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Background Oxalate nephropathy is a rare disorder that can result in acute kidney injury (AKI) and progresses to end-stage kidney disease (ESKD). The causes can be either primary or secondary. Primary hyperoxaluria includes a group of hereditary disorders with enzymatic defects in the glyoxylate pathway, resulting in decreased oxalate metabolism. Secondary hyperoxaluria, often overlooked can result from increased intestinal absorption, nutritional deficiencies, decreased fluid intake, impaired excretion, and increased dietary consumption of oxalate. Case presentation We present a Caucasian case of acute oxalate induced nephropathy associated with consumption of large quantities of green vegetables in a patient with chronic kidney disease (CKD). Imaging study showed no evidence of kidney stone, but a kidney biopsy revealed acute tubular injury, tubular atrophy, interstitial fibrosis, and dense tubular deposition of calcium oxalate crystals. Upon further questioning the patient, we learned that in the months prior to presentation, he had very significantly increased his consumption of green vegetables. Because of no clinical improvement, the patient was initiated and maintained on hemodialysis. Conclusion This report illustrates a case of acute oxalate nephropathy in the setting of very high dietary consumption of oxalate-rich foods in a patient with advanced CKD. Special attention should be given to the secondary causes of hyperoxaluria in patients with predisposing conditions such as CKD.

Background Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. Conclusion Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.

Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.

This paper deals with the seismic vulnerability of monumental unreinforced masonry (URM) towers, the fragility of which has not yet been sufficiently studied. Thus, the present paper fills this gap by developing models to investigate the seismic response of URM towers up to collapse. On mount Athos, Greece, there exist more than a hundred medieval towers, having served mainly as campaniles or fortifications. Eight representative towers were selected for a thorough investigation to estimate their seismic response characteristics. Their history and architectural features are initially discussed and a two-step analysis follows: (i) limit analysis is performed to estimate the collapse mechanism and the locations of critical cracks, (ii) non-linear explicit dynamic analyses are then carried out, developing finite element (FE) simulations, with cracks modelled as interfacial surfaces to derive the capacity curves. A meaningful definition of the damage states is proposed based on the characteristics of their capacity curves, with the ultimate limit state related to collapse. The onset of slight damage-state is characterised by the formation and development of cracks responsible for the collapse mechanism of the structure. Apart from these two, another two additional limit states are also specified: the moderate damage-state and the extensive one. Fragility and vulnerability curves are finally generated which can help the assessment and preservation of cultural heritage URM towers.

Background Inadequate training of health care workers responsible for the sterilization of surgical instruments in low- and middle-income countries compromises the safety of workers and patients alike. Methods A mixed methods research study was initiated in the Lake Zone areas of Northwestern Tanzania in the summer of 2018. The goal was to identify the impact of education and training on sterile processing practices at ten hospitals. Quantitative data analyzed included hospital assessments of sterile processing practices prior to and 4 months after training, as well as participant test scores collected at the beginning of training, after 5 days of classes, and 4 months after mentorship was completed. Thematic analysis of interviews with participants 4 months post-training was completed to identify associated impact of training. Results Improvement in test scores were found to be directly related to sterile processing training. The greatest sterile processing practice changes identified through hospital assessments involved how instruments were cleaned, both at point of use and during the cleaning process, resulting in rusted and discoloured instruments appearing as new again. Themes identified in participant interviews included: changes in practice, challenges in implementing practice changes, resource constraints, personal and professional growth, and increased motivation, confidence and responsibility. Conclusions Providing education and follow up support for workers in sterile processing resulted in increased knowledge of best practices, application of knowledge in practice settings, and awareness of issues that need to be overcome to decrease risks for patients and health care workers alike. Further research is needed to identify the impact of mentorship on hospital sterile processing practices in order to provide clear direction for future spending on training courses.

The single most significant risk factor for testosterone deficiency in men is obesity. The pathophysiological mechanisms involved in male obesity-related secondary hypogonadism are highly complex. Obesity-induced increase in levels of leptin, insulin, proinflammatory cytokines and oestrogen can cause a functional hypogonadotrophic hypogonadism with the defect present at the level of the hypothalamic gonadotrophin-releasing hormone (GnRH) neurons. The resulting hypogonadism by itself can worsen obesity, creating a self-perpetuating cycle. Obesity-induced hypogonadism is reversible with substantial weight loss. Lifestyle-measures form the cornerstone of management as they can potentially improve androgen deficiency symptoms irrespective of their effect on testosterone levels. In selected patients, bariatric surgery can reverse the obesity-induced hypogonadism. If these measures fail to relieve symptoms and to normalise testosterone levels, in appropriately selected men, testosterone replacement therapy could be started. Aromatase inhibitors and selective oestrogen receptor modulators are not recommended due to lack of consistent clinical trial-based evidence.

Purpose: This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD). Methods: A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. Results: A total of 996 cases of rhegmatogenous and tractional retinal detachment repair were identified. The average time from the RD surgery to MH diagnosis was 72 days. The incidence of subsequent MH formation in patients who underwent surgery was 0.8% (8/996). The presence of ERM prior to MH repair was noted in 50% of these cases (4/8). In cases with at least 3 months of postoperative follow-up, MH closure was achieved in 100% of eyes after a single surgery. The mean preoperative visual acuity (VA) was 2.06 logMAR (logarithm of the minimum angle of resolution) units (Snellen equivalent, 20/2296) and significantly improved to 0.72 logMAR units (Snellen, 20/104; P = .017) at the last follow-up after MH repair. All patients had improvement in VA at the final postoperative visit, with a VA of 20/200 or better achieved in 87.5% of cases. Conclusions: Although MH formation after successful RD repair is uncommon, favorable visual and anatomic results can be obtained.

