics (eg, cytogenetics/fluorescence in situ hybridization (FISH), serum free light chains), novel therapeutics, and trained manpower, and limited financial resources are key challanges. An optimal utilization of available resources with continued educational activities of treating physicians focused on improving knowledge in the management of such patients may be a way forward to improve the outcome of myeloma patients in these countries. Our current approach to the management of this disease is presented here through a discussion of clinical vignettes. Copyright © 2016 Elsevier Inc. All rights reserved.

Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.

PubMed

Gomez-de-León, Andrés; Gómez-Almaguer, David; Ruiz-Delgado, Guillermo J; Ruiz-Arguelles, Guillermo J

2017-09-01

The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.

Tactical resource allocation and elective patient admission planning in care processes.

PubMed

Hulshof, Peter J H; Boucherie, Richard J; Hans, Erwin W; Hurink, Johann L

2013-06-01

Tactical planning of resources in hospitals concerns elective patient admission planning and the intermediate term allocation of resource capacities. Its main objectives are to achieve equitable access for patients, to meet production targets/to serve the strategically agreed number of patients, and to use resources efficiently. This paper proposes a method to develop a tactical resource allocation and elective patient admission plan. These tactical plans allocate available resources to various care processes and determine the selection of patients to be served that are at a particular stage of their care process. Our method is developed in a Mixed Integer Linear Programming (MILP) framework and copes with multiple resources, multiple time periods and multiple patient groups with various uncertain treatment paths through the hospital, thereby integrating decision making for a chain of hospital resources. Computational results indicate that our method leads to a more equitable distribution of resources and provides control of patient access times, the number of patients served and the fraction of allocated resource capacity. Our approach is generic, as the base MILP and the solution approach allow for including various extensions to both the objective criteria and the constraints. Consequently, the proposed method is applicable in various settings of tactical hospital management.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; King, Richard; Ramsey, Wayne; Kelly, Cate; Thiagarajan, Malar

2017-05-05

This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service. Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback. There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in priority setting and system redesign. This framework identifies potential opportunities to initiate disinvestment activities in a systematic integrated approach that can be applied across a whole organisation using transparent, evidence-based methods. Incorporating considerations for disinvestment into existing decision-making systems and processes might be achieved quickly with minimal cost; however establishment of new systems requires research into appropriate methods and provision of appropriate skills and resources to deliver them.

A fully integrated distance readout ELISA-Chip for point-of-care testing with sample-in-answer-out capability.

PubMed

Liu, Dan; Li, Xingrui; Zhou, Junkai; Liu, Shibo; Tian, Tian; Song, Yanling; Zhu, Zhi; Zhou, Leiji; Ji, Tianhai; Yang, Chaoyong

2017-10-15

Enzyme-linked immunosorbent assay (ELISA) is a popular laboratory technique for detection of disease-specific protein biomarkers with high specificity and sensitivity. However, ELISA requires labor-intensive and time-consuming procedures with skilled operators and spectroscopic instrumentation. Simplification of the procedures and miniaturization of the devices are crucial for ELISA-based point-of-care (POC) testing in resource-limited settings. Here, we present a fully integrated, instrument-free, low-cost and portable POC platform which integrates the process of ELISA and the distance readout into a single microfluidic chip. Based on manipulation using a permanent magnet, the process is initiated by moving magnetic beads with capture antibody through different aqueous phases containing ELISA reagents to form bead/antibody/antigen/antibody sandwich structure, and finally converts the molecular recognition signal into a highly sensitive distance readout for visual quantitative bioanalysis. Without additional equipment and complicated operations, our integrated ELISA-Chip with distance readout allows ultrasensitive quantitation of disease biomarkers within 2h. The ELISA-Chip method also showed high specificity, good precision and great accuracy. Furthermore, the ELISA-Chip system is highly applicable as a sandwich-based platform for the detection of a variety of protein biomarkers. With the advantages of visual analysis, easy operation, high sensitivity, and low cost, the integrated sample-in-answer-out ELISA-Chip with distance readout shows great potential for quantitative POCT in resource-limited settings. Copyright © 2017. Published by Elsevier B.V.

Video Monitoring a Simulation-Based Quality Improvement Program in Bihar, India.

PubMed

Dyer, Jessica; Spindler, Hilary; Christmas, Amelia; Shah, Malay Bharat; Morgan, Melissa; Cohen, Susanna R; Sterne, Jason; Mahapatra, Tanmay; Walker, Dilys

2018-04-01

Simulation-based training has become an accepted clinical training andragogy in high-resource settings with its use increasing in low-resource settings. Video recordings of simulated scenarios are commonly used by facilitators. Beyond using the videos during debrief sessions, researchers can also analyze the simulation videos to quantify technical and nontechnical skills during simulated scenarios over time. Little is known about the feasibility and use of large-scale systems to video record and analyze simulation and debriefing data for monitoring and evaluation in low-resource settings. This manuscript describes the process of designing and implementing a large-scale video monitoring system. Mentees and Mentors were consented and all simulations and debriefs conducted at 320 Primary Health Centers (PHCs) were video recorded. The system design, number of video recordings, and inter-rater reliability of the coded videos were assessed. The final dataset included a total of 11,278 videos. Overall, a total of 2,124 simulation videos were coded and 183 (12%) were blindly double-coded. For the double-coded sample, the average inter-rater reliability (IRR) scores were 80% for nontechnical skills, and 94% for clinical technical skills. Among 4,450 long debrief videos received, 216 were selected for coding and all were double-coded. Data quality of simulation videos was found to be very good in terms of recorded instances of "unable to see" and "unable to hear" in Phases 1 and 2. This study demonstrates that video monitoring systems can be effectively implemented at scale in resource limited settings. Further, video monitoring systems can play several vital roles within program implementation, including monitoring and evaluation, provision of actionable feedback to program implementers, and assurance of program fidelity.

A simple method for low-contrast detectability, image quality and dose optimisation with CT iterative reconstruction algorithms and model observers.

PubMed

Bellesi, Luca; Wyttenbach, Rolf; Gaudino, Diego; Colleoni, Paolo; Pupillo, Francesco; Carrara, Mauro; Braghetti, Antonio; Puligheddu, Carla; Presilla, Stefano

2017-01-01

The aim of this work was to evaluate detection of low-contrast objects and image quality in computed tomography (CT) phantom images acquired at different tube loadings (i.e. mAs) and reconstructed with different algorithms, in order to find appropriate settings to reduce the dose to the patient without any image detriment. Images of supraslice low-contrast objects of a CT phantom were acquired using different mAs values. Images were reconstructed using filtered back projection (FBP), hybrid and iterative model-based methods. Image quality parameters were evaluated in terms of modulation transfer function; noise, and uniformity using two software resources. For the definition of low-contrast detectability, studies based on both human (i.e. four-alternative forced-choice test) and model observers were performed across the various images. Compared to FBP, image quality parameters were improved by using iterative reconstruction (IR) algorithms. In particular, IR model-based methods provided a 60% noise reduction and a 70% dose reduction, preserving image quality and low-contrast detectability for human radiological evaluation. According to the model observer, the diameters of the minimum detectable detail were around 2 mm (up to 100 mAs). Below 100 mAs, the model observer was unable to provide a result. IR methods improve CT protocol quality, providing a potential dose reduction while maintaining a good image detectability. Model observer can in principle be useful to assist human performance in CT low-contrast detection tasks and in dose optimisation.

Asthma prevalence and severity in low-resource communities.

PubMed

Cruz, Álvaro A; Stelmach, Rafael; Ponte, Eduardo V

2017-06-01

The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings.

Using diffusion k-means for simple stellar population modeling of low S/N quasar host galaxy spectra

NASA Astrophysics Data System (ADS)

Mosby, Gregory; Tremonti, Christina A.; Hooper, Eric; Wolf, Marsha J.; Sheinis, Andrew; Richards, Joseph

2016-01-01

Quasar host galaxies (QHGs) represent a unique stage in galaxy evolution that can provide a glimpse into the relationship between an active supermassive black hole (SMBH) and its host galaxy. However, observing the hosts of high luminosity, unobscured quasars in the optical is complicated by the large ratio of quasar to host galaxy light. One strategy in optical spectroscopy is to use offset longslit observations of the host galaxy. This method allows the centers of QHGs to be analyzed apart from other regions of their host galaxies. But light from the accreting black hole's point spread function still enters the host galaxy observations, and where the contrast between the host and intervening quasar light is favorable, the host galaxy is faint, producing low signal-to-noise (S/N) data. This stymies traditional stellar population methods that might rely on high S/N features in galaxy spectra to recover key galaxy properties like its star formation history (SFH). In response to this challenge, we have developed a method of stellar population modeling using diffusion k-means (DFK) that can recover SFHs from rest frame optical data with S/N ~ 5 Å^-1. Specifically, we use DFK to cultivate a reduced stellar population basis set. This DFK basis set of four broad age bins is able to recover a range of SFHs. With an analytic description of the seeing, we can use this DFK basis set to simultaneously model the SFHs and the intervening quasar light of QHGs as well. We compare the results of this method with previous techniques using synthetic data and find that our new method has a clear advantage in recovering SFHs from QHGs. On average, the DFK basis set is just as accurate and decisively more precise. This new technique could be used to analyze other low S/N galaxy spectra like those from higher redshift or integral field spectroscopy surveys.This material is based upon work supported by the National Science Foundation under grant no. DGE -0718123 and the Advanced Opportunity fellowship program at the University of Wisconsin-Madison. This research was performed using the computer resources and assistance of the UW-Madison Center For High Throughput Computing (CHTC) in the Department of Computer Sciences.

Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

PubMed Central

Wall, Stephen N.; Lee, Anne CC; Niermeyer, Susan; English, Mike; Keenan, William J.; Carlo, Wally; Bhutta, Zulfiqar A.; Bang, Abhay; Narayanan, Indira; Ariawan, Iwan; Lawn, Joy E.

2009-01-01

Background Each year approximately 10 million babies do not breathe immediately at birth, of which about 6 million require basic neonatal resuscitation. The major burden is in low-income settings, where health system capacity to provide neonatal resuscitation is inadequate. Objective To systematically review the evidence for neonatal resuscitation content, training and competency, equipment and supplies, cost, and key program considerations, specifically for resource-constrained settings. Results Evidence from several observational studies shows that facility-based basic neonatal resuscitation may avert 30% of intrapartum-related neonatal deaths. Very few babies require advanced resuscitation (endotracheal intubation and drugs) and these newborns may not survive without ongoing ventilation; hence, advanced neonatal resuscitation is not a priority in settings without neonatal intensive care. Of the 60 million nonfacility births, most do not have access to resuscitation. Several trials have shown that a range of community health workers can perform neonatal resuscitation with an estimated effect of a 20% reduction in intrapartum-related neonatal deaths, based on expert opinion. Case studies illustrate key considerations for scale up. Conclusion Basic resuscitation would substantially reduce intrapartum-related neonatal deaths. Where births occur in facilities, it is a priority to ensure that all birth attendants are competent in resuscitation. Strategies to address the gap for home births are urgently required. More data are required to determine the impact of neonatal resuscitation, particularly on long-term outcomes in low-income settings. PMID:19815203

Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point.

PubMed

Mendis, Shanthi; Abegunde, Dele; Oladapo, Olulola; Celletti, Francesca; Nordet, Porfirio

2004-01-01

Assess capacity of health-care facilities in a low-resource setting to implement the absolute risk approach for assessment of cardiovascular risk in hypertensive patients and effective management of hypertension. A descriptive cross-sectional study in Egbeda and Oluyole local government areas of Oyo State in Nigeria in 56 randomly selected primary- (n = 42) and secondary-level (n = 2) health-care and private health-care (n = 12) facilities. One thousand consecutive, known hypertensives attending the selected facilities for follow-up, and health-care providers working in the above randomly selected facilities, were interviewed. About two-thirds of hypertensives utilized primary-care centers both for diagnosis and for follow-up. Laboratory and other investigations to exclude secondary hypertension or to assess target organ damage were not available in the majority of facilities, particularly in primary care. A considerable knowledge and awareness gap related to hypertension and its complications was found, both among patients and health-care providers. Blood pressure control rates were poor (28% with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg] and drug prescription patterns were not evidence based and cost effective. The majority of patients (73%) in this low socio-economic group (mean monthly income 73 US dollars) had to pay fully, out of their own pocket, for consultations and medications. If the absolute risk approach for assessment of risk and effective management of hypertension is to be implemented in low-resource settings, appropriate policy measures need to be taken to improve the competency of health-care providers, to provide basic laboratory facilities and to develop affordable financing mechanisms.

Computer-Supported Feedback Message Tailoring for Healthcare Providers in Malawi: Proof-of-Concept.

PubMed

Landis-Lewis, Zach; Douglas, Gerald P; Hochheiser, Harry; Kam, Matthew; Gadabu, Oliver; Bwanali, Mwatha; Jacobson, Rebecca S

2015-01-01

Although performance feedback has the potential to help clinicians improve the quality and safety of care, healthcare organizations generally lack knowledge about how this guidance is best provided. In low-resource settings, tools for theory-informed feedback tailoring may enhance limited clinical supervision resources. Our objectives were to establish proof-of-concept for computer-supported feedback message tailoring in Malawi, Africa. We conducted this research in five stages: clinical performance measurement, modeling the influence of feedback on antiretroviral therapy (ART) performance, creating a rule-based message tailoring process, generating tailored messages for recipients, and finally analysis of performance and message tailoring data. We retrospectively generated tailored messages for 7,448 monthly performance reports from 11 ART clinics. We found that tailored feedback could be routinely generated for four guideline-based performance indicators, with 35% of reports having messages prioritized to optimize the effect of feedback. This research establishes proof-of-concept for a novel approach to improving the use of clinical performance feedback in low-resource settings and suggests possible directions for prospective evaluations comparing alternative designs of feedback messages.

Leadership Development of Rehabilitation Professionals in a Low-Resource Country: A Transformational Leadership, Project-Based Model.

PubMed

Pascal, Maureen Romanow; Mann, Monika; Dunleavy, Kim; Chevan, Julia; Kirenga, Liliane; Nuhu, Assuman

2017-01-01

This paper presents an overview of the activities and outcomes of the Leadership Institute (LI), a short-term leadership development professional development course offered to physiotherapists in a low-resource country. Previous studies have provided examples of the benefits of such programs in medicine and nursing, but this has yet to be documented in the rehabilitation literature. The prototype of leadership development presented may provide guidance for similar trainings in other low-resource countries and offer the rehabilitation community an opportunity to build on the model to construct a research agenda around rehabilitation leadership development. The course used a constructivist approach to integrate participants' experiences, background, beliefs, and prior knowledge into the content. Transformational leadership development theory was emphasized with the generation of active learning projects, a key component of the training. Positive changes after the course included an increase in the number of community outreach activities completed by participants and increased involvement with their professional organization. Thirteen leadership projects were proposed and presented. The LI provided present and future leaders throughout Rwanda with exposure to transformative leadership concepts and offered them the opportunity to work together on projects that enhanced their profession and met the needs of underserved communities. Challenges included limited funding for physiotherapy positions allocated to hospitals in Rwanda, particularly in the rural areas. Participants experienced difficulties in carrying out leadership projects without additional funding to support them. While the emphasis on group projects to foster local advocacy and community education is highly recommended, the projects would benefit from a strong long-term mentorship program and further budgeting considerations. The LI can serve as a model to develop leadership skills and spur professional growth in low-resource settings. Leadership development is necessary to address worldwide inequities in health care. The LI model presents a method to cultivate transformational leadership and work toward improvements in health care and delivery of service.

Implementation of genomics research in Africa: challenges and recommendations

PubMed Central

Adebamowo, Sally N.; Francis, Veronica; Tambo, Ernest; Diallo, Seybou H.; Landouré, Guida; Nembaware, Victoria; Dareng, Eileen; Muhamed, Babu; Odutola, Michael; Akeredolu, Teniola; Nerima, Barbara; Ozumba, Petronilla J.; Mbhele, Slee; Ghanash, Anita; Wachinou, Ablo P.; Ngomi, Nicholas

2018-01-01

ABSTRACT Background: There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. Objective: The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. Methods: The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. Results: Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. Conclusions: The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings. PMID:29336236

Resources of learning through hidden curriculum: Iranian nursing students’ perspective

PubMed Central

Karimi, Zohreh; Ashktorab, Tahereh; Mohammadi, Eesa; Abedi, Heidarali; Zarea, Kourosh

2015-01-01

Background: Students tend to internalize and perpetuate the patterns of behavior and the values surrounding them. Review of literature showed that there are several student learning sources through the hidden curriculum, but they have not been identified in nursing yet. Hence, the purpose of this study is explanation of learning resources in the hidden curriculum in the view of baccalaureate nursing students. Materials and Methods: This qualitative study was carried out in 2012 with the participation of 32 baccalaureate nursing students in Nursing and Midwifery College of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran by purposeful sampling strategies. Data were collected by semi-structured interviews and continued to the level of data saturation and themes’ emergence. Data analysis was performed through inductive content analysis method. Result: “Instructor as the unique learning element,” “various learning resources in the clinical setting,” and “instructive nature of the education environment” were extracted as the main themes, each of which incorporated some categories. Conclusion: Baccalaureate undergraduate nursing students learnt the hidden curriculum by the resources such as instructors, resources existing in the clinical setting, and the university campus. Therefore, more research is recommended for the identification of other resources. In order to promote positive messages and reduce the negative messages of the hidden curricula running at academic and clinical settings, nursing educators and nurses need to learn more about this issue in the nursing profession. PMID:26430684

The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

PubMed Central

2011-01-01

Background Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research. Methods Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French), date (January 1st, 1994 to January 17th, 2011) and article type (original research). Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form. Results We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health. Conclusions and Recommendations Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses can help to ensure that pMTCT interventions for LMICs reach their full potential by focussing on unanswered questions in four areas: local assessment of rapidly evolving HIV MTCT options; strategies to improve coverage and reach underserved populations; evaluation of a more comprehensive set of MTCT approaches including primary HIV prevention and reproductive counselling; integration of HIV MTCT and other sexual and reproductive health services. PMID:21306625

Development and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi

PubMed Central

Hundalani, Shilpa G; Richards-Kortum, Rebecca; Oden, Maria; Kawaza, Kondwani; Gest, Alfred; Molyneux, Elizabeth

2015-01-01

Background Low-cost bubble continuous positive airway pressure (bCPAP) systems have been shown to improve survival in neonates with respiratory distress, in developing countries including Malawi. District hospitals in Malawi implementing CPAP requested simple and reliable guidelines to enable healthcare workers with basic skills and minimal training to determine when treatment with CPAP is necessary. We developed and validated TRY (T: Tone is good, R: Respiratory Distress and Y=Yes) CPAP, a simple algorithm to identify neonates with respiratory distress who would benefit from CPAP. Objective To validate the TRY CPAP algorithm for neonates with respiratory distress in a low-resource setting. Methods We constructed an algorithm using a combination of vital signs, tone and birth weight to determine the need for CPAP in neonates with respiratory distress. Neonates admitted to the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi, were assessed in a prospective, cross-sectional study. Nurses and paediatricians-in-training assessed neonates to determine whether they required CPAP using the TRY CPAP algorithm. To establish the accuracy of the TRY CPAP algorithm in evaluating the need for CPAP, their assessment was compared with the decision of a neonatologist blinded to the TRY CPAP algorithm findings. Results 325 neonates were evaluated over a 2-month period; 13% were deemed to require CPAP by the neonatologist. The inter-rater reliability with the algorithm was 0.90 for nurses and 0.97 for paediatricians-in-training using the neonatologist's assessment as the reference standard. Conclusions The TRY CPAP algorithm has the potential to be a simple and reliable tool to assist nurses and clinicians in identifying neonates who require treatment with CPAP in low-resource settings. PMID:25877290

Low-Cost 3D Printers Enable High-Quality and Automated Sample Preparation and Molecular Detection

PubMed Central

Chan, Kamfai; Coen, Mauricio; Hardick, Justin; Gaydos, Charlotte A.; Wong, Kah-Yat; Smith, Clayton; Wilson, Scott A.; Vayugundla, Siva Praneeth; Wong, Season

2016-01-01

Most molecular diagnostic assays require upfront sample preparation steps to isolate the target’s nucleic acids, followed by its amplification and detection using various nucleic acid amplification techniques. Because molecular diagnostic methods are generally rather difficult to perform manually without highly trained users, automated and integrated systems are highly desirable but too costly for use at point-of-care or low-resource settings. Here, we showcase the development of a low-cost and rapid nucleic acid isolation and amplification platform by modifying entry-level 3D printers that cost between $400 and $750. Our modifications consisted of replacing the extruder with a tip-comb attachment that houses magnets to conduct magnetic particle-based nucleic acid extraction. We then programmed the 3D printer to conduct motions that can perform high-quality extraction protocols. Up to 12 samples can be processed simultaneously in under 13 minutes and the efficiency of nucleic acid isolation matches well against gold-standard spin-column-based extraction technology. Additionally, we used the 3D printer’s heated bed to supply heat to perform water bath-based polymerase chain reactions (PCRs). Using another attachment to hold PCR tubes, the 3D printer was programmed to automate the process of shuttling PCR tubes between water baths. By eliminating the temperature ramping needed in most commercial thermal cyclers, the run time of a 35-cycle PCR protocol was shortened by 33%. This article demonstrates that for applications in resource-limited settings, expensive nucleic acid extraction devices and thermal cyclers that are used in many central laboratories can be potentially replaced by a device modified from inexpensive entry-level 3D printers. PMID:27362424

Training hospital providers in basic CPR skills in Botswana: Acquisition, retention and impact of novel training techniques☆

PubMed Central

Meaney, Peter A.; Sutton, Robert M.; Tsima, Billy; Steenhoff, Andrew P.; Shilkofski, Nicole; Boulet, John R.; Davis, Amanda; Kestler, Andrew M.; Church, Kasey K.; Niles, Dana E.; Irving, Sharon Y.; Mazhani, Loeto; Nadkarni, Vinay M.

2013-01-01

Objective Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. Results Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p < 0.01; adult 28% vs. 48%, p < 0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p < 0.01) and 6 months (38% vs. 67%, p < 0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p = 0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. Conclusions HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction. PMID:22561463

Should oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence.

PubMed

Hundley, V A; Avan, B I; Sullivan, C J; Graham, W J

2013-02-01

Using misoprostol to prevent postpartum haemorrhage (PPH) in home-birth settings remains controversial. To review the safety and effectiveness of oral misoprostol in preventing PPH in home-birth settings. The Cochrane Library, PubMed, and POPLINE were searched for articles published until 31 March 2012. Studies, conducted in low-resource countries, comparing oral misoprostol with a placebo or no treatment in a home-birth setting. Studies of misoprostol administered by other routes were excluded. Data were extracted by two reviewers and independently checked for accuracy by a third. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were sythesised and meta-analysis was performed where appropriate. Ten papers describing two randomised and four non randomised trials. Administration of misoprostol was associated with a significant reduction in the incidence of PPH (RR 0.58, 95% CI 0.38-0.87), additional uterotonics (RR 0.34, 95% CI 0.16-0.73), and referral for PPH (RR 0.49, 95% CI 0.37-0.66). None of the studies was large enough to detect a difference in maternal mortality, and none reported neonatal mortality. Shivering and pyrexia were the most common side effects. The finding that the distribution of oral misoprostol through frontline health workers is effective in reducing the incidence of PPH could be a significant step forwards in reducing maternal deaths in low-resource countries. However, given the limited number of high-quality studies in this review, further randomised controlled trials are required to confirm the association, particularly in different implementation settings. Adverse effects have not been systematically captured, and there has been limited consideration of the potential for inappropriate or inadvertent use of misoprostol. Further evidence is needed to inform the development of implementation and safety guidelines on the routine availability of misoprostol. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Assessment of four calculation methods proposed by the EC for waste hazardous property HP 14 'Ecotoxic'.

PubMed

Hennebert, Pierre; Humez, Nicolas; Conche, Isabelle; Bishop, Ian; Rebischung, Flore

2016-02-01

Legislation published in December 2014 revised both the List of Waste (LoW) and amended Appendix III of the revised Waste Framework Directive 2008/98/EC; the latter redefined hazardous properties HP 1 to HP 13 and HP 15 but left the assessment of HP 14 unchanged to allow time for the Directorate General of the Environment of the European Commission to complete a study that is examining the impacts of four different calculation methods for the assessment of HP 14. This paper is a contribution to the assessment of the four calculation methods. It also includes the results of a fifth calculation method; referred to as "Method 2 with extended M-factors". Two sets of data were utilised in the assessment; the first (Data Set #1) comprised analytical data for 32 different waste streams (16 hazardous (H), 9 non-hazardous (NH) and 7 mirror entries, as classified by the LoW) while the second data set (Data Set #2), supplied by the eco industries, comprised analytical data for 88 waste streams, all classified as hazardous (H) by the LoW. Two approaches were used to assess the five calculation methods. The first approach assessed the relative ranking of the five calculation methods by the frequency of their classification of waste streams as H. The relative ranking of the five methods (from most severe to less severe) is: Method 3>Method 1>Method 2 with extended M-factors>Method 2>Method 4. This reflects the arithmetic ranking of the concentration limits of each method when assuming M=10, and is independent of the waste streams, or the H/NH/Mirror status of the waste streams. A second approach is the absolute matching or concordance with the LoW. The LoW is taken as a reference method and the H wastes are all supposed to be HP 14. This point is discussed in the paper. The concordance for one calculation method is established by the number of wastes with identical classification by the considered calculation method and the LoW (i.e. H to H, NH to NH). The discordance is established as well, that is when the waste is classified "H" in the LoW and "NH" by calculation (i.e. an under-estimation of the hazard). For Data Set #1, Method 2 with extended M-factors matches best with the LoW (80% concordant H and non-H by LoW, and 13% discordant for H waste by LoW). This method more correctly classifies wastes containing substances with high ecotoxicity. Methods 1 and 3 have nearly as good matches (76% and 72% concordant H and non-H by LoW, and 13% and 6% respectively discordant for H waste by LoW). Method 2 with extended M-factors, but limited to the M-factors published in the CLP has insufficient concordance (64% concordant H and non-H by LoW, and 50% discordant for H waste by LoW). As the same method with extended M-factors gives the best performance, the lower performance is due to the limited set of M-factors in the CLP. Method 4 is divergent (60% concordant H and non-H by LoW, and 56% discordant for H waste by LoW). For Data Set #2, Methods 2 and 4 do not correctly classify 24 air pollution control residues from incineration 19 01 07(∗) (3/24 and 2/24 respectively), and should not be used, while Methods 3, 1 and 2 with extended M-factors successfully classify 100% of them as hazardous. From the two sets of data, Method 2 with extended M-factors (corresponding more closely to the CLP methods used for products) matches best with the LoW when the LoW code is safely known, and Method 3 and 1 will deviate from the LoW if the samples contain substances with high ecotoxicity (in particular PAHs). Methods 2 and 4 are not recommended. Formally, this conclusion depends on the waste streams that are used for the comparison of methods and the relevancy of the classification as hazardous for ecotoxicity in the LoW. Since the set is large (120 waste streams) and no selection has been made here in the available data, the conclusion should be robust. Copyright © 2015 Elsevier Ltd. All rights reserved.

Empowering Teachers with Low-Intensity Strategies to Support Instruction: Self-Monitoring in an Elementary Resource Classroom

ERIC Educational Resources Information Center

Ennis, Robin Parks; Lane, Kathleen Lynne; Oakes, Wendy Peia

2018-01-01

Self-monitoring is a low-intensity strategy teachers can use to support instruction in classrooms across the grade span in various instructional settings and content areas. This study extended the knowledge base by examining the effectiveness of self-monitoring through a systematic replication with three students with specific learning…

Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia.

PubMed

Devi, B C R; Tang, T S; Corbex, M

2008-12-01

The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy

PubMed Central

Brittain, Kirsty; Mellins, Claude A.; Zerbe, Allison; Remien, Robert H.; Abrams, Elaine J.; Myer, Landon; Wilson, Ira B.

2016-01-01

Maternal adherence to antiretroviral therapy (ART) is a concern and monitoring adherence presents a significant challenge in low-resource settings. We investigated the association between self-reported adherence, measured using a simple three-item scale, and elevated viral load (VL) among HIV-infected pregnant and postpartum women on ART in Cape Town, South Africa. This is the first reported use of this scale in a non-English speaking setting and it achieved good psychometric characteristics (Cronbach α = 0.79). Among 452 women included in the analysis, only 12 % reported perfect adherence on the self-report scale, while 92 % had a VL <1000 copies/mL. Having a raised VL was consistently associated with lower median adherence scores and the area under the curve for the scale was 0.599, 0.656 and 0.642 using a VL cut-off of ≥50, ≥1000 and ≥10000 copies/mL, respectively. This simple self-report adherence scale shows potential as a first-stage adherence screener in this setting. Maternal adherence monitoring in low resource settings requires attention in the era of universal ART, and the value of this simple adherence scale in routine ART care settings warrants further investigation. PMID:27278548

Strengthening expertise for health technology assessment and priority-setting in Africa

PubMed Central

Doherty, Jane E; Wilkinson, Thomas; Edoka, Ijeoma; Hofman, Karen

2017-01-01

ABSTRACT Background: Achieving sustainable universal health coverage depends partly on fair priority-setting processes that ensure countries spend scarce resources wisely. While general health economics capacity-strengthening initiatives exist in Africa, less attention has been paid to developing the capacity of individuals, institutions and networks to apply economic evaluation in support of health technology assessment and effective priority-setting. Objective: On the basis of international  lessons, to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. Methods: A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Results: Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Conclusions: Research organisations have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. These would help to meet the priority-setting needs of African countries and contribute to sustainable universal health coverage. PMID:29035166

Intersection of Social Institutions with Civic Development

ERIC Educational Resources Information Center

Youniss, James; Hart, Daniel

2005-01-01

We propose that institutions can serve as a resource to promote civic identity in youth from low-wealth and other settings. We show how recent studies support this proposition and can constructively reorient developmental research and theory.

Introduction of automated blood pressure devices intended for a low resource setting in rural Tanzania.

PubMed

Baker, Elinor Chloe; Hezelgrave, Natasha; Magesa, Stephen M; Edmonds, Sally; de Greeff, Annemarie; Shennan, Andrew

2012-04-01

Regular blood pressure (BP) monitoring is a cost-effective means of early identification and management of hypertensive disease in pregnancy. In much of rural sub-Saharan Africa, the ability to take and act on accurate BP measurements is lacking as a result of poorly functioning or absent equipment and/or inadequate staff education. This study describes the feasibility of using validated automated BP devices suitable for low-resource settings (LRS) in primary health-care facilities in rural Tanzania. Following a primary survey, 19 BP devices were distributed to 11 clinics and re-assessed at one, three, six, 12 and 36 months. Devices were used frequently with high levels of user satisfaction and good durability. We conclude that the use of automated BP devices in LRS is feasible and sustainable. An assessment of their ability to reduce maternal and perinatal morbidity and mortality is vital.

Containment of Ebola and Polio in Low-Resource Settings Using Principles and Practices of Emergency Operations Centers in Public Health.

PubMed

Shuaib, Faisal M; Musa, Philip F; Muhammad, Ado; Musa, Emmanuel; Nyanti, Sara; Mkanda, Pascal; Mahoney, Frank; Corkum, Melissa; Durojaiye, Modupeoluwa; Nganda, Gatei Wa; Sani, Samuel Usman; Dieng, Boubacar; Banda, Richard; Ali Pate, Muhammad

Emergency Operations Centers (EOCs) have been credited with driving the recent successes achieved in the Nigeria polio eradication program. EOC concept was also applied to the Ebola virus disease outbreak and is applicable to a range of other public health emergencies. This article outlines the structure and functionality of a typical EOC in addressing public health emergencies in low-resource settings. It ascribes the successful polio and Ebola responses in Nigeria to several factors including political commitment, population willingness to engage, accountability, and operational and strategic changes made by the effective use of an EOC and Incident Management System. In countries such as Nigeria where the central or federal government does not directly hold states accountable, the EOC provides a means to improve performance and use data to hold health workers accountable by using innovative technologies such as geographic position systems, dashboards, and scorecards.