Artisanal and small-scale gold mining (ASGM) in Tanzania results in occupational exposures and environmental contamination to toxic chemical elements such as arsenic and mercury. Populations living in such areas may be exposed by various routes, and prenatal exposure to arsenic and mercury has been associated with adverse birth outcomes and developmental delays. The aim of this study was to determine if levels of arsenic and mercury differed among pregnant women living in areas with and without ASGM activities in Northern Tanzania. This cross-sectional study is part of the ongoing Mining and Health prospective longitudinal study. Spot urine samples and dried blood spots were collected at the antenatal health clinics from pregnant women (n = 1056) at 16-27 weeks gestation. Urine samples were analyzed for total arsenic (T-As) and dried blood spots were analyzed for total mercury (T-Hg). Women in the ASGM cohort had median T-As levels (9.4 μg/L; IQR: 4.9-15.1) and T-Hg levels (1.2 μg/L; IQR: 0.8-1.86) that were significantly higher than the median T-As levels (6.28 μg/L; IQR: 3.7-14.1) and T-Hg levels (0.66 μg/L; IQR: 0.3-1.2) of women in the non-ASGM cohort (Mann-Whitney U test, T-As: z = -9.881, p = 0.0005; T-Hg: z = -3.502, p 0.0001). Among pregnant women from ASGM areas, 25% had urinary T-As and 75% had blood T-Hg above the established human biomonitoring reference values of 15 and 0.80 μg/L. In the ASGM cohort, lower maternal education and low socioeconomic status increased the odds of higher T-As levels by 20% (p 0.05) and 10% (p 0.05), respectively. Women involved in mining activities and those of low socioeconomic status had increased odds of higher T-Hg by 70% (p 0.001) and 10% (p 0.05), respectively. Arsenic and mercury concentrations among women in non-ASGM areas suggest exposure sources beyond ASGM activities that need to be identified. Arsenic and mercury levels in women in Tanzania are of public health concern and their association with adverse birth and child developmental outcomes will be examined in future studies on this cohort.

Mining is an important source of revenue for many developing countries, however, the social, environmental and economic impacts of mining are often poorly monitored. The recent transition of a gold mine in Western Tanzania—from large-scale gold mine under private, multinational ownership, to medium-scale public and national owned mine with limited life length offers a prime opportunity to understand the implications of changes in ownership and scale on the local economy and community well-being. We conducted 44 semi-structured interviews with community members in four villages adjacent to the mine site. We find that the local economy and public service provision contracted in response to the mine transition and downscaling, with ramifications for food security and healthcare access. Community members also highlighted the lack of information surrounding the mine transformation. This illustrates that considering the post-transition phase of large-scale mines is important for providing long run sustainable livelihood strategies in mining communities.

The replacement of rear-view mirrors with camera-monitor systems introduces new opportunities for design, such as altering the image quality and the rearward field-of-view. We investigated how the image quality and field-of-view might affect the distance and time-to-contact estimation of other vehicles. Eighty-six subjects estimated either their egocentric distance to a stationary vehicle (Experiment I) or the time-to-contact to an approaching vehicle (Experiment II). Throughout the experiments, the pixel density and either the field-of-view or the viewing condition varied. A larger field-of-view increased distance estimation accuracy and confidence. Reduced pixel density led to larger estimates. In contrast, reduced pixel density and simulated dirt shortened time-to-contact estimates. This is compatible with a safety strategy applied under conditions of impaired vision. Moreover, a limited benefit was observed for higher pixel densities. Therefore, camera-monitor systems with large field-of-view and a pixel density of around 300 ppi could ensure accurate TTC and distance estimation. Practitioner summary: A camera’s field-of-view and image quality are important parameters for camera-monitor systems. In two experiments, we investigated the effects of these two parameters on rearward distance and time-to-contact estimation. Whereas a larger field-of-view improved distance estimation accuracy, increasing the pixel density had a limited effect in the estimation of time-to-contact.

Background: In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). Objectives: To verify the differences in TB and HIV services in EE vs. WE. Methods: Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. Results: Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. Conclusion: Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.

Anthony Kapesa,1 Namanya Basinda,1 Elias C Nyanza,2 Joshua Monge3,†, Sospatro E Ngallaba,4 Joseph R Mwanga,4 Eliningaya J Kweka5,6 1Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Department of Environmental and Occupational Health and GIS, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 3Department of Health, Ukerewe District Council, Mwanza, Tanzania; 4Department of Epidemiology, Biostatisticsand Behavioural Sciences, School of Public Health, Catholic University of Health Sciences and Allied Sciences, Mwanza, Tanzania; 5Department of Parasitology and Medical Entomology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 6Division of Livestock and Human Disease Vector Control, Tropical Pesticides Research Institute, Arusha, Tanzania†Deceased — died on June 16, 2019Correspondence: Eliningaya J Kweka Email eliningaya.kweka@tpri.go.tzBackground: Surveillance of the clinical morbidity of malaria remains key for disease monitoring for subsequent development of appropriate interventions. This case study presents the current status of malaria morbidities following a second round of mass distribution of long-lasting insecticidal nets (LLINs) on Ukerewe Island, northwestern Tanzania.Methods: A retrospective review of health-facility registers to determine causes of inpatient morbidities for every admitted child aged < 5 years was conducted to ascertain the contribution of malaria before and after distribution of LLINs. This review was conducted from August 2016 to July 2018 in three selected health facilities. To determine the trend of malaria admissions in the selected facilities, additional retrospective collection of all malaria and other causes of admission was conducted for both < 5- and > 5-year-old patients from July 2014 to June 2018. For comparison purposes, monthly admissions of malaria and other causes from all health facilities in the district were also collected. Moreover, an LLIN-coverage study was conducted among randomly selected households (n=684).Results: Between August 2016 and July 2018, malaria was the leading cause of inpatient morbidity, accounting for 44.1% and 20.3% among patients < 5 and > 5 years old, respectively. Between October 2017 and January 2018, the mean number of admissions of patients aged < 5 years increased 2.7-fold at one health center and 1.02-fold for all admissions in the district. Additionally, approximately half the households in the study area had poor of LLIN coverage 1 year after mass distribution.Conclusion: This trend analysis of inpatient morbidities among children aged < 5 years revealed an upsurge in malaria admissions in some health facilities in the district, despite LLIN intervention. This suggests the occurrence of an unnoticed outbreak of malaria admissions in all health facilities.Keywords: malaria surveillance, inpatient morbidity, children < 5 years old, Tanzania

Brain gliomas represent some of the most aggressive tumors encountered by modern medicine and, despite major efforts to optimize early diagnosis and treatment, the prognosis remains poor. Due to the complex structure of the brain and the unique mechanical properties of the extracellular matrix, gliomas invade and expand into the brain parenchyma, along white matter tracts and within perivascular spaces, usually sparing normal vessels. Different methods have been developed to study the mechanical properties of gliomas in a wide range of scales, from cells and the microscale to tissues and the macroscale. In this review, the current view on glioma mechanics is presented and the methods used to determine glioma mechanical properties are outlined. Their principles and current state of affairs are discussed.

Background: Artisanal and small-scale gold mining (ASGM) is associated with release of neurotoxic metallic or metalloid chemical elements including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As). Objective: To examine associations between prenatal exposure and co-exposure to total lead (T-Pb), total mercury (T-Hg), total cadmium (T-Cd) and total arsenic (T-As) and infant neurodevelopment at 6 to 12 months of age in areas with ASGM activities in Tanzania. Methods: Women in their second trimester of pregnancy who resided in ASGM areas were enrolled from 2015 to 2017 (n = 883). At 6 to 12 months of age, children were assessed with the Malawi Developmental Assessment Tool (MDAT) (n = 439). We measured T-Pb, T-Hg, and T-Cd in maternal dried blood spots and T-As in maternal urines. Poisson regression was used to examine associations between prenatal concentrations of these elements and neurodevelopmental outcomes. Results: Prenatal T-Hg concentration was associated with global neurodevelopment status (aPR 1.03, CI:1.01–1.04; p

Serous cystadenocarcinoma of the pancreas is a rare but well-established entity. The origin and evolution of this disorder remain unclear, but even metastatic cases have an excellent prognosis. These tumors are very similar to benign serous cystic neoplasms (SCNs) of the pancreas, except that they tend to be larger, are locally invasive, and present distant metastasis. The most frequent local invasion is adjacent vessels, spleen, stomach, and duodenum. The most common site of distant metastasis is the liver. Diagnosis via imaging as well as pathology examination may be misguided due to atypical characteristics of the tumor. In fact, in some, the diagnosis of malignancy was established only after metastases were detected. We present a 60-year-old female patient with malignant serous microcystic cystadenocarcinoma of the pancreas and liver metastasis that was initially misdiagnosed as a metastatic renal cell carcinoma. The patient underwent tumor resection and liver metastasectomy and she is currently doing well after three years of follow-up, with no tumor recurrence or new metastatic liver nodules based on imaging findings.

Background: Exposure to arsenic and mercury in artisanal and small-scale gold mining (ASGM) communities is an issue that predominantly affects low and middle-income countries. Large epidemiology studies in these communities are rare, and the impact of such exposures on reproductive outcomes are not well understood. Objective: To examine associations between prenatal maternal arsenic and mercury exposure and birth outcomes in both ASGM and non-ASGM communities in Northern Tanzania. Methods: This longitudinal prospective study included 961 women (ASGM = 788, non-ASGM = 173) of the original cohort of 1056 who were followed until a pregnancy outcome was registered. Maternal spot urine samples and dried blood spots were used to measure total arsenic (T-As) and total mercury (T-Hg) in the second trimester of pregnancy. Data on adverse birth outcomes were collected in 5 categories: spontaneous abortion, stillbirth, preterm birth, low birth weight, and visible congenital anomalies. Mann-Whitney U-tests were used to test for differences between median T-As and T-Hg by area of residence. Logistic regression models were used to estimate the odds of stillbirth and visible congenital anomalies given maternal T-As and T-Hg levels. Modified Poisson regressions were used to estimate relative risk ratios between maternal T-As and T-Hg levels and composite adverse birth outcome, spontaneous abortion, low birth weight, and preterm birth. Results: Statistically significant differences were found in median T-As (9.6 vs. 6.3 µg/L, Mann-Whitney U-tests, Z = −3.50, p

Background. Tanzania has seen explosive development in small scale gold mining (SGM) operations. Recently, the use of cyanide has become more common in SGM, especially in the reprocessing of mercury-amalgamated tailings from artisanal mining sites. Objectives. The primary objective of this study was to examine the level of knowledge and adherence to the Cyanide Code among workers and managers at SGM operations in northwestern Tanzania that use cyanide for gold extraction, focusing on workers' safety. Methods. A cross-sectional study of workers and managers at 17 selected SGM sites was conducted. A random-cluster approach was used to recruit 215 mine workers and 23 mine managers who worked at the same sites for more than three months. Individuals participated in structured face-to-face interviews. Site evaluation checklists were also administered to assess adherence. Results. The majority of the SGM workers (61.4%, n=132) were not aware of the Cyanide Code. Among the mine managers, 64.2% (n=15) were aware of the Cyanide Code. Fifty-four percent of workers and 39.1% of managers did not adhere to the Cyanide Code. Workers who reported being trained on the Cyanide Code were significantly more likely to have knowledge about the Cyanide Code guidelines compared to untrained workers (adjusted odds ratio =20.3, confidence interval: 7.5 – 54.8). Discussion. Wide variations in knowledge of and adherence to the Cyanide Code were found. A manager's knowledge of Cyanide Code was significantly associated with workers' knowledge. High worker and manager knowledge was associated with increased site safety performance. Even though all the SGM sites were physically visited, some potentially hazardous practices may not have been revealed by managers and workers because of fear of possible regulatory actions due to disclosure of concerns related to their operation's safety compliance. Conclusions. The limited knowledge of the Cyanide Code among workers and managers, combined with poor adherence to cyanide waste management practices, indicates that there is a need for education, health promotion and sensitization among workers and managers to improve worker safety and minimize environmental health impacts. Participant Consent: Obtained Competing Interests. The authors declare no competing financial interests. Ethics Approval: Ethical approval was obtained from the Conjoint Catholic University of Health and Allied Sciences and Bugando Medical Centre Research Review and Ethics Committee (Ref. BREC/001/35/2014). Permission to conduct research in Geita District was obtained from the respective authorities at the regional and district levels and from owners of the SGM sites.