Performance of the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis and rifampin resistance in a low-incidence, high-resource setting.

PubMed

Rice, Jason P; Seifert, Marva; Moser, Kathleen S; Rodwell, Timothy C

2017-01-01

Performance of the Xpert MTB/RIF assay, designed to simultaneously detect Mycobacterium tuberculosis complex (MTBC) and rifampin (RIF) resistance, has been well documented in low-resource settings with high TB-incidence. However, few studies have assessed its accuracy in low TB incidence settings. We evaluated the performance of Xpert MTB/RIF using clinical sputum specimens routinely collected from suspect pulmonary TB patients over a 4-year time period in San Diego County, California. Xpert MTB/RIF results were compared to acid-fast bacilli (AFB) smear microscopy, mycobacterial culture, and phenotypic drug susceptibility testing (DST). Of 751 sputum specimens, 134 (17.8%) were MTBC culture-positive and 2 (1.5%) were multidrug-resistant (MDR). For the detection of MTBC, Xpert MTB/RIF sensitivity was 89.6% (97.7% and 74.5% in smear-positive and -negative sputa, respectively) and specificity was 97.2%; while AFB smear sensitivity and specificity were 64.9% and 77.8%, respectively. Xpert MTB/RIF detected 35 of 47 smear-negative culture-positive specimens, and excluded 124 of 137 smear-positive culture-negative specimens. Xpert MTB/RIF also correctly excluded 99.2% (121/122) of nontuberculous mycobacteria (NTM) specimens, including all 33 NTM false-positives by smear microscopy. For the detection of RIF resistance, Xpert MTB/RIF sensitivity and specificity were 100% and 98.3%, respectively. Our findings demonstrate that Xpert MTB/RIF is able to accurately detect MTBC and RIF resistance in routinely collected respiratory specimens in a low TB-incidence setting, with comparable performance to that achieved in high-incidence settings; and suggest that under these conditions the assay has particular utility in detecting smear-negative TB cases, excluding smear-positive patients without MTBC disease, and differentiating MTBC from NTM.

Performance of the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis and rifampin resistance in a low-incidence, high-resource setting

PubMed Central

Rice, Jason P.; Moser, Kathleen S.; Rodwell, Timothy C.

2017-01-01

Performance of the Xpert MTB/RIF assay, designed to simultaneously detect Mycobacterium tuberculosis complex (MTBC) and rifampin (RIF) resistance, has been well documented in low-resource settings with high TB-incidence. However, few studies have assessed its accuracy in low TB incidence settings. We evaluated the performance of Xpert MTB/RIF using clinical sputum specimens routinely collected from suspect pulmonary TB patients over a 4-year time period in San Diego County, California. Xpert MTB/RIF results were compared to acid-fast bacilli (AFB) smear microscopy, mycobacterial culture, and phenotypic drug susceptibility testing (DST). Of 751 sputum specimens, 134 (17.8%) were MTBC culture-positive and 2 (1.5%) were multidrug-resistant (MDR). For the detection of MTBC, Xpert MTB/RIF sensitivity was 89.6% (97.7% and 74.5% in smear-positive and -negative sputa, respectively) and specificity was 97.2%; while AFB smear sensitivity and specificity were 64.9% and 77.8%, respectively. Xpert MTB/RIF detected 35 of 47 smear-negative culture-positive specimens, and excluded 124 of 137 smear-positive culture-negative specimens. Xpert MTB/RIF also correctly excluded 99.2% (121/122) of nontuberculous mycobacteria (NTM) specimens, including all 33 NTM false-positives by smear microscopy. For the detection of RIF resistance, Xpert MTB/RIF sensitivity and specificity were 100% and 98.3%, respectively. Our findings demonstrate that Xpert MTB/RIF is able to accurately detect MTBC and RIF resistance in routinely collected respiratory specimens in a low TB-incidence setting, with comparable performance to that achieved in high-incidence settings; and suggest that under these conditions the assay has particular utility in detecting smear-negative TB cases, excluding smear-positive patients without MTBC disease, and differentiating MTBC from NTM. PMID:29016684

Application of a New Resource-Constrained Triage Method to Military-Age Victims

DTIC Science & Technology

2009-12-01

evidence based, does not consider resources, and has been shown to be scientifically and opera- tionally flawed.’ General P . K. Carlton, former USAF Surgeon...metric that can be used to predict sur- vival probability) P ^ (t) = the survival probability of victims with original SCORE s treated in time period t. n...function coefficients were derived on the design set, and validated on the test set. The logistic function has the form: P ^ - 1/(1 + e"), where P ^ is

Development and validation of a self-administered questionnaire to estimate the distance and mode of children's travel to school in urban India.

PubMed

Tetali, Shailaja; Edwards, Phil; Murthy, G V S; Roberts, I

2015-10-28

Although some 300 million Indian children travel to school every day, little is known about how they get there. This information is important for transport planners and public health authorities. This paper presents the development of a self-administered questionnaire and examines its reliability and validity in estimating distance and mode of travel to school in a low resource urban setting. We developed a questionnaire on children's travel to school. We assessed test re-test reliability by repeating the questionnaire one week later (n = 61). The questionnaire was improved and re-tested (n = 68). We examined the convergent validity of distance estimates by comparing estimates based on the nearest landmark to children's homes with a 'gold standard' based on one-to-one interviews with children using detailed maps (n = 50). Most questions showed fair to almost perfect agreement. Questions on usual mode of travel (κ 0.73- 0.84) and road injury (κ 0.61- 0.72) were found to be more reliable than those on parental permissions (κ 0.18- 0.30), perception of safety (κ 0.00- 0.54), and physical activity (κ -0.01- 0.07). The distance estimated by the nearest landmark method was not significantly different than the in-depth method for walking , 52 m [95 % CI -32 m to 135 m], 10 % of the mean difference, and for walking and cycling combined, 65 m [95 % CI -30 m to 159 m], 11 % of the mean difference. For children who used motorized transport (excluding private school bus), the nearest landmark method under-estimated distance by an average of 325 metres [95 % CI -664 m to 1314 m], 15 % of the mean difference. A self-administered questionnaire was found to provide reliable information on the usual mode of travel to school, and road injury, in a small sample of children in Hyderabad, India. The 'nearest landmark' method can be applied in similar low-resource settings, for a reasonably accurate estimate of the distance from a child's home to school.

Comparison of LED and Conventional Fluorescence Microscopy for Detection of Acid Fast Bacilli in a Low-Incidence Setting

PubMed Central

Minion, Jessica; Pai, Madhukar; Ramsay, Andrew; Menzies, Dick; Greenaway, Christina

2011-01-01

Introduction Light emitting diode fluorescence microscopes have many practical advantages over conventional mercury vapour fluorescence microscopes, which would make them the preferred choice for laboratories in both low- and high-resource settings, provided performance is equivalent. Methods In a nested case-control study, we compared diagnostic accuracy and time required to read slides with the Zeiss PrimoStar iLED, LW Scientific Lumin, and a conventional fluorescence microscope (Leica DMLS). Mycobacterial culture was used as the reference standard, and subgroup analysis by specimen source and organism isolated were performed. Results There was no difference in sensitivity or specificity between the three microscopes, and agreement was high for all comparisons and subgroups. The Lumin and the conventional fluorescence microscope were equivalent with respect to time required to read smears, but the Zeiss iLED was significantly time saving compared to both. Conclusions Light emitting diode microscopy should be considered by all tuberculosis diagnostic laboratories, including those in high income countries, as a replacement for conventional fluorescence microscopes. Our findings provide support to the recent World Health Organization policy recommending that conventional fluorescence microscopy be replaced by light emitting diode microscopy using auramine staining in all settings where fluorescence microscopy is currently used. PMID:21811622

A grid-enabled web service for low-resolution crystal structure refinement.

PubMed

O'Donovan, Daniel J; Stokes-Rees, Ian; Nam, Yunsun; Blacklow, Stephen C; Schröder, Gunnar F; Brunger, Axel T; Sliz, Piotr

2012-03-01

Deformable elastic network (DEN) restraints have proved to be a powerful tool for refining structures from low-resolution X-ray crystallographic data sets. Unfortunately, optimal refinement using DEN restraints requires extensive calculations and is often hindered by a lack of access to sufficient computational resources. The DEN web service presented here intends to provide structural biologists with access to resources for running computationally intensive DEN refinements in parallel on the Open Science Grid, the US cyberinfrastructure. Access to the grid is provided through a simple and intuitive web interface integrated into the SBGrid Science Portal. Using this portal, refinements combined with full parameter optimization that would take many thousands of hours on standard computational resources can now be completed in several hours. An example of the successful application of DEN restraints to the human Notch1 transcriptional complex using the grid resource, and summaries of all submitted refinements, are presented as justification.

Layperson trauma training in low- and middle-income countries: a review.

PubMed

Callese, Tyler E; Richards, Christopher T; Shaw, Pamela; Schuetz, Steven J; Issa, Nabil; Paladino, Lorenzo; Swaroop, Mamta

2014-07-01

Prehospital trauma systems are rudimentary in many low- and middle-income countries (LMICs) and require laypersons to stabilize and transport injured patients. The World Health Organization recommends educating layperson first responders as an essential step in the development of Emergency Medical Services systems in LMICs. This systematic review examines trauma educational initiatives for layperson first responders in resource-poor settings. Layperson first-responder training and education program publications were identified using PubMed MEDLINE and Scopus databases. Articles addressing physicians, professional Emergency Medical Services training, or epidemiologic descriptions were excluded. Publications were assessed by independent reviewers, and those included underwent thematic analysis. Thirteen publications met inclusion criteria. Four themes emerged regarding the development of layperson first-responder training programs: (1) An initial needs assessment of a region's existing trauma system of care and laypersons' baseline emergency care knowledge focuses subsequent educational interventions; (2) effective programs adapt to and leverage existing resources; (3) training methods should anticipate participants with low levels of education and literacy; and (4) postimplementation evaluation allows for curriculum improvement. Technology, such as online and remote learning platforms, can be used to operationalize each theme. Successful training programs for layperson first responders in LMICs identify and maximize existing resources are adaptable to learners with little formal education and are responsive to postimplementation evaluation. Educational platforms that leverage technology to deliver content may facilitate first-responder trauma education in underresourced areas. Themes identified can inform the development of trauma systems of care to decrease mortality and physiological severity scores in trauma patients in LMICs. Copyright © 2014 Elsevier Inc. All rights reserved.

You have no Choice but to go on: How Physicians and Midwives in Ghana Cope with High Rates of Perinatal Death.

PubMed

Petrites, Alissa D; Mullan, Patricia; Spangenberg, Kathryn; Gold, Katherine J

2016-07-01

Objectives Healthcare providers in low-resource settings confront high rates of perinatal mortality. How providers cope with such challenges can affect their well-being and patient care; we therefore sought to understand how physicians and midwives make sense of and cope with these deaths. Methods We conducted semi-structured interviews with midwives, obstetrician-gynecologists, pediatricians and trainee physicians at a large teaching hospital in Kumasi, Ghana. Interviews focused on participants' coping strategies surrounding perinatal death. We identified themes from interview transcripts using qualitative content analysis. Results Thirty-six participants completed the study. Themes from the transcripts revealed a continuum of control/self-efficacy and engagement with the deaths. Providers demonstrated a commitment to push on with their work and provide the best care possible. In select cases, they described the transformative power of attitude and sought to be agents of change. Conclusions Physicians and midwives in a low-resource country in sub-Saharan Africa showed remarkable resiliency in coping with perinatal death. Still, future work should focus on training clinicians in coping and strengthening their self-efficacy and engagement.

The Internet as an Information Source for Environmental Chemicals--First Results of the Evaluation of the Meta-Database of Internet Resources.

ERIC Educational Resources Information Center

Voigt, Kristina; Benz, Joachim; Bruggemann, Rainer

An evaluation approach using the mathematical method of the Hasse diagram technique is applied on 20 environmental and chemical Internet resources. The data for this evaluation procedure are taken out of a metadatabase called DAIN (Metadatabase of Internet Resources for Environmental Chemicals) which is set up by the GSF Research Centre for…

The downside of goal-focused leadership: the role of personality in subordinate exhaustion.

PubMed

Perry, Sara Jansen; Witt, L A; Penney, Lisa M; Atwater, Leanne

2010-11-01

Exhaustion has a significant impact on employees and organizations, and leader behavior may affect it. We applied conservation of resources theory to test propositions regarding the joint effects of goal-focused leadership (GFL) and personality on employee exhaustion. We proposed that the relationship between GFL and exhaustion depends on employees' standing on both conscientiousness and emotional stability. Specifically, we expected that high-conscientiousness subordinates experience greater compatibility with a goal-focused leader because of their predisposition to direct resources toward achievement and goal setting, resulting in lower exhaustion under such a leader than among low-conscientiousness employees. Furthermore, high emotional stability may compensate for GFL incompatibility among low-conscientiousness employees by providing additional resources to manage GFL. In contrast, employees low on both traits likely experience greater exhaustion under a goal-focused leader compared with other employees. Results revealed a 3-way interaction in 2 independent samples and were generally supportive of our predictions. GFL was associated with heightened exhaustion among individuals in the low-emotional-stability, low-conscientiousness group but not among workers having any other trait combination. (c) 2010 APA, all rights reserved.

Fast high resolution reconstruction in multi-slice and multi-view cMRI

NASA Astrophysics Data System (ADS)

Velasco Toledo, Nelson; Romero Castro, Eduardo

2015-01-01

Cardiac magnetic resonance imaging (cMRI) is an useful tool in diagnosis, prognosis and research since it functionally tracks the heart structure. Although useful, this imaging technique is limited in spatial resolution because heart is a constant moving organ, also there are other non controled conditions such as patient movements and volumetric changes during apnea periods when data is acquired, those conditions limit the time to capture high quality information. This paper presents a very fast and simple strategy to reconstruct high resolution 3D images from a set of low resolution series of 2D images. The strategy is based on an information reallocation algorithm which uses the DICOM header to relocate voxel intensities in a regular grid. An interpolation method is applied to fill empty places with estimated data, the interpolation resamples the low resolution information to estimate the missing information. As a final step a gaussian filter that denoises the final result. A reconstructed image evaluation is performed using as a reference a super-resolution reconstructed image. The evaluation reveals that the method maintains the general heart structure with a small loss in detailed information (edge sharpening and blurring), some artifacts related with input information quality are detected. The proposed method requires low time and computational resources.

Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

PubMed

Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

2016-05-18

The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Impact of hypothermia on implementation of CPAP for neonatal respiratory distress syndrome in a low-resource setting.

PubMed

Carns, Jennifer; Kawaza, Kondwani; Quinn, M K; Miao, Yinsen; Guerra, Rudy; Molyneux, Elizabeth; Oden, Maria; Richards-Kortum, Rebecca

2018-01-01

Neonatal hypothermia is widely associated with increased risks of morbidity and mortality, but remains a pervasive global problem. No studies have examined the impact of hypothermia on outcomes for preterm infants treated with CPAP for respiratory distress syndrome (RDS). This retrospective analysis assessed the impact of hypothermia on outcomes of 65 neonates diagnosed with RDS and treated with either nasal oxygen (N = 17) or CPAP (N = 48) in a low-resource setting. A classification tree approach was used to develop a model predicting survival for subjects diagnosed with RDS. Survival to discharge was accurately predicted based on three variables: mean temperature, treatment modality, and mean respiratory rate. None of the 23 neonates with a mean temperature during treatment below 35.8°C survived to discharge, regardless of treatment modality. Among neonates with a mean temperature exceeding 35.8°C, the survival rate was 100% for the 31 neonates treated with CPAP and 36.4% for the 11 neonates treated with nasal oxygen (p<0.001). For neonates treated with CPAP, outcomes were poor if more than 50% of measured temperatures indicated hypothermia (5.6% survival). In contrast, all 30 neonates treated with CPAP and with more than 50% of temperature measurements above 35.8°C survived to discharge, regardless of initial temperature. The results of our study suggest that successful implementation of CPAP to treat RDS in low-resource settings will require aggressive action to prevent persistent hypothermia. However, our results show that even babies who are initially cold can do well on CPAP with proper management of hypothermia.