Background: Improvements to prognostic models in metastatic castration-resistant prostate cancer have the potential to augment clinical trial design and guide treatment strategies. In partnership with Project Data Sphere, a not-for-profit initiative allowing data from cancer clinical trials to be shared broadly with researchers, we designed an open-data, crowdsourced, DREAM (Dialogue for Reverse Engineering Assessments and Methods) challenge to not only identify a better prognostic model for prediction of survival in patients with metastatic castration-resistant prostate cancer but also engage a community of international data scientists to study this disease. Methods Data from the comparator arms of four phase 3 clinical trials in first-line metastatic castration-resistant prostate cancer were obtained from Project Data Sphere, comprising 476 patients treated with docetaxel and prednisone from the ASCENT2 trial, 526 patients treated with docetaxel, prednisone, and placebo in the MAINSAIL trial, 598 patients treated with docetaxel, prednisone or prednisolone, and placebo in the VENICE trial, and 470 patients treated with docetaxel and placebo in the ENTHUSE 33 trial. Datasets consisting of more than 150 clinical variables were curated centrally, including demographics, laboratory values, medical history, lesion sites, and previous treatments. Data from ASCENT2, MAINSAIL, and VENICE were released publicly to be used as training data to predict the outcome of interestnamely, overall survival. Clinical data were also released for ENTHUSE 33, but data for outcome variables (overall survival and event status) were hidden from the challenge participants so that ENTHUSE 33 could be used for independent validation. Methods were evaluated using the integrated time-dependent area under the curve (iAUC). The reference model, based on eight clinical variables and a penalised Cox proportional-hazards model, was used to compare method performance. Further validation was done using data from a fifth trialENTHUSE M1in which 266 patients with metastatic castration-resistant prostate cancer were treated with placebo alone. Findings 50 independent methods were developed to predict overall survival and were evaluated through the DREAM challenge. The top performer was based on an ensemble of penalised Cox regression models (ePCR), which uniquely identified predictive interaction effects with immune biomarkers and markers of hepatic and renal function. Overall, ePCR outperformed all other methods (iAUC 0·791; Bayes factor >5) and surpassed the reference model (iAUC 0·743; Bayes factor >20). Both the ePCR model and reference models stratified patients in the ENTHUSE 33 trial into high-risk and low-risk groups with significantly different overall survival (ePCR: hazard ratio 3·32, 95% CI 2·394·62, p, European Union within the ERC grant LatentCauses supported the work of C.F and I.K. German Research Foundation (DFG) within the Collaborative Research Centre 1243, subproject A17 awarded to C.F. German Federal Ministry of Education and Research (BMBF) through the Research Consortium e:AtheroMED (Systems medicine of myocardial infarction and stroke) under the auspices of the e:Med Programme (grant # 01ZX1313C) supported the work of D.P.A., P.D., C.F., C.K., I.K., N.K., M.L., H.S. and J.F.S. at the Institute of Computational Biology. NIH Grants RR025747-01, MH086633 and 1UL1TR001111, and NSF Grants SES-1357666, DMS-14-07655 and BCS0826844 supported the work of C.H., J.I., E.L., Y.W., H.Y., H.Z. and J.Z. NSFC Grant Nos. 61332013, 61572139 supported the work of X.L, Y.L, Y.Z., and S.Z. National Natural Science Foundation of China grants [Nos. 61422309, 61379092] was awarded to S.Z. The Patrick C. Walsh Prostate Research Fund and the Johns Hopkins Individualized Health Initiative supported the work of R.Y.C., D.D., Y.D., Z.J., K.R., Z.W. and Y.Z. FCT Ph.D. Grant SFRH/BD/80925/2011 was awarded to S.C. Clinical Persona Inc., East Palo Alto, CA supported the work of L.B. and D.K. The Finnish Cultural Foundation and the Drug Research Doctoral Programme (DRDP) at the University of Turku supported T.D.L. The National Research Foundation Singapore and the Singapore Ministry of Education, under its Research Centres of Excellence initiative, supported the work of J.G. and K.T. A grant from the Russian Science Foundation 14-24-00155 was awarded to M.D.K. A*MIDEX grant (no. ANR-11-IDEX-0001-02) was awarded to P.J.B. NSERC supported the work of R.G. The Israeli Centers of Research Excellence (I-CORE) program (Center No. 4/11) supported the work of E.G. Academy of Finland (grants 292611, 269862, 272437, 279163, 295504), National Cancer Institute (16X064), and Cancer Society of Finland supported the work of T.A. Academy of Finland (grant 268531) supported the work of T.M

Recent technological advances have led to tremendous capacities for collecting, storing and analyzing data being created at an ever-increasing speed from diverse sources. Academic institutions which offer open and distance learning programs, such as the Hellenic Open University, can benefit from big data relating to its students’ information and communication systems and the use of modern techniques and tools of big data analytics provided that the student’s right to privacy is not compromised. The balance between data mining and maintaining privacy can be reached through anonymisation methods but on the other hand this approach raises technical problems such as the loss of a certain amount of information found in the original data. Considering the learning process as a framework of interacting roles and factors, the discovery of patterns in that system can be really useful and beneficial firstly for the learners and furthermore, the ability to publish and share these results would be very helpful for the whole academic institution.

Background: Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA. Objectives: We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score. Methods: This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score ≤ 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done. Results: Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p < 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p < 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p < 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post -dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p < 0.001). Conclusion: BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns. Keywords: Newborn, birth asphyxia, Hypoxic Ischemic Encephalopathy (HIE) outcomes, predictors of survival.

Most new caries lesions are found in the pits and fissures of the occlusal surface. Radiographs have extremely low sensitivity for early occlusal decay, and by the time the lesion is severe enough to appear on a radiograph, it typically has penetrated well into the dentin and surgical intervention is required. The occlusal surfaces are often heavily stained, and visual and tactile detection have poor sensitivity and specificity. Previous near-infrared imaging studies at wavelengths beyond 1300nm have demonstrated that stains are not visible and demineralization on the occlusal surfaces can be viewed without interference from stains. The objective of our study is to determine how the contrast between sound and lesion areas on occlusal surfaces varies with wavelength from the visible to 2350nm and determine to what degree stains interfere with that contrast. The lesion contrast for reflectance is measured in 55 extracted teeth with suspected occlusal lesions from 400 to 2350nm employing silicon and indium gallium arsenide imaging arrays. In addition, the lesion contrast is measured on 25 extracted teeth with suspected occlusal lesions from 400 to 1600nm in reflectance and from 830 to 1400nm in transillumination before and after stains are removed using a ultrasonic scaler. The highest lesion contrast in reflectance is measured at wavelengths >1700 nm. Stains interfere significantly at wavelengths 1700 nm for reflectance (1700 to 2350nm) and near 1300nm (1250 to 1350nm) for transillumination.

BackgroundData collection and integrated reporting between the multiple health facilities for supporting more efficient care linkages is an indispensable element for prevention of mother-to-child transmission of HIV (PMTCT) by fostering continuity of patient care and improving the treatment cascade for HIV-infected pregnant women. mHealth potentially presents timely solutions to the data challenges related to efficient and effective care delivery in resource-constrained settings, particularly in low- and middle-income countries.MethodsThis randomized controlled pilot study used stratified random sampling for the selection of seven intervention and seven control sites in Misungwi, Tanzania, a rural district in the northwestern region. Twenty-eight health workers at seven intervention health facilities used the Tanzania Health Information Technology (T-HIT) system during a 3-month period from February 23, 2015, through May 23, 2015, to capture antenatal, delivery, and postnatal patient visits.ResultsT-HIT was designed for use on tablets with the goal to improve reporting, surveillance and monitoring of HIV rates and care delivery in the remote and rural settings. Health workers successfully recorded 2,453 visits. Of these, 1,594 were antenatal visits, 484 deliveries were recorded, and 375 were postnatal visits. Within the antenatal visits, 96% of women had a single visit (1474). Healthcare workers were unable to test 6.7% of women antenatally for HIV.ConclusionThe T-HIT pilot demonstrated the feasibility for implementing an mHealth integrated solution in a rural, low-resource setting that links tablet-based surveillance, health worker capacity-building and patient reminders into a single robust and responsive system. Although the implementation phase was only three months, the pilot generated evidence that T-HIT has potential for improving patient outcomes by providing more comprehensive, linked, and timely PMTCT care data at the individual and clinic levels.