Improving spine surgical access, appropriateness and efficiency in metropolitan, urban and rural settings

PubMed Central

Zarrabian, Mohammad; Bidos, Andrew; Fanti, Caroline; Young, Barry; Drew, Brian; Puskas, David; Rampersaud, Raja

2017-01-01

Background The Inter-professional Spine Assessment and Education Clinics (ISAEC) were developed to improve primary care assessment, education and management of patients with persistent or recurrent low back pain–related symptoms. This study aims to determine the effect of ISAEC on access for surgical assessment, referral appropriateness and efficiency for patients meeting a priori referral criteria in rural, urban and metropolitan settings. Methods We conducted a retrospective review of prospective data from networked ISAEC clinics in Thunder Bay, Hamilton and Toronto, Ontario. For patients meeting surgical referral criteria, wait times for surgical assessment, surgical referral–related magnetic resonance imaging (MRI) scans and appropriateness of referral were recorded. Results Overall 422 patients, representing 10% of all ISAEC patients in the study period, were referred for surgical assessment. The average wait times for surgical assessment were 5.4, 4.3 and 2.2 weeks at the metropolitan, urban and rural centres, respectively. Referral MRI usage for the group decreased by 31%. Of the patients referred for formal surgical assessment, 80% had leg-dominant pain and 96% were deemed appropriate surgical referrals. Conclusion Contrary to geographic concentration of health care resources in metropolitan settings, the greatest decrease in wait times was achieved in the rural setting. A networked, shared-cared model of care for patients with low back pain–related symptoms significantly improved access for surgical assessment despite varying geographic practice settings and barriers. The greatest reductions were noted in the rural setting. In addition, significant improvements in referral appropriateness and efficiency were achieved compared with historical reports across all sites.

Improving the Nutritional Resource Environment for Healthy Living Through Community-based Participatory Research

PubMed Central

Sloane, David C; Diamant, Allison L; Lewis, LaVonna B; Yancey, Antronette K; Flynn, Gwendolyn; Nascimento, Lori Miller; McCarthy, William J; Guinyard, Joyce Jones; Cousineau, Michael R

2003-01-01

OBJECTIVES To build health promotion capacity among community residents through a community-based participatory model, and to apply this model to study the nutritional environment of an urban area to better understand the role of such resources in residents' efforts to live a healthy life. DESIGN A multiphase collaborative study that inventoried selected markets in targeted areas of high African-American concentration in comparison with markets in a contrasting wealthier area with fewer African Americans. SETTING A community study set in the Los Angeles metropolitan area. PARTICIPANTS African-American community organizations and community residents in the target areas. INTERVENTIONS Two surveys of market inventories were conducted. The first was a single-sheet form profiling store conditions and the availability of a small selection of healthy foods. The second provided detailed information on whether the store offered fruit, vegetables, low-fat dairy products, dried goods and other items necessary for residents to consume a nutritious diet. RESULTS The targeted areas were significantly less likely to have important items for living a healthier life. The variety and quality of fresh fruit and vegetable produce was significantly lower in the target areas. Such products as 1% milk, skim milk, low-fat and nonfat cheese, soy milk, tofu, whole grain pasta and breads, and low-fat meat and poultry items were sig-nificantly less available. CONCLUSIONS Healthy food products were significantly less available in the target areas. The authors conclude from these results that the health disparities experienced by African-American communities have origins that extend beyond the health delivery system and individual behaviors inasmuch as adherence to the healthy lifestyle associated with low chronic disease risk is more difficult in resource-poor neighborhoods than in resource-rich ones. PMID:12848840

Using Isomap to differentiate between anthropogenic and natural effects on groundwater dynamics in a complex geological setting

NASA Astrophysics Data System (ADS)

Boettcher, Steven; Merz, Christoph; Lischeid, Gunnar

2015-04-01

The water budget of many catchments has vastly changed throughout the last decades. Intensified land use and increased water withdrawal for drinking water production and irrigation are likely to intensify pressure on water resources. According to model predictions, changing rainfall intensity, duration and spatial distribution in conjunction with increasing temperatures will worsen the situation in the future. The current water resources management has to adapt to these negative developments and to account for competing demands and threats. Essential for successful management applications is the identification and the quantification of the cause-and-effect chains driving the hydrological behavior of a catchment on the scale of management. It needs to check direction and magnitude of intended effects of measures taken as well as to identify unintended side effects that interact with natural effects in heterogeneous environments (Wood et al., 1988; Bloschl and Sivapalan, 1995). Therefore, these tools have to be able to distinguish between natural and anthropogenic driven impacts, even in complex geological settings like the Pleistocene landscape of North-East Germany. This study presents an approach that utilizes monitoring data to detect and quantitatively describe the predominant processes or factors of an observed hydrological system. The multivariate data analysis involves a non-linear dimension reduction method called Isometric Feature Mapping (Isomap, Tenenbaum et al., 2000) to extract information about the causes for the observed dynamics. Ordination methods like Isomap are used to derive a meaningful low-dimensional representation of a complex, high-dimensional data set. The approach is based on the hypothesis, that the number of processes which explain the variance of the data is relative low although the intensity of the processes varies in time and space. Therefore, the results can be interpreted in reference to the effective hydrological processes which control the system. The method was applied on a data set of groundwater head and lake water level. Two factors explaining more than 95 percent of the observed spatial variations were identified: (1) the anthropogenic impact of a waterworks in the study area and (2) natural groundwater recharge dynamics of different degrees of dampening at the respective sites of observation. The spatial variation of the identified processes revealed previously unknown hydraulic connections between two aquifers and between surface water bodies and groundwater. The obtained information can be used to reduce model structure uncertainty and a more efficient process-based modeling of hydraulic system behavior. Thus, the approach provides essential information to evaluate and adapt strategies for an integrated water resources management in complex landscapes. Bloschl, G., Sivapalan, M., 1995. Scale Issues in Hydrological Modeling - a Review. Hydrological Processes, 9(3-4): 251-290. Tenenbaum, J.B., de Silva, V., Langford, J.C., 2000. A global geometric framework for nonlinear dimensionality reduction. Science, 290: 2319-2323. Wood, E.F., Sivapalan, M., Beven, K., Band, L., 1988. Effects of Spatial Variability and Scale with Implications to Hydrologic Modeling. Journal of Hydrology, 102(1-4): 29-47.

Feasibility intervention trial of two types of improved cookstoves in three resource-limited settings: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes. Design We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138). Methods At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period. Discussion Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide. Trial registration ClinicalTrials.gov NCT01686867 PMID:24112419

Pathogen reduction and blood transfusion safety in Africa: strengths, limitations and challenges of implementation in low-resource settings.

PubMed

Ware, A D; Jacquot, C; Tobian, A A R; Gehrie, E A; Ness, P M; Bloch, E M

2018-01-01

Transfusion-transmitted infection risk remains an enduring challenge to blood safety in Africa. A high background incidence and prevalence of the major transfusion-transmitted infections (TTIs), dependence on high-risk donors to meet demand, suboptimal testing and quality assurance collectively contribute to the increased risk. With few exceptions, donor testing is confined to serological evaluation of human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) and syphilis. Barriers to implementation of broader molecular methods include cost, limited infrastructure and lack of technical expertise. Pathogen reduction (PR), a term used to describe a variety of methods (e.g. solvent detergent treatment or photochemical activation) that may be applied to blood following collection, offers the means to diminish the infectious potential of multiple pathogens simultaneously. This is effective against different classes of pathogen, including the major TTIs where laboratory screening is already implemented (e.g. HIV, HBV and HCV) as well pathogens that are widely endemic yet remain unaddressed (e.g. malaria, bacterial contamination). We sought to review the available and emerging PR techniques and their potential application to resource-constrained parts of Africa, focusing on the advantages and disadvantages of such technologies. PR has been slow to be adopted even in high-income countries, primarily given the high costs of use. Logistical considerations, particularly in low-resourced parts of Africa, also raise concerns about practicality. Nonetheless, PR offers a rational, innovative strategy to contend with TTIs; technologies in development may well present a viable complement or even alternative to targeted screening in the future. © 2017 International Society of Blood Transfusion.

Improving rates of cotrimoxazole prophylaxis in resource-limited settings: implementation of a quality improvement approach.

PubMed

Bardfield, J; Agins, B; Palumbo, M; Wei, A L; Morris, J; Marston, B

2014-12-01

To demonstrate the effectiveness of quality improvement methods to monitor and improve administration of cotrimoxazole (CTX) prophylaxis to improve health outcomes among adults living with HIV/AIDS in low resource countries. Program evaluation. HIV/AIDS health care facilities in Uganda, Mozambique, Namibia and Haiti. Performance measures based on national guidelines are developed in each country. These may include CD4 monitoring, ART adherence and uptake of CTX prophylaxis. CTX prophylaxis is routinely selected, because it has been shown to reduce HIV-related morbidity and mortality. Patient records are sampled using a standard statistical table to achieve a minimum confidence interval of 90% with a spread of ±8% in participating clinics. If an electronic medical record is available, all patients are reviewed. Routine review of performance measures, usually every 6 months, is conducted to identify gaps in care. Improvement interventions are developed and implemented at health facilities, informed by performance results, and local/national public health priorities. Median clinic rates of CTX prophylaxis. Median performance rates of CTX prophylaxis generally improved for adult HIV+ patients between 2006 and 2013 across countries, with median clinic rates higher than baseline at follow-up in 16 of 18 groups of clinics implementing CTX -focused improvement projects. Quality management offers a data-driven method to improve the quality of HIV care in low resource countries. Application of improvement principles has been shown to be effective to increase the rates of CTX prophylaxis in national HIV programs in multiple countries. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

How natural is the supernatural? Synthesis of the qualitative literature from low and middle income countries on cultural practices and traditional beliefs influencing the perinatal period.

PubMed

Raman, Shanti; Nicholls, Rachel; Ritchie, Jan; Razee, Husna; Shafiee, Samaneh

2016-08-01

to review qualitative research studies conducted in low resource settings around the perinatal continuum over the past two decades, with particular focus on the cultural realm; to identify common themes in the research-base, in order to provide policy direction for culturally appropriate perinatal interventions. systematic literature search of electronic databases from 1990 to 2014, including Medline, Embase, CINAHL and PsycINFO, using relevant search terms such as traditional beliefs, practices, pregnancy, childbirth; established criteria used to determine quality of studies; and thematic synthesis of the literature enabled by NVivo 10 software. low and middle income countries using the World Bank classification. religious and spiritual beliefs strongly influenced behaviour over the perinatal period. Beliefs in supernatural influences, particularly malevolent forces were widespread, such that pregnancy was concealed in many parts of Africa and Asia. In most low resource settings, pregnancy and childbirth were seen as normal phenomena. Rituals played an important part for women and their infants, reinforced by inter-generational support. Cross-cutting themes that emerged were: (1) the role of women as mothers, demonstrating their'goodness' by bearing pain and suffering; (2) the idea of the 'natural' incorporating the supernatural; and (3) negotiating change across generations. a diverse repertoire of cultural practices influences perinatal well-being across low resource settings. Health practitioners and policy-makers need to acknowledge the primacy of women's reproductive roles, the cultural constructions of motherhood; that supernatural forces are believed to exert powerful influences on the health of mother and infant; that inter-generational tensions result in resisting or embracing change. Public health planners and practitioners need to take culture seriously, not ignore the contribution of culture in shaping women's behaviours and choices throughout the perinatal continuum and deliver contextually specific, culturally responsive care to optimise perinatal health and well-being. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Low cost and open source multi-fluorescence imaging system for teaching and research in biology and bioengineering.

PubMed

Nuñez, Isaac; Matute, Tamara; Herrera, Roberto; Keymer, Juan; Marzullo, Timothy; Rudge, Timothy; Federici, Fernán

2017-01-01

The advent of easy-to-use open source microcontrollers, off-the-shelf electronics and customizable manufacturing technologies has facilitated the development of inexpensive scientific devices and laboratory equipment. In this study, we describe an imaging system that integrates low-cost and open-source hardware, software and genetic resources. The multi-fluorescence imaging system consists of readily available 470 nm LEDs, a Raspberry Pi camera and a set of filters made with low cost acrylics. This device allows imaging in scales ranging from single colonies to entire plates. We developed a set of genetic components (e.g. promoters, coding sequences, terminators) and vectors following the standard framework of Golden Gate, which allowed the fabrication of genetic constructs in a combinatorial, low cost and robust manner. In order to provide simultaneous imaging of multiple wavelength signals, we screened a series of long stokes shift fluorescent proteins that could be combined with cyan/green fluorescent proteins. We found CyOFP1, mBeRFP and sfGFP to be the most compatible set for 3-channel fluorescent imaging. We developed open source Python code to operate the hardware to run time-lapse experiments with automated control of illumination and camera and a Python module to analyze data and extract meaningful biological information. To demonstrate the potential application of this integral system, we tested its performance on a diverse range of imaging assays often used in disciplines such as microbial ecology, microbiology and synthetic biology. We also assessed its potential use in a high school environment to teach biology, hardware design, optics, and programming. Together, these results demonstrate the successful integration of open source hardware, software, genetic resources and customizable manufacturing to obtain a powerful, low cost and robust system for education, scientific research and bioengineering. All the resources developed here are available under open source licenses.

Low cost and open source multi-fluorescence imaging system for teaching and research in biology and bioengineering

PubMed Central

Herrera, Roberto; Keymer, Juan; Marzullo, Timothy; Rudge, Timothy

2017-01-01

The advent of easy-to-use open source microcontrollers, off-the-shelf electronics and customizable manufacturing technologies has facilitated the development of inexpensive scientific devices and laboratory equipment. In this study, we describe an imaging system that integrates low-cost and open-source hardware, software and genetic resources. The multi-fluorescence imaging system consists of readily available 470 nm LEDs, a Raspberry Pi camera and a set of filters made with low cost acrylics. This device allows imaging in scales ranging from single colonies to entire plates. We developed a set of genetic components (e.g. promoters, coding sequences, terminators) and vectors following the standard framework of Golden Gate, which allowed the fabrication of genetic constructs in a combinatorial, low cost and robust manner. In order to provide simultaneous imaging of multiple wavelength signals, we screened a series of long stokes shift fluorescent proteins that could be combined with cyan/green fluorescent proteins. We found CyOFP1, mBeRFP and sfGFP to be the most compatible set for 3-channel fluorescent imaging. We developed open source Python code to operate the hardware to run time-lapse experiments with automated control of illumination and camera and a Python module to analyze data and extract meaningful biological information. To demonstrate the potential application of this integral system, we tested its performance on a diverse range of imaging assays often used in disciplines such as microbial ecology, microbiology and synthetic biology. We also assessed its potential use in a high school environment to teach biology, hardware design, optics, and programming. Together, these results demonstrate the successful integration of open source hardware, software, genetic resources and customizable manufacturing to obtain a powerful, low cost and robust system for education, scientific research and bioengineering. All the resources developed here are available under open source licenses. PMID:29140977

Activity-based costing of health-care delivery, Haiti

PubMed Central

Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

2018-01-01

Abstract Objective To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Methods Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient’s medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Findings Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Conclusion Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated. PMID:29403096

Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

PubMed

Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta A; Davis, William Austin; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

2018-03-01

Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.

Internet use among Ugandan adolescents: implications for HIV intervention.

PubMed

Ybarra, Michele L; Kiwanuka, Julius; Emenyonu, Nneka; Bangsberg, David R

2006-11-01

The Internet is fast gaining recognition as a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. The feasibility and accessibility of Internet-based health interventions in resource-limited settings, where cost-effective interventions are most needed, is unknown. To determine the utility of developing technology-based interventions in resource-limited settings, availability and patterns of usage of the Internet first need to be assessed. The Uganda Media and You Survey was a cross-sectional survey of Internet use among adolescents (ages 12-18 years) in Mbarara, Uganda, a municipality mainly serving a rural population in sub-Saharan Africa. Participants were randomly selected among eligible students attending one of five participating secondary day and boarding schools in Mbarara, Uganda. Of a total of 538 students selected, 93% (500) participated. Of the total respondents, 45% (223) reported ever having used the Internet, 78% (175) of whom reported going online in the previous week. As maternal education increased, so too did the odds of adolescent Internet use. Almost two in five respondents (38% [189]) reported already having used a computer or the Internet to search for health information. Over one-third (35% [173]) had used the computer or Internet to find information about HIV/AIDS, and 20% (102) had looked for sexual health information. Among Internet users, searching for HIV/AIDS information on a computer or online was significantly related to using the Internet weekly, emailing, visiting chat rooms, and playing online games. In contrast, going online at school was inversely related to looking for HIV/AIDS information via technology. If Internet access were free, 66% (330) reported that they would search for information about HIV/AIDS prevention online. Both the desire to use, and the actual use of, the Internet to seek sexual health and HIV/AIDS information is high among secondary school students in Mbarara. The Internet may be a promising strategy to deliver low-cost HIV/AIDS risk reduction interventions in resource-limited settings with expanding Internet access.

Improving the large scale purification of the HIV microbicide, griffithsin.

PubMed

Fuqua, Joshua L; Wanga, Valentine; Palmer, Kenneth E

2015-02-22

Griffithsin is a broad spectrum antiviral lectin that inhibits viral entry and maturation processes through binding clusters of oligomannose glycans on viral envelope glycoproteins. An efficient, scaleable manufacturing process for griffithsin active pharmaceutical ingredient (API) is essential for particularly cost-sensitive products such as griffithsin -based topical microbicides for HIV-1 prevention in resource poor settings. Our previously published purification method used ceramic filtration followed by two chromatography steps, resulting in a protein recovery of 30%. Our objective was to develop a scalable purification method for griffithsin expressed in Nicotiana benthamiana plants that would increase yield, reduce production costs, and simplify manufacturing techniques. Considering the future need to transfer griffithsin manufacturing technology to resource poor areas, we chose to focus modifying the purification process, paying particular attention to introducing simple, low-cost, and scalable procedures such as use of temperature, pH, ion concentration, and filtration to enhance product recovery. We achieved >99% pure griffithsin API by generating the initial green juice extract in pH 4 buffer, heating the extract to 55°C, incubating overnight with a bentonite MgCl2 mixture, and final purification with Capto™ multimodal chromatography. Griffithsin extracted with this protocol maintains activity comparable to griffithsin purified by the previously published method and we are able to recover a substantially higher yield: 88 ± 5% of griffithsin from the initial extract. The method was scaled to produce gram quantities of griffithsin with high yields, low endotoxin levels, and low purification costs maintained. The methodology developed to purify griffithsin introduces and develops multiple tools for purification of recombinant proteins from plants at an industrial scale. These tools allow for robust cost-effective production and purification of griffithsin. The methodology can be readily scaled to the bench top or industry and process components can be used for purification of additional proteins based on biophysical characteristics.

Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations.

PubMed

Haberer, Jessica E; Sabin, Lora; Amico, K Rivet; Orrell, Catherine; Galárraga, Omar; Tsai, Alexander C; Vreeman, Rachel C; Wilson, Ira; Sam-Agudu, Nadia A; Blaschke, Terrence F; Vrijens, Bernard; Mellins, Claude A; Remien, Robert H; Weiser, Sheri D; Lowenthal, Elizabeth; Stirratt, Michael J; Sow, Papa Salif; Thomas, Bruce; Ford, Nathan; Mills, Edward; Lester, Richard; Nachega, Jean B; Bwana, Bosco Mwebesa; Ssewamala, Fred; Mbuagbaw, Lawrence; Munderi, Paula; Geng, Elvin; Bangsberg, David R

2017-01-01

Introduction : Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods : In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion : The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.

Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh

PubMed Central

Mullany, Luke C.; Ladhani, Karima; Uddin, Jamal; Mitra, Dipak; Ahmed, Parvez; Christian, Parul; Labrique, Alain; DasGupta, Sushil K.; Lokken, R. Peter; Quaiyum, Mohammed; Baqui, Abdullah H

2016-01-01

BACKGROUND: Gestational age (GA) is frequently unknown or inaccurate in pregnancies in low-income countries. Early identification of preterm infants may help link them to potentially life-saving interventions. METHODS: We conducted a validation study in a community-based birth cohort in rural Bangladesh. GA was determined by pregnancy ultrasound (<20 weeks). Community health workers conducted home visits (<72 hours) to assess physical/neuromuscular signs and measure anthropometrics. The distribution, agreement, and diagnostic accuracy of different clinical methods of GA assessment were determined compared with early ultrasound dating. RESULTS: In the live-born cohort (n = 1066), the mean ultrasound GA was 39.1 weeks (SD 2.0) and prevalence of preterm birth (<37 weeks) was 11.4%. Among assessed newborns (n = 710), the mean ultrasound GA was 39.3 weeks (SD 1.6) (8.3% preterm) and by Ballard scoring the mean GA was 38.9 weeks (SD 1.7) (12.9% preterm). The average bias of the Ballard was –0.4 weeks; however, 95% limits of agreement were wide (–4.7 to 4.0 weeks) and the accuracy for identifying preterm infants was low (sensitivity 16%, specificity 87%). Simplified methods for GA assessment had poor diagnostic accuracy for identifying preterm births (community health worker prematurity scorecard [sensitivity/specificity: 70%/27%]; Capurro [5%/96%]; Eregie [75%/58%]; Bhagwat [18%/87%], foot length <75 mm [64%/35%]; birth weight <2500 g [54%/82%]). Neonatal anthropometrics had poor to fair performance for classifying preterm infants (areas under the receiver operating curve 0.52–0.80). CONCLUSIONS: Newborn clinical assessment of GA is challenging at the community level in low-resource settings. Anthropometrics are also inaccurate surrogate markers for GA in settings with high rates of fetal growth restriction. PMID:27313070

Responding to intimate partner violence: Healthcare providers' current practices and views on integrating a safety decision aid into primary care settings.

PubMed

Alvarez, Carmen; Debnam, Katrina; Clough, Amber; Alexander, Kamila; Glass, Nancy E

2018-04-01

Supportive care for survivors of intimate partner violence (IPV) remains limited in primary care settings. Low-income and Spanish-speaking survivors of IPV are even more disadvantaged, given the dearth of linguistically and culturally appropriate interventions for IPV. We conducted semi-structured individual interviews with 17 healthcare workers, including physicians, nurses, and social workers, to describe how healthcare workers serving primarily low-income, Latina populations are currently screening and responding to IPV disclosure, and to explore the acceptability of integrating an interactive, personalized safety decision aid application-myPlan app-into the clinic setting. Despite recognition of IPV as a problem, none of the clinical sites had a protocol to guide screening and response to IPV disclosure. Screening practices varied across the sites, sometimes conducted by medical assistants prior to the provider visit and other times by the physician or nurse provider. When IPV was disclosed, it was often during assessment for a presenting problem such as poor sleep or anxiety. Most healthcare workers felt that clinical and community resources were limited for their patients experiencing IPV. The "warm hand-off" to a social worker was the most common response strategy when possible; otherwise, women were given information about available resources such as hotlines and safe houses. We discuss structural, family, and individual barriers to accessing safety resources for underserved women and review how an easily accessible safety decision app, such as myPlan, could be a resource for women to safely tailor an action plan for her situation. © 2018 Wiley Periodicals, Inc.

EXPANDING CAPD IN LOW-RESOURCE SETTINGS: A DISTANCE LEARNING APPROACH.

PubMed

Rope, Robert; Nanayakkara, Nishantha; Wazil, Abdul; Dickowita, Sewmini; Abeyeskera, Rajitha; Gunerathne, Lishanthe; Adoosoriya, Dinuka; Karunasena, Nishamani; Ratnayake, Charaka; Anand, Shuchi; Saxena, Anjali

2018-05-23

Despite growing need, treatment for end-stage renal disease is limited in low- and middle-income countries due to resource restraints. We describe the development of an educational curriculum and quality improvement program to support continuous ambulatory peritoneal dialysis (CAPD) performed primarily by non-nephrology providers in Sri Lanka. We developed a program of education, outcome tracking, and expert consultation to support providers in Kandy, Sri Lanka. Education included videos and in-person didactics covering core topics in CAPD. Event-tracking sheets recorded root causes and management of infections and hospitalizations. Conferences reviewed clinical cases and overall clinic management. We evaluated the patient census, peritonitis rates, and root causes and management of infections over 1 year. The curriculum was published through the International Society of Nephrology online academy. High provider turnover limited curriculum assessments. The CAPD patient census rose from 63 to 116 during the year. The peritonitis rate declined significantly, from 0.8 episodes per patient-year in the first 6 months to 0.4 in the latter 6 months, though the most common root causes of peritonitis, related to contamination events and hygiene, persisted. The appropriate ascertainment of culture data and prescription of antibiotics also increased. Our project supported the expansion of a CAPD program in a resource-limited setting, while also improving peritonitis outcomes. Ongoing challenges include ensuring a durable educational system for rotating providers, tracking outcomes beyond peritonitis, and formalizing management protocols. Our program can serve as an example of how established dialysis programs can support the burgeoning work of providers in resource-limited setting.

Principal Perceptions toward the Leadership Responsibilities and Practices of the Superintendency in High and Low Achievement School Districts with High and Low Superintendent Turnover

ERIC Educational Resources Information Center

Colby-Rooney, Danielle M.

2013-01-01

The purpose of this study was to determine the perceptions of building principals toward superintendent leadership responsibilities and practices of goal setting, nonnegotiable goals for achievement and instruction, board alignment with support of district goals, monitoring goals for achievement and instruction, use of resources to support the…

42 CFR 412.152 - Definitions for the Hospital Readmissions Reduction Program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... disproportionate share of low-income patients under § 412.106, outliers under subpart F of this part, and a low.... The floor adjustment factor is set at 0.99 for FY 2013, 0.98 for FY 2014, and 0.97 for FY 2015 and... standardized amount adjusted for resource utilization by the applicable MS-DRG relative weight and adjusted for...

42 CFR 412.152 - Definitions for the Hospital Readmissions Reduction Program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... disproportionate share of low-income patients under § 412.106, outliers under subpart F of this part, and a low.... The floor adjustment factor is set at 0.99 for FY 2013, 0.98 for FY 2014, and 0.97 for FY 2015 and... standardized amount adjusted for resource utilization by the applicable MS-DRG relative weight and adjusted for...

42 CFR 412.152 - Definitions for the Hospital Readmissions Reduction Program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... disproportionate share of low-income patients under § 412.106, outliers under subpart F of this part, and a low.... The floor adjustment factor is set at 0.99 for FY 2013, 0.98 for FY 2014, and 0.97 for FY 2015 and... standardized amount adjusted for resource utilization by the applicable MS-DRG relative weight and adjusted for...

78 FR 52208 - 60-Day Notice of Proposed Information Collection Section 3 Business Registry Surveys

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-22

... opportunities generated by such financial assistance to local low- and very low-income persons and to award... employment and contracting set forth in the Section 3 regulation at 24 CFR 135.30. In November 2011, HUD..., Los Angeles, Miami, and Washington, DC as a resource to help agencies that receive certain HUD funds...

Assessing Self-Regulation in the Classroom: Validation of the BIS-11 and the BRIEF in Low-Income, Ethnic Minority School-Age Children

ERIC Educational Resources Information Center

Charles McCoy, Dana L.; Raver, C. Cybele; Lowenstein, Amy E.; Tirado-Strayer, Nicole

2011-01-01

Research Findings: At present, few resources are available to researchers, teachers, and practitioners who wish to quickly and reliably assess children's self-regulation within the classroom context, and particularly within settings serving low-income and ethnic minority children. This paper explores the psychometric properties of a teacher-report…

Learning Disabilities Screening and Evaluation Guide for Low- and Middle-Income Countries. Occasional Paper. RTI Press Publication OP-0052-1804

ERIC Educational Resources Information Center

Hayes, Anne M.; Dombrowski, Eileen; Shefcyk, Allison H.; Bulat, Jennae

2018-01-01

Learning disabilities are among the most common disabilities experienced in childhood and adulthood. Although identifying learning disabilities in a school setting is a complex process, it is particularly challenging in low- and middle-income countries that lack the appropriate resources, tools, and supports. This guide provides an introduction to…

Improving Urban Minority Girls' Health Via Community Summer Programming.

PubMed

Bohnert, Amy M; Bates, Carolyn R; Heard, Amy M; Burdette, Kimberly A; Ward, Amanda K; Silton, Rebecca L; Dugas, Lara R

2017-12-01

Summertime has emerged as a high-risk period for weight gain among low-income minority youth who often experience a lack of resources when not attending school. Structured programming may be an effective means of reducing risk for obesity by improving obesogenic behaviors among these youth. The current multi-method study examined sedentary time, physical activity, and dietary intake among low-income urban minority girls in two contexts: an unstructured summertime setting and in the context of a structured 4-week community-based summer day camp program promoting physical activity. Data were analyzed using paired-sample t tests and repeated-measure analyses of variance with significance at the p < .05 level. Results evidenced no significant differences in total calories and fat consumed between the unstructured and structured settings. Participants exhibited significant increases in fruit consumption and physical activity and significant decreases in sedentary time of over 2 h/day and dairy consumption when engaged in structured summer programming. All improvements were independent of weight status and age, and African-American participants evidenced greater changes in physical activity during programming. The study concludes that structured, community-based summertime programming may be associated with fewer obesogenic behaviors in low-income urban youth and may be a powerful tool to address disparities in weight gain and obesity among high-risk samples.

An Optimal Method for Detecting Internal and External Intrusion in MANET

NASA Astrophysics Data System (ADS)

Rafsanjani, Marjan Kuchaki; Aliahmadipour, Laya; Javidi, Mohammad M.

Mobile Ad hoc Network (MANET) is formed by a set of mobile hosts which communicate among themselves through radio waves. The hosts establish infrastructure and cooperate to forward data in a multi-hop fashion without a central administration. Due to their communication type and resources constraint, MANETs are vulnerable to diverse types of attacks and intrusions. In this paper, we proposed a method for prevention internal intruder and detection external intruder by using game theory in mobile ad hoc network. One optimal solution for reducing the resource consumption of detection external intruder is to elect a leader for each cluster to provide intrusion service to other nodes in the its cluster, we call this mode moderate mode. Moderate mode is only suitable when the probability of attack is low. Once the probability of attack is high, victim nodes should launch their own IDS to detect and thwart intrusions and we call robust mode. In this paper leader should not be malicious or selfish node and must detect external intrusion in its cluster with minimum cost. Our proposed method has three steps: the first step building trust relationship between nodes and estimation trust value for each node to prevent internal intrusion. In the second step we propose an optimal method for leader election by using trust value; and in the third step, finding the threshold value for notifying the victim node to launch its IDS once the probability of attack exceeds that value. In first and third step we apply Bayesian game theory. Our method due to using game theory, trust value and honest leader can effectively improve the network security, performance and reduce resource consumption.

Resource allocation in public health practice: a national survey of local public health officials.

PubMed

Baum, Nancy M; DesRoches, Catherine; Campbell, Eric G; Goold, Susan Dorr

2011-01-01

The purpose of this study was to gain an empirical understanding of the types of allocation decisions local health officials (LHOs) make and the factors that influence those allocation decisions. We conducted a national survey of LHOs in the United States in 2008 to 2009. The sample was stratified by the size of the population served by the department. We merged our data with data from the 2008 National Association of County and City Health Officials Profile survey. Descriptive statistics were generated using weighted data. Our final sample size was 608 respondents, with an average of 10 years experience. The LHOs reported little shifting of resources among population groups but greater capacity to redirect staffing time. Less than half of LHOs reported using economic analyses or conducting needs assessments when setting priorities. Having sole provider status in a community strongly influenced LHOs' allocation decisions. In addition, the effectiveness of activities, previous budget allocations, and input from boards of health were influential factors in allocation decisions. Public expectations were moderately to very influential, but direct public input had a low impact on allocation decisions. Survey findings provide a clearer understanding of how LHOs fulfill their obligations as stewards of public health resources and ensure effective activities and access to needed services. It may be useful to assess the value of more structured allocation methods (eg, decision frameworks) in the allocation process. Expanding opportunities for public engagement in priority setting may also be valuable for difficult allocation decisions.

Participation of low-income women in genetic cancer risk assessment and BRCA 1/2 testing: the experience of a safety-net institution.