Low back pain affects an estimated half a billion people at any time worldwide. Although several noninvasive treatment strategies have been developed, in many cases, they cannot relief patients’ symptoms, thus low back discectomy is the appropriate treatment of choice. It is widely accepted that surgery alters the biomechanics of the functional motion segment and results in additional disc herniation at the adjacent level or the opposite side, more commonly than expected. After the discectomy, changes in vertebral load properties and kinetics could occur. As a result, biomechanical stress on the affected level as well as cyclic loads can cause lumbar disc reherniation (rLDH). Since the rate of recurrent disc herniation is about 5%-15%, further research should be done so as to quantify the postoperative lumbar spine kinematic pattern, with the use of wearable sensors technology, that could be a potential biomechanical factor causing rLDH.

Background New HIV infections in Tanzania have been decreasing, however some populations remain at higher risk. Despite of that, evidence on the magnitude of HIV infection and the associated factors and HIV/AIDS services uptake among fisherfolk in Tanzania are inadequately explored. This study therefore aimed at determining prevalence of HIV infection and utilization of HIV/AIDS services among fishfolk in selected Islands of Lake Victoria for evidence-based interventions. Methods Cross-sectional study determining status of HIV infection among fisherfolk (n = 456) and retrospective review of voluntary counselling and testing (VCT) registry (n = 1744) were done in Buchosa and Muleba districts. Structured questionnaire and HIV rapid test kits with the standard testing protocol were used as research tools. Results A total of 269 (58.9%) male and 187 (41.1%) female fisherfolk were recruited during the community survey. Prevalence of HIV infection was 14% in all surveyed landing sites with a site variation from as low as 7.2% to as high as 23.8%. Participants employed in fishing related employment had higher odds of being HIV infected (5.4 times) than those who practiced fishing and partly farming [OR = 5.40; 95%CI 1.88–15.61; p

The seismic response of five cultural heritage towers erected between the 9th and 10th century AD are investigated herein. Firstly, their architectural and modal characteristics were studied in the light of seismic events that hit the monuments. There exist several historical reports of strong earthquakes, as well as damaged structures and collapses. The limit analysis is adopted to examine the post-elastic behavior of the towers up to collapse due to out-of-plane failure. Recurrent damage modes were collected from recent earthquakes and a classification of four possible collapse mechanisms in towers and slender masonry structures is here proposed: overturning, separation of perpendicular walls, diagonal cracking, and dislocation of the belfry. A thorough examination of the towers under investigation verified the proposed damage classification. The capacity curves were derived combining the capacity curves of each of the collapse mechanisms. Damage thresholds were defined on these curves in correspondence with damage states. The studied group of structures is representative of a wider typology. A statistical approach was adopted to describe damage with seismic intensity, and vulnerability curves were generated. The results of this study will improve the understanding of the performance and the collapse mechanisms of slender masonry structures under seismic loading and provide a characterization of seismic vulnerability for the studied cultural heritage types of towers.

Purpose To describe the first reported case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) associated with a remote choroidal neovascular membrane (CNVM). Observations A 19-month-old girl with a normal prenatal and infantile history presented with esotropia of the left eye. Fundus examination demonstrated a large, elevated, charcoal-colored lesion in the nasal equatorial retina. There was dragging of the nasal retinal vessels and a retinal fold, presumed to have resulted from nasal traction from the lesion. There was also subretinal hemorrhage in the peripapillary macula. Multimodal imaging demonstrated a peripapillary choroidal neovascular membrane (CNVM) underlying the retinal fold. There was no leakage within the tumor or secondary retinal neovascularization. Examination of the fellow eye was unremarkable. The patient was diagnosed with peripheral CHRRPE with associated peripapillary CNVM. She was treated with serial intravitreal bevacizumab to the affected eye which resulted in a reduction in leakage from the CNVM and resolution of the subretinal hemorrhage. The CHRRPE remained stable on follow-up. Conclusions Peripheral CHRRPE can rarely be associated with a remote CNVM.

Item does not contain fulltext OBJECTIVE: This nationwide study gives a detailed description of the clinical features and long-term outcome of anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. METHODS: We collected patients prospectively from October 2013, and retrospectively from samples sent to our laboratory from January 2007. LGI1 antibodies were confirmed with both cell-based assay and immunohistochemistry. Clinical information was obtained in interviews with patients and their relatives and from medical records. Initial MRI and follow-up MRI were revised blindly. Neuropsychological assessment was performed in those patients with follow-up over 2 years. RESULTS: Annual incidence in the Netherlands was 0.83/million. A total of 34/38 patients had a limbic encephalitis. Subtle focal seizures (66%, autonomic or dyscognitive) and faciobrachial dystonic seizures (FBDS, 47%) mostly occurred before onset of memory disturbance. Later in the disease course, 63% had tonic-clonic seizures. Initial MRI showed hippocampal T2 hyperintensity in 74% of the patients. These lesions evolved regularly into mesial temporal sclerosis (44%). Substantial response to immunotherapy was seen in 80%, with early response of seizures and slow recovery of cognition. At follow-up >/=2 years, most surviving patients reported mild residual cognitive deficit with spatial disorientation. A total of 86% had persistent amnesia for the disease period. Relapses were common (35%) and presented up to 8 years after initial disease. Two-year case fatality rate was 19%. CONCLUSIONS: Anti-LGI1 encephalitis is a homogenous clinical syndrome, showing early FBDS and other focal seizures with subtle clinical manifestations, followed by memory disturbances. Better recognition will lead to earlier diagnosis, essential for prompt start of treatment. Long-term outcome of surviving patients is mostly favorable, but relapses are common.

The modest goal of this short note is to shed some light on the correct interpretation of micro/nanopillar compression experiments. We propose a modification of the way the stress-strain response in such experiments is calculated, aiming at answering open questions pertaining to discrepancies between the elastic moduli values calculated through micropillar compression experiments with those of the bulk materials, as well as the brittle-to-ductile transition in bulk metallic glasses (BMGs) when the size of the pillars is reduced below a certain threshold value.