PubMed

Komenaka, Ian K; Nodora, Jesse N; Madlensky, Lisa; Winton, Lisa M; Heberer, Meredith A; Schwab, Richard B; Weitzel, Jeffrey N; Martinez, Maria Elena

2016-07-01

Some communities and populations lack access to genetic cancer risk assessment (GCRA) and testing. This is particularly evident in safety-net institutions, which serve a large segment of low-income, uninsured individuals. We describe the experience of a safety-net clinic with limited resources in providing GCRA and BRCA1/2 testing. We compared the proportion and characteristics of high-risk women who were offered and underwent GCRA and genetic testing. We also provide a description of the mutation profile for affected women. All 125 patients who were offered GCRA accepted to undergo GCRA. Of these, 72 % had a breast cancer diagnosis, 70 % were Hispanic, 52.8 % were non-English speakers, and 66 % did not have health insurance. Eighty four (67 %) were offered genetic testing and 81 (96 %) agreed. Hispanic women, those with no medical insurance, and those with a family history of breast cancer were significantly more likely to undergo testing (p > 0.01). Twelve of 81 (15 %) patients were found to have deleterious mutations, seven BRCA1, and five BRCA2. Our experience shows that it is possible to offer GCRA and genetic testing even in the setting of limited resources for these services. This is important given that a large majority of the low-income women in our study agreed to undergo counseling and testing. Our experience could serve as a model for similar low-resource safety-net health settings.

The development and pilot testing of a multicomponent health promotion intervention (SEHER) for secondary schools in Bihar, India

PubMed Central

Shinde, Sachin; Pereira, Bernadette; Khandeparkar, Prachi; Sharma, Amit; Patton, George; Ross, David A; Weiss, Helen A; Patel, Vikram

2017-01-01

ABSTRACT Background: Schools can play an important role in health promotion by improving students’ health literacy, attitudes, health-related behaviours, social connection and self-efficacy. These interventions can be particularly valuable in low- and middle-income countries with low health literacy and high burden of disease. However, the existing literature provides poor guidance for the implementation of school-based interventions in low-resource settings. This paper describes the development and pilot testing of a multicomponent school-based health promotion intervention for adolescents in 75 government-run secondary schools in Bihar, India. Method: The intervention was developed in three stages: evidence review of the content and delivery of effective school health interventions; formative research to contextualize the proposed content and delivery, involving intervention development workshops with experts, teachers and students and content analysis of intervention manuals; and pilot testing in situ to optimize its feasibility and acceptability. Results: The three-stage process defined the intervention elements, refining their content and format of delivery. This intervention focused on promoting social skills among adolescents, engaging adolescents in school decision making, providing factual information, and enhancing their problem-solving skills. Specific intervention strategies were delivered at three levels (whole school, student group, and individual counselling) by either a trained teacher or a lay counsellor. The pilot study, in 50 schools, demonstrated generally good acceptability and feasibility of the intervention, though the coverage of intervention activities was lower in the teacher delivery schools due to competing teaching commitments, the participation of male students was lower than that of females, and one school dropped out because of concerns regarding the reproductive and sexual health content of the intervention. Conclusion: This SEHER approach provides a framework for adolescent health promotion in secondary schools in low-resource settings. We are now using a cluster-randomized trial to evaluate its effectiveness and cost-effectiveness. PMID:29115194

Fast reconstruction of high-qubit-number quantum states via low-rate measurements

NASA Astrophysics Data System (ADS)

Li, K.; Zhang, J.; Cong, S.

2017-07-01

Due to the exponential complexity of the resources required by quantum state tomography (QST), people are interested in approaches towards identifying quantum states which require less effort and time. In this paper, we provide a tailored and efficient method for reconstructing mixed quantum states up to 12 (or even more) qubits from an incomplete set of observables subject to noises. Our method is applicable to any pure or nearly pure state ρ and can be extended to many states of interest in quantum information processing, such as a multiparticle entangled W state, Greenberger-Horne-Zeilinger states, and cluster states that are matrix product operators of low dimensions. The method applies the quantum density matrix constraints to a quantum compressive sensing optimization problem and exploits a modified quantum alternating direction multiplier method (quantum-ADMM) to accelerate the convergence. Our algorithm takes 8 ,35 , and 226 seconds, respectively, to reconstruct superposition state density matrices of 10 ,11 ,and12 qubits with acceptable fidelity using less than 1 % of measurements of expectation. To our knowledge it is the fastest realization that people can achieve using a normal desktop. We further discuss applications of this method using experimental data of mixed states obtained in an ion trap experiment of up to 8 qubits.

Weak turbulence simulations with the Hermite-Fourier spectral method

NASA Astrophysics Data System (ADS)

Vencels, Juris; Delzanno, Gian Luca; Manzini, Gianmarco; Roytershteyn, Vadim; Markidis, Stefano

2015-11-01

Recently, a new (transform) method based on a Fourier-Hermite (FH) discretization of the Vlasov-Maxwell equations has been developed. The resulting set of moment equations is discretized implicitly in time with a Crank-Nicolson scheme and solved with a nonlinear Newton-Krylov technique. For periodic boundary conditions, this discretization delivers a scheme that conserves the total mass, momentum and energy of the system exactly. In this work, we apply the FH method to study a problem of Langmuir turbulence, where a low signal-to-noise ratio is important to follow the turbulent cascade and might require a lot of computational resources if studied with PIC. We simulate a weak (low density) electron beam moving in a Maxwellian plasma and subject to an instability that generates Langmuir waves and a weak turbulence field. We also discuss some optimization techniques to optimally select the Hermite basis in terms of its shift and scaling argument, and show that this technique improve the overall accuracy of the method. Finally, we discuss the applicability of the HF method for studying kinetic plasma turbulence. This work was funded by LDRD under the auspices of the NNSA of the U.S. by LANL under contract DE-AC52-06NA25396 and by EC through the EPiGRAM project (grant agreement no. 610598. epigram-project.eu).

The Application of Marketing Science to Educational Settings: A Bibliography.

ERIC Educational Resources Information Center

Stetz, Frank P.

This bibliography, based on searches of "Educational Index,""Resources in Education," and "Psychological Abstracts," lists articles, reports, and dissertations detailing the application of marketing science to educational settings. Entries are organized in five sections: research methods in marketing; marketing research; applications of marketing…

Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana.

PubMed

Efstathiou, Jason A; Heunis, Magda; Karumekayi, Talkmore; Makufa, Remigio; Bvochora-Nsingo, Memory; Gierga, David P; Suneja, Gita; Grover, Surbhi; Kasese, Joseph; Mmalane, Mompati; Moffat, Howard; von Paleske, Alexander; Makhema, Joseph; Dryden-Peterson, Scott

2016-01-01

There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public-private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability. © 2015 by American Society of Clinical Oncology.

Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

PubMed

Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

2018-01-01

Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

Sustainability in health care by allocating resources effectively (SHARE) 4: exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting.

PubMed

Harris, Claire; Ko, Henry; Waller, Cara; Sloss, Pamela; Williams, Pamela

2017-05-05

This is the fourth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Healthcare decision-makers have sought to improve the effectiveness and efficiency of services through removal or restriction of practices that are unsafe or of little benefit, often referred to as 'disinvestment'. A systematic, integrated, evidence-based program for disinvestment was being established within a large Australian health service network. Consumer engagement was acknowledged as integral to this process. This paper reports the process of developing a model to integrate consumer views and preferences into an organisation-wide approach to resource allocation. A literature search was conducted and interviews and workshops were undertaken with health service consumers and staff. Findings were drafted into a model for consumer engagement in resource allocation which was workshopped and refined. Although consumer engagement is increasingly becoming a requirement of publicly-funded health services and documented in standards and policies, participation in organisational decision-making is not widespread. Several consistent messages for consumer engagement in this context emerged from the literature and consumer responses. Opportunities, settings and activities for consumer engagement through communication, consultation and participation were identified within the resource allocation process. Sources of information regarding consumer values and perspectives in publications and locally-collected data, and methods to use them in health service decision-making, were identified. A model bringing these elements together was developed. The proposed model presents potential opportunities and activities for consumer engagement in the context of resource allocation.

Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

PubMed

Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

2016-10-19

Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

Anomaly Detection in Power Quality at Data Centers

NASA Technical Reports Server (NTRS)

Grichine, Art; Solano, Wanda M.

2015-01-01

The goal during my internship at the National Center for Critical Information Processing and Storage (NCCIPS) is to implement an anomaly detection method through the StruxureWare SCADA Power Monitoring system. The benefit of the anomaly detection mechanism is to provide the capability to detect and anticipate equipment degradation by monitoring power quality prior to equipment failure. First, a study is conducted that examines the existing techniques of power quality management. Based on these findings, and the capabilities of the existing SCADA resources, recommendations are presented for implementing effective anomaly detection. Since voltage, current, and total harmonic distortion demonstrate Gaussian distributions, effective set-points are computed using this model, while maintaining a low false positive count.

Pendulum Exercises After Hip Arthroscopy: A Video Technique.

PubMed

Sauber, Ryan; Saborio, George; Nickel, Beth M; Kivlan, Benjamin R; Christoforetti, John J

2016-08-01

Advanced hip joint-preserving arthroscopic techniques have been shown to improve patient-reported functional outcomes with low rates of postoperative complications. Prior work has shown that formation of adhesive scar is a potential source of persistent pain and cause for revision surgery. As resources for postoperative in-studio physical therapy become scarce, a home-based strategy to avoid scar formation without adding formal therapy cost may be beneficial. The purpose of this technical note is to introduce a patient-centered educational video technique for home-caregiver delivery of manual hip pendulum exercises in the postoperative setting. This video technique offers access to our method for pendulum exercise as part of early recovery after advanced hip arthroscopy.

Root System Water Consumption Pattern Identification on Time Series Data

PubMed Central

Figueroa, Manuel; Pope, Christopher

2017-01-01

In agriculture, soil and meteorological sensors are used along low power networks to capture data, which allows for optimal resource usage and minimizing environmental impact. This study uses time series analysis methods for outliers’ detection and pattern recognition on soil moisture sensor data to identify irrigation and consumption patterns and to improve a soil moisture prediction and irrigation system. This study compares three new algorithms with the current detection technique in the project; the results greatly decrease the number of false positives detected. The best result is obtained by the Series Strings Comparison (SSC) algorithm averaging a precision of 0.872 on the testing sets, vastly improving the current system’s 0.348 precision. PMID:28621739

Root System Water Consumption Pattern Identification on Time Series Data.

PubMed

Figueroa, Manuel; Pope, Christopher

2017-06-16

In agriculture, soil and meteorological sensors are used along low power networks to capture data, which allows for optimal resource usage and minimizing environmental impact. This study uses time series analysis methods for outliers' detection and pattern recognition on soil moisture sensor data to identify irrigation and consumption patterns and to improve a soil moisture prediction and irrigation system. This study compares three new algorithms with the current detection technique in the project; the results greatly decrease the number of false positives detected. The best result is obtained by the Series Strings Comparison (SSC) algorithm averaging a precision of 0.872 on the testing sets, vastly improving the current system's 0.348 precision.

Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health.

PubMed

Rasooly, Reuven; Bruck, Hugh Alan; Balsam, Joshua; Prickril, Ben; Ossandon, Miguel; Rasooly, Avraham

2016-05-17

Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD) cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB), and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1) image stacking to improve signal-to-noise ratios; (2) lasers to enable fluorescence excitation for flow cytometry; and (3) streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities), and provide for their use in low-cost medical diagnostics in resource-poor settings.

Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

PubMed Central

Rasooly, Reuven; Bruck, Hugh Alan; Balsam, Joshua; Prickril, Ben; Ossandon, Miguel; Rasooly, Avraham

2016-01-01

Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD) cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB), and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1) image stacking to improve signal-to-noise ratios; (2) lasers to enable fluorescence excitation for flow cytometry; and (3) streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities), and provide for their use in low-cost medical diagnostics in resource-poor settings. PMID:27196933

Integrating Soft Set Theory and Fuzzy Linguistic Model to Evaluate the Performance of Training Simulation Systems

PubMed Central

Chang, Kuei-Hu; Chang, Yung-Chia; Chain, Kai; Chung, Hsiang-Yu

2016-01-01

The advancement of high technologies and the arrival of the information age have caused changes to the modern warfare. The military forces of many countries have replaced partially real training drills with training simulation systems to achieve combat readiness. However, considerable types of training simulation systems are used in military settings. In addition, differences in system set up time, functions, the environment, and the competency of system operators, as well as incomplete information have made it difficult to evaluate the performance of training simulation systems. To address the aforementioned problems, this study integrated analytic hierarchy process, soft set theory, and the fuzzy linguistic representation model to evaluate the performance of various training simulation systems. Furthermore, importance–performance analysis was adopted to examine the influence of saving costs and training safety of training simulation systems. The findings of this study are expected to facilitate applying military training simulation systems, avoiding wasting of resources (e.g., low utility and idle time), and providing data for subsequent applications and analysis. To verify the method proposed in this study, the numerical examples of the performance evaluation of training simulation systems were adopted and compared with the numerical results of an AHP and a novel AHP-based ranking technique. The results verified that not only could expert-provided questionnaire information be fully considered to lower the repetition rate of performance ranking, but a two-dimensional graph could also be used to help administrators allocate limited resources, thereby enhancing the investment benefits and training effectiveness of a training simulation system. PMID:27598390

Integrating Soft Set Theory and Fuzzy Linguistic Model to Evaluate the Performance of Training Simulation Systems.

PubMed

Chang, Kuei-Hu; Chang, Yung-Chia; Chain, Kai; Chung, Hsiang-Yu

2016-01-01

The advancement of high technologies and the arrival of the information age have caused changes to the modern warfare. The military forces of many countries have replaced partially real training drills with training simulation systems to achieve combat readiness. However, considerable types of training simulation systems are used in military settings. In addition, differences in system set up time, functions, the environment, and the competency of system operators, as well as incomplete information have made it difficult to evaluate the performance of training simulation systems. To address the aforementioned problems, this study integrated analytic hierarchy process, soft set theory, and the fuzzy linguistic representation model to evaluate the performance of various training simulation systems. Furthermore, importance-performance analysis was adopted to examine the influence of saving costs and training safety of training simulation systems. The findings of this study are expected to facilitate applying military training simulation systems, avoiding wasting of resources (e.g., low utility and idle time), and providing data for subsequent applications and analysis. To verify the method proposed in this study, the numerical examples of the performance evaluation of training simulation systems were adopted and compared with the numerical results of an AHP and a novel AHP-based ranking technique. The results verified that not only could expert-provided questionnaire information be fully considered to lower the repetition rate of performance ranking, but a two-dimensional graph could also be used to help administrators allocate limited resources, thereby enhancing the investment benefits and training effectiveness of a training simulation system.

Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings.

PubMed

Lopez, Melissa S; Baker, Ellen S; Milbourne, Andrea M; Gowen, Rose M; Rodriguez, Ana M; Lorenzoni, Cesaltina; Mwaba, Catherine; Msadabwe, Susan Citonje; Tavares, José Humberto; Fontes-Cintra, Georgia; Zucca-Matthes, Gustavo; Callegaro-Filho, Donato; Ramos-Martin, Danielle; Thiago de Carvalho, Icaro; Coelho, Robson; Marques, Renato Moretti; Chulam, Thiago; Pontremoli-Salcedo, Mila; Nozar, Fernanda; Fiol, Veronica; Maza, Mauricio; Arora, Sanjeev; Hawk, Ernest T; Schmeler, Kathleen M

2017-10-01

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study

PubMed Central

Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede

2015-01-01

Background Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. Objective The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. Methods This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Results Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. Conclusions The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions. ClinicalTrial Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY) PMID:26582138

Graphical Methods for Reducing, Visualizing and Analyzing Large Data Sets Using Hierarchical Terminologies

PubMed Central

Jing, Xia; Cimino, James J.