The gradient plasticity theory proposed by Aifantis and coworkers has been successfully used to model size effect phenomena at the microscale and nanoscale, by introducing into the formulation an internal length scale associated with the phenomenological coefficients of the gradient plasticity model. In this paper, Aifantis’ gradient plasticity theory is applied to model the sample size-dependent torsion of thin wires, with a strain-dependent internal length scale as well as grain size dependence based on the Hall-Petch relationship. This study reveals that internal length scale is related with sample size and grain size, with such a connection determined by the ductility of the material.

Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance; at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Methods: Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used; the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility; subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Results: Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465); Arthritis 52% (241/465); Dental problems 27% (124/465); Hypertension 23% (107/465); Backache 22% (105/465); Malaria 28% (132/465); Hearing problems 26% (121/645); Urinary tract Infection 35% (165/465); Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis; some of the geriatrics had more than two diseases. Conclusion: The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable.

Parkinson's disease is a degenerative disorder of the central nervous system affecting the substantia nigra in the midbrain. It accounts for 1.5% of the population in Europe over 60 years of age. Recent advances in the medical treatment of Parkinson's disease have improved the quality of life and life expectancy of the patients. However, it remains a debilitating disease. Spinal disorders are frequent in these patients, and as the population ages, more patients with Parkinson's disease are expected to require spinal surgery. Spinal surgery in patients with Parkinson's disease has been associated with an exceptionally high rate of complications; failures and reoperations are common, and patient outcomes are dismal.

A previous study has demonstrated the ability to roughly estimate the percentage of fast-twitch muscle fibers for the vastus lateralis through the analysis of peak torque values during fatiguing isokinetic testing. We examined whether use of the hamstrings influenced peak torque and electromyographic (EMG) responses for the quadriceps during fatiguing isokinetic muscle actions. On 2 separate occasions, 21 men (mean age = 23 years) performed 50 repeated, maximal concentric isokinetic muscle actions of the left leg extensors at a velocity of 180°·s. For 1 trial, the subjects maximally flexed the knee joint after each full extension to bring the dynamometer's lever arm back to the starting position. For the other trial, the subjects relaxed after each maximal extension and an investigator assisted in returning the lever arm. Surface EMG signals were detected from the vastus lateralis and biceps femoris throughout testing. Dependent variables that assessed the decline in peak torque and EMG mean frequency for the vastus lateralis were examined using dependent samples t-tests, effect size statistics, and the number of subjects who exceeded the minimal difference needed to be considered real. Our results showed small mean differences between the trials (Cohen's d ≤0.136). For the estimated percentage of fast-twitch fibers, none of the subjects showed a difference between trials that we considered meaningful. The mean estimated percentages of fast-twitch fibers were 61.6 and 60.1. Collectively, use of the hamstrings during fatiguing isokinetic testing of the quadriceps had little influence on peak torque and EMG.

The elastic macro-mechanical properties of masonry are investigated herein by taking into account the presence of a weakly non-local heterogeneity within a simple gradient elasticity model. Masonry has a heterogeneous structure composed of masonry units bound by mortar. The homogenisation of masonry walls is a challenging task but also a very appealing method for modelling heterogeneity effects exhibited by masonry elements. In particular, it allows the use of smeared mechanical properties, thus avoiding the need of knowing the exact unit-to-unit and joint-to-joint geometry. Current codes provide very simplified empirical expressions to estimate an isotropic elastic modulus of masonry on the basis of its strength properties. The respective equations which do not take into account the anisotropy of masonry, present high scatter resulting in ambiguous safety. The homogenization argument employed in this work is based on a simple procedure utilising Aifantis’ gradient elasticity (GradEla) model. The GradEla model is a straight-forward extension of Hooke’s law by enhancing it with the addition of the Laplacian of the classical expression of the Hookean stress multiplied by an internal length accounting for the local heterogeneity. It has been successfully used to eliminate singularities from dislocation lines and crack tips, as well as in interpreting size effects. However its use in masonry structures has not yet been explored. A first step in this direction is attempted in this paper with emphasis on obtaining practical easy-to-use results rather than exhausting all other possibilities and complexities encountered in GradEla and its generalisation, as well as in more involved homogenisation procedures. In our analysis uniform vertical, horizontal and shear loads are assumed to act on the boundaries of the representative volume/surface element. The components of masonry are assumed to follow a gradient elastic stress distribution resulting in a gradient elastic homogenised model (GREHM). GREHM comprises a set of closed-form concise equations which estimate the elastic moduli in the longitudinal and transverse directions, the shear modulus and the Poisson’s ratio. The aforementioned orthotropic material properties are verified using experimental results and also, compared to other homogenisation models. The validation shows that the proposed equations can effectively estimate with considerable precision the elastic properties of masonry walls. To illustrate the resulting estimation of the orthotropic elastic properties, normalised graphs are provided.

Biomonitoring studies of vulnerable populations in low- and middle-income countries are limited because traditional sampling methods are challenging to implement in low-resource settings. The present study examined the feasibility, precision, and accuracy of dried blood spots (DBS) for human biomonitoring of nonessential elements (cadmium [Cd], mercury [Hg], and lead [Pb]) in an area of northern Tanzania with artisanal and small-scale gold mining activities. Pregnant women (n = 44) were recruited in Geita during antenatal clinic visits, and DBS from capillary blood were collected on filter paper. As a gold-standard comparison, venous blood was sampled from the same participants and compared with the DBS. Venous blood, DBS, and quality control samples were analyzed for chemical elements by inductively coupled plasma mass spectrometry. Field blanks were very clean for most elements, generally only twice as high as corresponding laboratory filter blanks. No significant differences were found between duplicate DBS samples taken from the same participants, with near perfect intraclass correlation coefficients (0.99) for Cd, Hg, and Pb, indicating excellent reliability. Moreover, correlation was strong (r2 > 0.9) and significant (p < 0.0001) between DBS and the quantitative venous blood, with regression line slopes close to 1.0 (0.847, 0.976, and 0.969 for Cd, Hg, and Pb, respectively), indicating high accuracy of the DBS method compared with the gold-standard approach. The DBS method is minimally invasive and was a feasible, precise, and accurate means of measuring exposure to Cd, Hg, and Pb in pregnant women in a low-resource setting. Environ Toxicol Chem 2019;38:1285-1293. © 2019 SETAC.