2011-01-01

Objective: To explore new graphical methods for reducing and analyzing large data sets in which the data are coded with a hierarchical terminology. Methods: We use a hierarchical terminology to organize a data set and display it in a graph. We reduce the size and complexity of the data set by considering the terminological structure and the data set itself (using a variety of thresholds) as well as contributions of child level nodes to parent level nodes. Results: We found that our methods can reduce large data sets to manageable size and highlight the differences among graphs. The thresholds used as filters to reduce the data set can be used alone or in combination. We applied our methods to two data sets containing information about how nurses and physicians query online knowledge resources. The reduced graphs make the differences between the two groups readily apparent. Conclusions: This is a new approach to reduce size and complexity of large data sets and to simplify visualization. This approach can be applied to any data sets that are coded with hierarchical terminologies. PMID:22195119

Dynamic autonomous routing technology for IP-based satellite ad hoc networks

NASA Astrophysics Data System (ADS)

Wang, Xiaofei; Deng, Jing; Kostas, Theresa; Rajappan, Gowri

2014-06-01

IP-based routing for military LEO/MEO satellite ad hoc networks is very challenging due to network and traffic heterogeneity, network topology and traffic dynamics. In this paper, we describe a traffic priority-aware routing scheme for such networks, namely Dynamic Autonomous Routing Technology (DART) for satellite ad hoc networks. DART has a cross-layer design, and conducts routing and resource reservation concurrently for optimal performance in the fluid but predictable satellite ad hoc networks. DART ensures end-to-end data delivery with QoS assurances by only choosing routing paths that have sufficient resources, supporting different packet priority levels. In order to do so, DART incorporates several resource management and innovative routing mechanisms, which dynamically adapt to best fit the prevailing conditions. In particular, DART integrates a resource reservation mechanism to reserve network bandwidth resources; a proactive routing mechanism to set up non-overlapping spanning trees to segregate high priority traffic flows from lower priority flows so that the high priority flows do not face contention from low priority flows; a reactive routing mechanism to arbitrate resources between various traffic priorities when needed; a predictive routing mechanism to set up routes for scheduled missions and for anticipated topology changes for QoS assurance. We present simulation results showing the performance of DART. We have conducted these simulations using the Iridium constellation and trajectories as well as realistic military communications scenarios. The simulation results demonstrate DART's ability to discriminate between high-priority and low-priority traffic flows and ensure disparate QoS requirements of these traffic flows.

Collaboratively reframing mental health for integration of HIV care in Ethiopia†

PubMed Central

Wissow, Lawrence S.; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

2015-01-01

Background Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. Method We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. Results In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient–provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists’ settings and clinical goals. Conclusions An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time. PMID:25012090

A public health approach to cervical cancer control: considerations of screening and vaccination strategies.

PubMed

Goldie, Sue

2006-11-01

Cervical cancer remains a leading cause of cancer death among women living in low-resource settings. In the last 3 decades, cytologic screening has -in theory -been available and yet more than 6 million women have died of this preventable disease. The necessary resources, infrastructure, and technological expertise, together with the need for repeated screenings at regular intervals, make cytologic screening difficult to implement in poor countries. As noncytologic approaches for the detection of HPV, simple visual screening methods for anogenital lesions caused by HPV, and the availability of an HPV-16/18 vaccine will enhance the linkage between screening and treatment, multiple factors will need to be considered when designing new, or modifying existing prevention strategies. Countryspecific decisions regarding the best strategy for cervical cancer control will need to rely on data from many sources and take into account complex epidemiologic, economic, social, political, and cultural factors, and be made despite uncertainty and incomplete information. A rigorous decision analytic approach using computerbased modeling methods enables linkage of the knowledge gained from empirical studies to real-world situations. This chapter provides an introduction to these methods, reviews lessons learned from cost-effectiveness analyses of cervical cancer screening in developed and developing countries, and emphasizes important qualitative themes to consider in designing cervical cancer prevention policies.

Dissemination of health-related research among scientists in three countries: access to resources and current practices.

PubMed

Tabak, Rachel G; Reis, Rodrigo S; Wilson, Paul; Brownson, Ross C

2015-01-01

In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap.

Global Health Initiatives of the International Oncology Community.

PubMed

Al-Sukhun, Sana; de Lima Lopes, Gilberto; Gospodarowicz, Mary; Ginsburg, Ophira; Yu, Peter Paul

2017-01-01

Cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries (LMICs), where 60% of the world's total new cases are diagnosed. The challenge for effective control of cancer is multifaceted. It mandates integration of effective cancer prevention, encouraging early detection, and utilization of resource-adapted therapeutic and supportive interventions. In the resource-constrained setting, it becomes challenging to deliver each service optimally, and efficient allocation of resources is the best way to improve the outcome. This concept was translated into action through development of resource-stratified guidelines, pioneered by the Breast Health Global Initiative (BHGI), and later adopted by most oncology societies in an attempt to help physicians deliver the best possible care in a limited-resource setting. Improving outcome entails collaboration between key stakeholders, including the pharmaceutical industry, local and national health authorities, the World Health Organization (WHO), and other nonprofit, patient-oriented organizations. Therefore, we started to observe global health initiatives-led by ASCO, the Union for International Cancer Control (UICC), and the WHO-to address these challenges at the international level. This article discusses some of these initiatives.

Interrogating scarcity: how to think about 'resource-scarce settings'.

PubMed

Schrecker, Ted

2013-07-01

The idea of resource scarcity permeates health ethics and health policy analysis in various contexts. However, health ethics inquiry seldom asks-as it should-why some settings are 'resource-scarce' and others not. In this article I describe interrogating scarcity as a strategy for inquiry into questions of resource allocation within a single political jurisdiction and, in particular, as an approach to the issue of global health justice in an interconnected world. I demonstrate its relevance to the situation of low- and middle-income countries (LMICs) with brief descriptions of four elements of contemporary globalization: trade agreements; the worldwide financial marketplace and capital flight; structural adjustment; imperial geopolitics and foreign policy. This demonstration involves not only health care, but also social determinants of health. Finally, I argue that interrogating scarcity provides the basis for a new, critical approach to health policy at the interface of ethics and the social sciences, with specific reference to market fundamentalism as the value system underlying contemporary globalization.

Classical multiparty computation using quantum resources

NASA Astrophysics Data System (ADS)

Clementi, Marco; Pappa, Anna; Eckstein, Andreas; Walmsley, Ian A.; Kashefi, Elham; Barz, Stefanie

2017-12-01

In this work, we demonstrate a way to perform classical multiparty computing among parties with limited computational resources. Our method harnesses quantum resources to increase the computational power of the individual parties. We show how a set of clients restricted to linear classical processing are able to jointly compute a nonlinear multivariable function that lies beyond their individual capabilities. The clients are only allowed to perform classical xor gates and single-qubit gates on quantum states. We also examine the type of security that can be achieved in this limited setting. Finally, we provide a proof-of-concept implementation using photonic qubits that allows four clients to compute a specific example of a multiparty function, the pairwise and.

Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in Haiti.

PubMed

deRiel, E; Puttkammer, N; Hyppolite, N; Diallo, J; Wagner, S; Honoré, J G; Balan, J G; Celestin, N; Vallès, J S; Duval, N; Thimothé, G; Boncy, J; Coq, N R L; Barnhart, S

2018-03-01

Electronic health information systems, including electronic medical records (EMRs), have the potential to improve access to information and quality of care, among other things. Success factors and challenges for novel EMR implementations in low-resource settings have increasingly been studied, although less is known about maturing systems and sustainability. One systematic review identified seven categories of implementation success factors: ethical, financial, functionality, organizational, political, technical and training. This case study applies this framework to iSanté, Haiti's national EMR in use in more than 100 sites and housing records for more than 750 000 patients. The author group, consisting of representatives of different agencies within the Haitian Ministry of Health (MSPP), funding partner the Centers for Disease Control and Prevention (CDC) Haiti, and implementing partner the International Training and Education Center for Health (I-TECH), identify successes and lessons learned according to the seven identified categories, and propose an additional cross-cutting category, sustainability. Factors important for long-term implementation success of complex information systems are balancing investments in hardware and software infrastructure upkeep, user capacity and data quality control; designing and building a system within the context of the greater eHealth ecosystem with a plan for interoperability and data exchange; establishing system governance and strong leadership to support local system ownership and planning for system financing to ensure sustainability. Lessons learned from 10 years of implementation of the iSanté EMR system are relevant to sustainability of a full range of increasingly interrelated information systems (e.g. for laboratory, supply chain, pharmacy and human resources) in the health sector in low-resource settings. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A collaborative comparison of objective structured clinical examination (OSCE) standard setting methods at Australian medical schools.

PubMed

Malau-Aduli, Bunmi Sherifat; Teague, Peta-Ann; D'Souza, Karen; Heal, Clare; Turner, Richard; Garne, David L; van der Vleuten, Cees

2017-12-01

A key issue underpinning the usefulness of the OSCE assessment to medical education is standard setting, but the majority of standard-setting methods remain challenging for performance assessment because they produce varying passing marks. Several studies have compared standard-setting methods; however, most of these studies are limited by their experimental scope, or use data on examinee performance at a single OSCE station or from a single medical school. This collaborative study between 10 Australian medical schools investigated the effect of standard-setting methods on OSCE cut scores and failure rates. This research used 5256 examinee scores from seven shared OSCE stations to calculate cut scores and failure rates using two different compromise standard-setting methods, namely the Borderline Regression and Cohen's methods. The results of this study indicate that Cohen's method yields similar outcomes to the Borderline Regression method, particularly for large examinee cohort sizes. However, with lower examinee numbers on a station, the Borderline Regression method resulted in higher cut scores and larger difference margins in the failure rates. Cohen's method yields similar outcomes as the Borderline Regression method and its application for benchmarking purposes and in resource-limited settings is justifiable, particularly with large examinee numbers.

A simplified risk-ranking system for prioritizing toxic pollution sites in low- and middle-income countries.

PubMed

Caravanos, Jack; Gualtero, Sandra; Dowling, Russell; Ericson, Bret; Keith, John; Hanrahan, David; Fuller, Richard

2014-01-01

In low- and middle-income countries (LMICs), chemical exposures in the environment due to hazardous waste sites and toxic pollutants are typically poorly documented and their health impacts insufficiently quantified. Furthermore, there often is only limited understanding of the health and environmental consequences of point source pollution problems, and little consensus on how to assess and rank them. The contributions of toxic environmental exposures to the global burden of disease are not well characterized. The aim of this study was to describe the simple but effective approach taken by Blacksmith Institute's Toxic Sites Identification Program to quantify and rank toxic exposures in LMICs. This system is already in use at more than 3000 sites in 48 countries such as India, Indonesia, China, Ghana, Kenya, Tanzania, Peru, Bolivia, Argentina, Uruguay, Armenia, Azerbaijan, and Ukraine. A hazard ranking system formula, the Blacksmith Index (BI), takes into account important factors such as the scale of the pollution source, the size of the population possibly affected, and the exposure pathways, and is designed for use reliably in low-resource settings by local personnel provided with limited training. Four representative case studies are presented, with varying locations, populations, pollutants, and exposure pathways. The BI was successfully applied to assess the extent and severity of environmental pollution problems at these sites. The BI is a risk-ranking tool that provides direct and straightforward characterization, quantification, and prioritization of toxic pollution sites in settings where time, money, or resources are limited. It will be an important and useful tool for addressing toxic pollution problems in LMICs. Although the BI does not have the sophistication of the US Environmental Protection Agency's Hazard Ranking System, the case studies presented here document the effectiveness of the BI in the field, especially in low-resource settings. Understanding of the risks posed by toxic pollution sites helps assure better use of resources to manage sites and mitigate risks to public health. Quantification of these hazards is an important input to assessments of the global burden of disease. Copyright © 2014 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Airborne Gravity Survey and Ground Gravity in Afghanistan: A Website for Distribution of Data

USGS Publications Warehouse

Abraham, Jared D.; Anderson, Eric D.; Drenth, Benjamin J.; Finn, Carol A.; Kucks, Robert P.; Lindsay, Charles R.; Phillips, Jeffrey D.; Sweeney, Ronald E.

2008-01-01

Afghanistan?s geologic setting suggests significant natural resource potential. Although important mineral deposits and petroleum resources have been identified, much of the country?s potential remains unknown. Airborne geophysical surveys are a well- accepted and cost-effective method for remotely obtaining information of the geological setting of an area. A regional airborne geophysical survey was proposed due to the security situation and the large areas of Afghanistan that have not been covered using geophysical exploration methods. Acting upon the request of the Islamic Republic of Afghanistan Ministry of Mines, the U.S. Geological Survey contracted with the U.S. Naval Research Laboratory to jointly conduct an airborne geophysical and remote sensing survey of Afghanistan. Data collected during this survey will provide basic information for mineral and petroleum exploration studies that are important for the economic development of Afghanistan. Additionally, use of these data is broadly applicable in the assessment of water resources and natural hazards, the inventory and planning of civil infrastructure and agricultural resources, and the construction of detailed maps. The U.S. Geological Survey is currently working in cooperation with the U.S. Agency of International Development to conduct resource assessments of the country of Afghanistan for mineral, energy, coal, and water resources, and to assess geologic hazards. These geophysical and remote sensing data will be used directly in the resource and hazard assessments.

CONSTRUCTION AND VALIDATION OF LOW COST LAPAROSCOPIC SIMULATOR USING ANDROID SMARTPHONE AND POP CAST AND A LAPTOP.

PubMed

Vyas, A; Goel, G

2017-09-01

Minimal invasive surgery training requires a lot of practice and for this purpose innovative tools are needed to develop methods for practice and training skills outside the operating room. Commercially available devices are readily available but cost effectiveness and availability are major limiting factors in resource limited setting. We present an innovative and cost effective laparoscopic simulator which can be easily manufactured and used for practice of laparoscopic surgery. Using a free android application, such as IP webcam we can relay video to laptop without the use of any cables and uniquely we use the flash of a camera as the light source and a selfie stick for movement of the camera. Use of this type of setup can help to reduce cost of simulated learning in low income countries and makes laparoscopic training facilities readily available. Copyright© Authors.

An accurate and inexpensive color-based assay for detecting severe anemia in a limited-resource setting

PubMed Central

McGann, Patrick T.; Tyburski, Erika A.; de Oliveira, Vysolela; Santos, Brigida; Ware, Russell E.; Lam, Wilbur A.

2016-01-01

Severe anemia is an important cause of morbidity and mortality among children in resource-poor settings, but laboratory diagnostics are often limited in these locations. To address this need, we developed a simple, inexpensive, and color-based point-of-care (POC) assay to detect severe anemia. The purpose of this study was to evaluate the accuracy of this novel POC assay to detect moderate and severe anemia in a limited-resource setting. The study was a cross-sectional study conducted on children with sickle cell anemia in Luanda, Angola. The hemoglobin concentrations obtained by the POC assay were compared to reference values measured by a calibrated automated hematology analyzer. A total of 86 samples were analyzed (mean hemoglobin concentration 6.6 g/dL). There was a strong correlation between the hemoglobin concentrations obtained by the POC assay and reference values obtained from an automated hematology analyzer (r=0.88, P<0.0001). The POC assay demonstrated excellent reproducibility (r=0.93, P<0.0001) and the reagents appeared to be durable in a tropical setting (r=0.93, P<0.0001). For the detection of severe anemia that may require blood transfusion (hemoglobin <5 g/dL), the POC assay had sensitivity of 88.9% and specificity of 98.7%. These data demonstrate that an inexpensive (<$0.25 USD) POC assay accurately estimates low hemoglobin concentrations and has the potential to become a transformational diagnostic tool for severe anemia in limited-resource settings. PMID:26317494

The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study).

PubMed

Massa, Ilaria; Balzi, William; Burattini, Costanza; Gentili, Nicola; Bucchi, Lauro; Nanni, Oriana; Gallegati, Davide; Pierini, Andrea; Amadori, Dino; Falcini, Fabio; Altini, Mattia

2017-08-01

In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Homology-based hydrogen bond information improves crystallographic structures in the PDB.