The prevalence of "diabesity" - diabetes related to obesity - has increased tremendously over the past few decades because of the global obesity epidemic. Although bariatric surgery is the best treatment option for patients with diabesity, a majority of patients are managed only with antidiabetic drugs for various reasons. Diabetes control with antidiabetic agents may affect diabesity outcomes positively or negatively because of their effects on body weight and other metabolic parameters. For this reason, rational use of anti-diabetic medications is imperative to optimise long-term management of diabesity. Understanding the molecular mechanisms of antidiabetic drugs and/or drug combinations on diabesity outcomes are therefore important not only for the basic scientists but also for clinicians. This review explores the molecular signalling cascades of antidiabetic medications in the management of diabesity.

Objective To identify factors predictive of pregnancy-related anxiety (PRA) among women in Mwanza, Tanzania. Design A cross-sectional study was used to explore the relationship between psychosocial health and preterm birth. Setting Antenatal clinics in the Ilemela and Nyamagana districts of Mwanza, Tanzania. Participants Pregnant women less than or equal to 32 weeks’ gestational age (n=212) attending the two antenatal clinics. Measures PRA was measured using a revised version of the 10-item PRA Questionnaire (PRA-Q). Predictive factors included social support (Multidimensional Scale of Perceived Social Support), stress (Perceived Stress Scale), depression (Edinburg Postpartum Depression Scale) and sociodemographic data. Bivariate analysis permitted variable selection while multiple linear regression analysis enabled identification of predictive factors of PRA. Results Twenty-five per cent of women in our sample scored 13 or higher (out of a possible 30) on the PRA-Q. Perceived stress, active depression and number of people living in the home were the only statistically significant predictors of PRA in our sample. Conclusions Our findings were contrary to most current literature which notes socioeconomic status and social support as significant factors in PRA. A greater understanding of the experience of PRA and its predictive factors is needed within the social cultural context of low/middle-income countries to support the development of PRA prevention strategies specific to low/middle income countries.

The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.

Background: Male involvement in reproductive health (RH) services in Africa has been associated with improved maternal and child health outcomes. The objective of this study was to determine the prevalence and factors affecting male partner attendance to available reproductive health services in Shinyanga district, north-western Tanzania.Methods: A house to house survey using a structured questionnaire was conducted among randomly selected married men. Additional in-depth interviews were conducted among married men found attending RH services. Factors that motivates the uptake of locally available RH services together with their partners were explored.Results: A total of 204 men participated in the study, 94.4 % (193/204) of them reported to have ever attended the RH service with their female partners at least once whereas 50.6% (103/204) of them attended at least thrice. Three quarters (154/204) attended HIV counselling and testing (VCT) and 63% (129/204) attended antenatal services (ANC). Reported attendance to sexually transmitted infections (STIs/STDs), prevention of HIV transmission from mother to child (PMTCT), and reproductive health cancer services were all less than 13%. The male partners age group (25-34 years; χ2=9.347, df =3 p-value < 0.001), female partner invitation to HR services (χ2= 29.901, df=1, p-value

Background context Hyperkyphosis confers a significant risk for neurologic deterioration as well as compromised cardiopulmonary function. Posterior vertebral column resection (PVCR) is a challenging but effective technique for spinal cord decompression and deformity correction that even under the setting of limited resources can be performed to reduce the technical difficulties, the operating time, and possibly the complications of the traditional two-staged vertebral column resection (VCR). Purpose To report on the results of VCR performed through a single posterior approach (PVCR) in the treatment of severe rigid kyphosis in a series of patients treated and followed at a Scoliosis Research Society Global Outreach Program site in West Africa. Study design Retrospective case series. Patient sample Forty-five consecutive patients treated with PVCR for correction of severe rigid kyphosis. Outcome measures Clinical and radiographic outcomes and complications; Scoliosis Research Society outcome instrument (SRS-22). Methods From 2002 to 2009, 45 patients (20 male and 25 female) underwent PVCR for kyphosis from congenital deformity (nine) or secondary to tuberculosis of the spine (36). Preoperative demographics, preop and postop neurologic status, SRS-22 scores and complications were recorded; upright full spine X-rays were available in all patients. Mean age was 14 years (6–47 years); mean follow-up 27 months (2–79 months). Mean preoperative kyphosis measured 108°. The deformity apex was resected via a costotransverse (thoracic) or posterolateral (lumbar) approach; neurosurveillance with sensory (somatosensory-evoked potentials) and motor (motor-evoked potentials) potential was used in all cases. Posterior instrumentation was used in all patients, and anterior structural cage was used in 32 patients. Results Intraoperative monitoring changes occurred in 10 patients (22%), and one patient progressed to complete spinal cord injury. Average preoperative local kyphosis was 108° and corrected to 600 postoperatively. Postoperatively, no additional patient showed neurologic deterioration; of the 11 patients with preoperative gait disturbances, 4 improved to normal gait, 5 remained the same, and 2 showed deterioration of their walking ability to nonambulating level. Total SRS-22 scores improved from 3.18 to 3.54 (p=.01), primarily self-image domain. Conclusions Posterior vertebral column resection was successfully undertaken for the management of thoracic and thoracolumbar hyperkyphosis, demonstrating improvements in overall kyphosis and clinical outcome. Neuromonitoring provided the required safety to perform these challenging complex spine deformity procedures.

Study Design Retrospective analysis of a prospectively collected single-center database. Objectives To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. Summary of Background Data Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. Methods A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. Results Major complications were seen in 85 cases, which consisted of neurologic deficits (n = 27; 17 transient and 10 permanent), wound infections (n = 17), implant-related problems (n = 35), progressive deformity (n = 13), and death (n = 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA indicated 3-column osteotomies as an independent risk factor for neurological deficit. Curves 100° and above were at higher risk for complications. Conclusions Postoperative complications were seen in 20% of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.

A filtration model for plastic flow based on the idea of a deformed material considered as a two-phase heterogeneous medium has been suggested. In this approach, the wave displacement is regarded as a shock transition in the medium. One of the phases (the excited one) is responsible for system restructuring, and the other phase (the normal one) is unrelated to structural transformations. The plastic wave is the result of the interaction of these two phases. The governing equations for the filtration model are obtained. They include the laws of momentum and mass conservation, as well as the filtration ratio of the phases.

ObjectivesTo explore and understand the experiences and priorities of pregnant women living with fears and worries related to fetal/infant and maternal health, the birthing process and ability to parent the infant (ie, pregnancy-related anxiety (PRA)) in Mwanza, Tanzania.DesignDescriptive phenomenological approach.SettingTwo clinics in the Ilemela and Nyamagana districts of Mwanza.ParticipantsPregnant and postpartum women who obtained high scores on a PRA scale during pregnancy in a larger quantitative study were contacted to participate in an interview (10 women, aged 18–34 years; 3 HIV positive).MeasuresSemi-structured interviews were undertaken, with guiding questions related to the women's experience during pregnancy. The Colaizzi method was used with transcripts that had been translated and back translated from Swahili to English and then hand-coded by the interviewer, with independent review by another researcher to verify the analysis.ResultsPRA, as experienced by women in Mwanza, was a state of worry and concern, often causing physical symptoms, and disrupting personal sense of peace. While some themes in the women's experiences reflected the domains examined in the PRA scale used to identify potential participants, others such as lack of knowledge, partner relationship, interactions with the healthcare system, spirituality and fear of HIV/AIDS were otherwise missing. Their prominence in the participants’ stories broadens our understanding of PRA.ConclusionsThe realities and viewpoints of women in low-income and middle-income countries (LMIC) experiencing PRA are still relatively unknown. The findings from this study provided much-needed insight into the perspectives and priorities of women in Mwanza who have experienced PRA and further support the need to explore this phenomenon in other LMIC. The additional domains identified reinforce the need for a PRA tool that accurately and adequately capture the complexities of PRA for women in this region.

Background: The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective: The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods: We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results: Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions: T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. [JMIR Mhealth Uhealth 2018;6(1):e16]

Study design Retrospective review. Objective The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a preoperative classification that stratifies surgical risk and case difficulty. Summary of Background Data Pediatric spinal deformity (PSD) surgery can be challenging technically as well as economically. Often, a multidisciplinary approach to managing these patients is necessary. In an environment where resources are limited, such as in global outreach efforts, a method for stratifying PSD surgical cases can be useful for allocating appropriate resources and assigning appropriate skill sets in order to optimize patient outcomes and to streamline efforts. Materials and Methods A total of 145 consecutive PSD patients who underwent instrumented spinal fusion were reviewed. Radiographic measurements and demographic data were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the preoperative neurologic status, body mass index and type of osteotomies. Multiple regression analysis (MRA) and logistic regression analysis (LRA) were applied to indicate risk factors for complications. Results The average age was 14.3 years (10–20 years). The etiology was idiopathic scoliosis (n = 71), congenital scoliosis (n = 38), infectious (n = 11), and others. 23 patients had neurologic deficits preoperatively. Twenty-three patients had a posterior vertebral column resection. Patients were classified as Level 1 (n = 5), Level 2 (n = 19), Level 3 (n = 24), Level 4 (n = 58), and Level 5 (n = 39). Intraoperative neuro-monitoring changes were observed in 46 cases. Major complications were seen in 45 cases. A major complication consisted of implant related (n = 13), deep wound infection (n = 8), neurologic deficit (n = 7), death (n = 2), and others (n = 9). MRA demonstrated a significant correlation between classified level and %EBL/TBV, operative time, and complication rate. The risk level predicted the occurrence of general (odds ratio [OR] = 1.54; 95% confidence interval [CI] = 1.08–2.21; p = .019) and neurologic (OR = 3.34; 95% CI = 1.06–17.70; p = .036) complications. Osteotomy and resection procedures were independent predictors for postoperative neurologic complications (OR = 1.7, 95% CI = 1.11–2.85; p = .015). Conclusion Corrective spine surgery for complex pediatric deformity is challenging and carries a substantial risk. No single parameter appears to independently predict postoperative complications. However, when all risk factors are considered, there is a trend toward increased intraoperative electromonitoring change and postoperative neurologic risk with the higher level score in our classification. The newly established surgical risk stratification based on patient-specific clinical and radiographic factors can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal outcomes.

This paper presents a software system based on smart cards technology for recording, monitoring and studying patients of any surgery specialty (General Surgery, Orthopedics, Neurosurgery, etc). The system is also suitable for the computerization of any surgery specialty clinic and the respective surgical material repositories. Dynamic customization functions adapt the system to the different characteristics of the surgery specialties. Special customization is involved concerning implantable materials. The .NET platform and Java Cards used for the development of the system and the architectural model of the system are designed towards satisfying the basic integration and interoperability issues. The developed system is “doctor-friendly” because it is based on classifications and knowledge grouping used in every day clinical practice provided from medical experts on the field but is not intended to be a complete Electronic Medical Record (EMR). The major scope of this effort is the development of a system that offers a fast and easy installable, low cost solution in health environments still immature in adopting solutions based exclusively on Informatics and is designed to be installed in small Private Medical Consulting Rooms to Community Clinics, Health Centers, Hospital Surgery Departments till Central Health Organizations.

Geophagy, the craving and intentional consumption of soil, is common especially among pregnant women in some low- and middle-income settings. Soils may contain a variety of non-nutritive components such as heavy metals and microbes or substances that interfere with gastrointestinal absorptive processes, posing health risks to pregnant women. Several hypotheses regarding the practice have been proposed but very few have examined the role of maternal stress. The practice of geophagy may help to alleviate stress or anxiety during gestation from perceived dietary or other pregnancy-related concerns. In this study, we evaluated several measures of maternal stress (general anxiety, Pregnancy-Related Anxiety Scores (10-item revised), and Perceived Stress Scores) and other covariates in relation to geophagic behaviour in early pregnancy in 227 women (12–19 weeks gestation) recruited from two hospitals in the Nyamagana district of Mwanza City, Tanzania. Geophagy was reported by 24.7% of the pregnant women. Using LASSO regression, self-reported treatment of nausea or vomiting during pregnancy (adjusted OR = 3.12, 95%CI: 1.43 to 6.83), paternal education level (adjusted OR = 2.79, 95%CI: 1.32 to 5.87 for primary or lower education level), antenatal hospital site (adjusted OR = 3.71, 95%CI: 1.78 to 7.75), prescription drug use prior to pregnancy (adjusted OR = 1.76, 95%CI: 0.87 to 3.56) and general anxiety (feeling worried, tense or anxious in the past four weeks) (adjusted OR = 1.81, 95%CI: 0.88 to 3.72) were associated with geophagic behaviour. Given that relatively little has been done to examine geophagy in relation to the public health risk it may pose to pregnant women, these findings suggest the need for further investigations regarding maternal stress.

The corresponding author regret that co-author name was incorrectly published as "Elias C. Papadopoulus" in the article. The correct name of the author should be displayed as "Elias C. Papadopoulos".