PubMed

van Beusekom, Bart; Touw, Wouter G; Tatineni, Mahidhar; Somani, Sandeep; Rajagopal, Gunaretnam; Luo, Jinquan; Gilliland, Gary L; Perrakis, Anastassis; Joosten, Robbie P

2018-03-01

The Protein Data Bank (PDB) is the global archive for structural information on macromolecules, and a popular resource for researchers, teachers, and students, amassing more than one million unique users each year. Crystallographic structure models in the PDB (more than 100,000 entries) are optimized against the crystal diffraction data and geometrical restraints. This process of crystallographic refinement typically ignored hydrogen bond (H-bond) distances as a source of information. However, H-bond restraints can improve structures at low resolution where diffraction data are limited. To improve low-resolution structure refinement, we present methods for deriving H-bond information either globally from well-refined high-resolution structures from the PDB-REDO databank, or specifically from on-the-fly constructed sets of homologous high-resolution structures. Refinement incorporating HOmology DErived Restraints (HODER), improves geometrical quality and the fit to the diffraction data for many low-resolution structures. To make these improvements readily available to the general public, we applied our new algorithms to all crystallographic structures in the PDB: using massively parallel computing, we constructed a new instance of the PDB-REDO databank (https://pdb-redo.eu). This resource is useful for researchers to gain insight on individual structures, on specific protein families (as we demonstrate with examples), and on general features of protein structure using data mining approaches on a uniformly treated dataset. © 2017 The Protein Society.

Evaluation of paradoxical TB–associated IRIS with the use of standardized case definitions for resource limited settings

PubMed Central

Eshun-Wilson, Ingrid; Havers, Fiona; Nachega, Jean B; Prozesky, Hans W; Taljaard, Jantjie J; Zeier, Michele D; Cotton, Mark; Simon, Gary; Soentjens, Patrick

2011-01-01

Objective Standardized case definitions have recently been proposed by the International Network for the Study of HIV-associated IRIS (INSHI) for use in resource-limited settings. We evaluated paradoxical TB-associated IRIS in a large cohort from a TB endemic setting with the use of these case definitions. Design A retrospective cohort analysis. Methods We reviewed records from 1250 South African patients who initiated anti-retroviral therapy (ART) over a five-year period. Results 333 (27%) of the patients in the cohort had prevalent TB at the initiation of ART. Of 54 possible paradoxical TB-associated IRIS cases, 35 fulfilled the INSHI case definitions (11% of TB cases). Conclusions INSHI standardised case definitions were used successfully in identifying paradoxical TB-associated IRIS in this cohort and resulted in a similar proportion of TB IRIS cases (11%) as that reported in previous studies from resource-limited settings (8-13%). This case definition should be evaluated prospectively. PMID:20160249

Taming the BEAST—A Community Teaching Material Resource for BEAST 2

PubMed Central

Barido-Sottani, Joëlle; Bošková, Veronika; Plessis, Louis Du; Kühnert, Denise; Magnus, Carsten; Mitov, Venelin; Müller, Nicola F.; PečErska, Jūlija; Rasmussen, David A.; Zhang, Chi; Drummond, Alexei J.; Heath, Tracy A.; Pybus, Oliver G.; Vaughan, Timothy G.; Stadler, Tanja

2018-01-01

Abstract Phylogenetics and phylodynamics are central topics in modern evolutionary biology. Phylogenetic methods reconstruct the evolutionary relationships among organisms, whereas phylodynamic approaches reveal the underlying diversification processes that lead to the observed relationships. These two fields have many practical applications in disciplines as diverse as epidemiology, developmental biology, palaeontology, ecology, and linguistics. The combination of increasingly large genetic data sets and increases in computing power is facilitating the development of more sophisticated phylogenetic and phylodynamic methods. Big data sets allow us to answer complex questions. However, since the required analyses are highly specific to the particular data set and question, a black-box method is not sufficient anymore. Instead, biologists are required to be actively involved with modeling decisions during data analysis. The modular design of the Bayesian phylogenetic software package BEAST 2 enables, and in fact enforces, this involvement. At the same time, the modular design enables computational biology groups to develop new methods at a rapid rate. A thorough understanding of the models and algorithms used by inference software is a critical prerequisite for successful hypothesis formulation and assessment. In particular, there is a need for more readily available resources aimed at helping interested scientists equip themselves with the skills to confidently use cutting-edge phylogenetic analysis software. These resources will also benefit researchers who do not have access to similar courses or training at their home institutions. Here, we introduce the “Taming the Beast” (https://taming-the-beast.github.io/) resource, which was developed as part of a workshop series bearing the same name, to facilitate the usage of the Bayesian phylogenetic software package BEAST 2. PMID:28673048

Taming the BEAST-A Community Teaching Material Resource for BEAST 2.

PubMed

Barido-Sottani, Joëlle; Bošková, Veronika; Plessis, Louis Du; Kühnert, Denise; Magnus, Carsten; Mitov, Venelin; Müller, Nicola F; PecErska, Julija; Rasmussen, David A; Zhang, Chi; Drummond, Alexei J; Heath, Tracy A; Pybus, Oliver G; Vaughan, Timothy G; Stadler, Tanja

2018-01-01

Phylogenetics and phylodynamics are central topics in modern evolutionary biology. Phylogenetic methods reconstruct the evolutionary relationships among organisms, whereas phylodynamic approaches reveal the underlying diversification processes that lead to the observed relationships. These two fields have many practical applications in disciplines as diverse as epidemiology, developmental biology, palaeontology, ecology, and linguistics. The combination of increasingly large genetic data sets and increases in computing power is facilitating the development of more sophisticated phylogenetic and phylodynamic methods. Big data sets allow us to answer complex questions. However, since the required analyses are highly specific to the particular data set and question, a black-box method is not sufficient anymore. Instead, biologists are required to be actively involved with modeling decisions during data analysis. The modular design of the Bayesian phylogenetic software package BEAST 2 enables, and in fact enforces, this involvement. At the same time, the modular design enables computational biology groups to develop new methods at a rapid rate. A thorough understanding of the models and algorithms used by inference software is a critical prerequisite for successful hypothesis formulation and assessment. In particular, there is a need for more readily available resources aimed at helping interested scientists equip themselves with the skills to confidently use cutting-edge phylogenetic analysis software. These resources will also benefit researchers who do not have access to similar courses or training at their home institutions. Here, we introduce the "Taming the Beast" (https://taming-the-beast.github.io/) resource, which was developed as part of a workshop series bearing the same name, to facilitate the usage of the Bayesian phylogenetic software package BEAST 2. © The Author(s) 2017. Published by Oxford University Press, on behalf of the Society of Systematic Biologists.

Pathway to Independence: Implications for Developing A Sustainable MIS Program in low Resource settings.

PubMed

Mobolaji, Oludara; Fiemu, Nwariaku; Akanmu, Ibrahim; Kish, Pursnani; Omolara, Williams; Foluso, Omodele; Roland, Osuoji; Stephen, Ikuerowo; Adebimpe, Aderounmu

2013-01-01

Gastrointestinal surgery has been at the forefront of advances in minimally invasive surgery (MIS). In the low resource settings of the developing countries, despite the benefits of MIS, its uptake in sub-Saharan African countries has been slow. The present study reports the process of developing a minimally-invasive surgery service line as well as surgical outcomes in LASUTH. METHODS. We reviewed medical records of all patients who underwent minimally invasive surgery at LASUTH between March 2011 and March 2012. During each of three training missions in LASUTH patients with Gastrointestinal and gynaecological surgical conditions were carefully selected, and prepared for surgery. All patients were admitted a day prior to surgery. A description of the surgical technique and the skills training used is also presented. A total of 24 laparoscopic procedures were performed between March 2011 and March 2012. There were more females 17(70.8%) than males 7(29.2%), with a female to male ratio of 2.5:1. The age range was from 18 yrs to 75 yrs with a peak in the age group between 21-30 yrs. The chief complaints were right hypochondrial pain in 9 cases (37.5%) and right iliac fossa pain in 6 cases (25%) whilst others were right groin swelling, dysphagia, infertility and intersex state. The results presented in respect of conversion rate, length of post operative stay and complications rate are similar to the pattern in more established centers. The use of team training as done in LASUTH helps to accelerate the rate of learning and ensures sustainability.

Streptococcal pharyngitis in schoolchildren in Bamako, Mali.

PubMed

Tapia, Milagritos D; Sow, Samba O; Tamboura, Boubou; Keita, Mahamadou M; Berthe, Abdoulaye; Samake, Mariam; Nataro, James P; Onwuchekwa, Uma O; Penfound, Thomas A; Blackwelder, William; Dale, James B; Kotloff, Karen L

2015-05-01

Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren. Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.

Assessing the global reach and value of a provider-facing healthcare app using large-scale analytics

PubMed Central

Easton, George; Gillespie, Scott

2017-01-01

Background The rapid global adoption of mobile health (mHealth) smartphone apps by healthcare providers presents challenges and opportunities in medicine. Challenges include ensuring the delivery of high-quality, up-to-date and optimised information. Opportunities include the ability to study global practice patterns, access to medical and surgical care and continuing medical education needs. Methods We studied users of a free anaesthesia calculator app used worldwide. We combined traditional app analytics with in-app surveys to collect user demographics and feedback. Results 31 173 subjects participated. Users were from 206 countries and represented a spectrum of healthcare provider roles. Low-income country users had greater rates of app use (p<0.001) and ascribed greater importance of the app to their practice (p<0.001). Physicians from low-income countries were more likely to adopt the app (p<0.001). The app was used primarily for paediatric patients. The app was used around the clock, peaking during times typical for first start cases. Conclusions This mHealth app is a valuable decision support tool for global healthcare providers, particularly those in more resource-limited settings and with less training. App adoption and use may provide a mechanism for measuring longitudinal changes in access to surgical care and engaging providers in resource-limited settings. In-app surveys and app analytics provide a window into healthcare provider behaviour at a breadth and level of detail previously impossible to achieve. Given the potentially immense value of crowdsourced information, healthcare providers should be encouraged to participate in these types of studies. PMID:29082007

Construction of an evaluation index system of water resources bearing capacity: An empirical study in Xi’an, China

NASA Astrophysics Data System (ADS)

Qu, X. E.; Zhang, L. L.

2017-08-01

In this paper, a comprehensive evaluation of the water resources bearing capacity of Xi’an is performed. By constructing a comprehensive evaluation index system of the water resources bearing capacity that included water resources, economy, society, and ecological environment, we empirically studied the dynamic change and regional differences of the water resources bearing capacities of Xi’an districts through the TOPSIS method (Technique for Order Preference by Similarity to an Ideal Solution). Results show that the water resources bearing capacity of Xi’an significantly increased over time, and the contributions of the subsystems from high to low are as follows: water resources subsystem, social subsystem, ecological subsystem, and economic subsystem. Furthermore, there are large differences between the water resources bearing capacities of the different districts in Xi’an. The water resources bearing capacities from high to low are urban areas, Huxian, Zhouzhi, Gaoling, and Lantian. Overall, the water resources bearing capacity of Xi’an is still at a the lower level, which is highly related to the scarcity of water resources, population pressure, insufficient water saving consciousness, irrational industrial structure, low water-use efficiency, and so on.

Challenges and impact of conducting vaccine trials in Asia and Africa

PubMed Central

Kochhar, Sonali

2013-01-01

Immunization is one of the most beneficial and cost-effective disease prevention measures. There are global efforts to develop new vaccines for disease control. The vaccine clinical trials must be conducted in the countries where they will be used. This has led to vaccine trials being conducted across Asia and Africa where there is a high burden of infectious diseases. The setup and successful conduct of International standard GCP vaccine trials across trial centers located in resource constrained settings are challenging. The challenges, ethical considerations and impact of the implementation of clinical trials in low-resource settings are highlighted here to help vaccine development programs successfully conduct such trials. PMID:23321645

A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings.

PubMed

Olusanya, B O; Iskander, I F; Slusher, T M; Wennberg, R P

2016-05-01

Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

Appointment systems are essential for improving chronic disease care in resource-poor settings: learning from experiences with HIV patients in Africa.

PubMed

Chalker, John C; Wagner, Anita K; Tomson, Göran; Johnson, Keith; Wahlström, Rolf; Ross-Degnan, Dennis

2013-09-01

Lessons learned from treating patients with HIV infection can inform care systems for other chronic conditions. For antiretroviral treatment, attending appointments on time correlates with medication adherence; however, HIV clinics in East Africa, where attendance rates vary widely, rarely include systems to schedule appointments or to track missed appointments or patient follow-up. An introduction of low-cost, paper-based patient appointment and tracking systems led to an improvement in timely clinic attendance rates and tracking missing patients. An effective appointment system is critical to managing patients with chronic conditions and can be introduced in resource-limited settings, possibly without having to add staff.

Low-cost bioanalysis on paper-based and its hybrid microfluidic platforms.

PubMed

Dou, Maowei; Sanjay, Sharma Timilsina; Benhabib, Merwan; Xu, Feng; Li, XiuJun

2015-12-01

Low-cost assays have broad applications ranging from human health diagnostics and food safety inspection to environmental analysis. Hence, low-cost assays are especially attractive for rural areas and developing countries, where financial resources are limited. Recently, paper-based microfluidic devices have emerged as a low-cost platform which greatly accelerates the point of care (POC) analysis in low-resource settings. This paper reviews recent advances of low-cost bioanalysis on paper-based microfluidic platforms, including fully paper-based and paper hybrid microfluidic platforms. In this review paper, we first summarized the fabrication techniques of fully paper-based microfluidic platforms, followed with their applications in human health diagnostics and food safety analysis. Then we highlighted paper hybrid microfluidic platforms and their applications, because hybrid platforms could draw benefits from multiple device substrates. Finally, we discussed the current limitations and perspective trends of paper-based microfluidic platforms for low-cost assays. Copyright © 2015 Elsevier B.V. All rights reserved.

Semi-supervised word polarity identification in resource-lean languages.

PubMed

Dehdarbehbahani, Iman; Shakery, Azadeh; Faili, Heshaam

2014-10-01

Sentiment words, as fundamental constitutive parts of subjective sentences, have a substantial effect on analysis of opinions, emotions and beliefs. Most of the proposed methods for identifying the semantic orientations of words exploit rich linguistic resources such as WordNet, subjectivity corpora, or polarity tagged words. Shortage of such linguistic resources in resource-lean languages affects the performance of word polarity identification in these languages. In this paper, we present a method which exploits a language with rich subjectivity analysis resources (English) to identify the polarity of words in a resource-lean foreign language. The English WordNet and a sparse foreign WordNet infrastructure are used to create a heterogeneous, multilingual and weighted semantic network. To identify the semantic orientation of foreign words, a random walk based method is applied to the semantic network along with a set of automatically weighted English positive and negative seeds. In a post-processing phase, synonym and antonym relations in the foreign WordNet are used to filter the random walk results. Our experiments on English and Persian languages show that the proposed method can outperform state-of-the-art word polarity identification methods in both languages. Copyright © 2014 Elsevier Ltd. All rights reserved.

Developing a mental health care plan in a low resource setting: the theory of change approach.

PubMed

Hailemariam, Maji; Fekadu, Abebaw; Selamu, Medhin; Alem, Atalay; Medhin, Girmay; Giorgis, Tedla Wolde; DeSilva, Mary; Breuer, Erica

2015-09-28

Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.

Patient's Self-Assessment of Social-Approval After Mandibulectomy with Disarticulation: the Necessity for Jaw Reconstruction Following Loss of Facial Symmetry in a Resource-Poor African Setting.

PubMed

Aluko-Olokun, Bayo; Olaitan, Ademola A

2017-12-01

Mandibulectomy with disarticulation is usually carried out without reconstruction in Low-Income-Countries. Lower standards of living are usually acceptable and adapted to, in poor societies. This study compares patient's self-assessment of social approval among reconstructed and non-reconstructed cases of mandibulectomy with disarticulation in a resource-poor African setting. This questionnaire-based study documented patient's self-assessment of social approval of themselves following mandibulectomy with disarticulation. 12 derived queries were administered on each patient, to test what they perceived of social acceptability of their facial features following mandibulectomy. All 10 patients who underwent mandibular reconstruction reported that they felt confident engaging in all forms of social activity, while all 10 who had resection without reconstruction did not. The low social approval perceived by patients who have undergone mandibulectomy with disarticulation without reconstruction necessitates that surgeons must strive to reconstruct this anatomical region even under circumstances of severe resource-constraint. The culture in the third-world is not supportive of patients who have not undergone reconstruction following resection, in spite of being victims of all-pervading poverty. Level IV, investigative study.