In resource-limited settings, national tuberculosis (TB) control programmes are highly dependent on external funds, which may pose a challenge to programme sustainability. There is a recognized need ...for developing guidance around sustainable programming of current TB control initiatives.
The aim of this study was to explore public health practitioners' perspectives on the sustainability of TB control initiatives in Pakistan at the primary health care (PHC) level.
Guided by an interpretive epistemology, online in-depth interviews were conducted with 10 public health practitioners who had experience as resource planners in the TB control programme in Pakistan. Thematic content analysis was employed to the textual data as the analytical approach.
Three themes were inductively derived from the thematic analysis: community involvement, stakeholder engagement and efficient use of the PHC system. Community involvement was a determinant in sustaining TB control initiatives. This was attributed to the nature of the disease and prevalent health seeking behaviour. Stakeholder engagement was associated with funding arrangements between public and private partners and considered important in how new initiatives can be made part of the routine structure. Overall, having an efficient PHC system was deemed critical in sustaining current TB control initiatives at the PHC level in Pakistan.
Fostering an enabling operational environment through regulations, supporting the utilization of existing resources, expanding the network of providers, inclusive planning, increasing spending on research and cost-effective testing are pivotal for sustaining the TB control initiatives.
Hepatitis C virus affects millions of people around the world. The primary therapy comprises of interferon alpha and ribavarin. The most common side effects of this treatment include flu like ...symptoms and psychiatric issues. One of the rare complications of the combined therapy is the development of demyelinating lesions in the central nervous system. Our case report presents a 35-year-old man who was a known case of Hepatitis C presenting to us with altered level of consciousness and decreased vision. He had been treated as per the standard therapy for Hepatitis C infection with interferon alpha and ribavarin. During the course of this therapy, he developed significant loss of vision. This was in fact due to serious and rare complication of the treatment which was demonstrated on the MRI as demyelinating lesions in the deep periventricular white matter bilaterally. Visual Evoked Potential study was performed which concluded bilateral dysfunction of the optic pathway. The treatment of Hepatitis C with interferon alpha and ribavarin may present with a wide array of adverse effects which includes a rare complication of central nervous system demyelination as well. Research suggests that early treatment of Multiple Sclerosis (MS) is beneficial in the long run with a better prognosis and minimal changes on MRI of the patient. Therefore this complication of the treatment should be kept in mind as one of the main differential diagnosis. By finding the extent of the inflammation, and consequently doing an MRI alongside a lumbar puncture, can serve to diagnose a rare condition mimicking multiple sclerosis while treating with interferon alpha.
Abstract
In this article, I present a critique of Robert Geraci's Apocalyptic artificial intelligence (AI) discourse, drawing attention to certain shortcomings which become apparent when the ...analytical lens shifts from religion to the race–religion nexus. Building on earlier work, I explore the phenomenon of existential risk associated with Apocalyptic AI in relation to “White Crisis,” a modern racial phenomenon with premodern religious origins. Adopting a critical race theoretical and decolonial perspective, I argue that all three phenomena are entangled and they should be understood as a strategy, albeit perhaps merely rhetorical, for maintaining white hegemony under nonwhite contestation. I further suggest that this claim can be shown to be supported by the disclosure of continuity through change in the long‐durée entanglement of race and religion associated with the establishment, maintenance, expansion, and refinement of the modern/colonial world system if and when such phenomena are understood as iterative shifts in a programmatic trajectory of domination which might usefully be framed as “algorithmic racism.”
Groundwater recharge is affected by various anthropogenic activities, land use and land cover (LULC) change among these. The long-term temporal and seasonal changes in LULC have a substantial ...influence on groundwater flow dynamics. Therefore, assessment of the impacts of LULC changes on recharge is necessary for the sustainable management of groundwater resources. The objective of this study is to examine the effects of LULC changes on groundwater recharge in the northwestern part of Bangladesh. Spatially distributed monthly groundwater recharge was simulated using a semi-physically based water balance model. Long-term temporal LULC change analysis was conducted using LULC maps from 2006 to 2016, while wet and dry LULC maps were used to examine seasonal changes. The results show that the impervious built-up area has increased by 80.3%, whereas vegetated land cover has decreased by 16.4% over the study period. As a result, groundwater recharge in 2016 has decreased compared to the level seen in 2006. However, the decrease in recharge due to long-term temporal LULC changes is very small at the basin scale (2.6 mm/year), although the impact on regional level is larger (17.1 mm/year) due to urbanization. Seasonal LULC variations also affect recharge due to the higher potential for dry seasonal LULC compared to the wet seasonal LULC, a substantial difference (20.6 mm/year). The results reveal important information about the groundwater system and its response to land cover changes in northwestern Bangladesh.
•The effect of LULC changes on groundwater recharge is evaluated using a spatially distributed water balance model.•Impervious built-up area has increased by 80.3%, whereas vegetated land cover has decreased by 16.4% over the study period.•The decrease in recharge due to long-term temporal LULC changes is very small at the basin scale (2.6 mm/year).•The impact of LULC changes on groundwater recharge at the regional level is larger (17.1 mm/year) due to urbanization.•The seasonal changes in LULC have a substantial influence on groundwater recharge.
Endoplasmic reticulum (ER) is the site of protein synthesis, protein folding, maintainance of calcium homeostasis, synthesis of lipids and sterols. Genetic or environmental insults can alter its ...function generating ER stress. ER senses stress mainly by three stress sensor pathways, namely protein kinase R-like endoplasmic reticulum kinase-eukaryotic translation-initiation factor 2
α
, inositol-requiring enzyme 1
α
-X-box-binding protein 1 and activating transcription factor 6-CREBH, which induce unfolded protein responses (UPR) after the recognition of stress. Recent studies have demonstrated that ER stress and UPR signaling are involved in cancer, metabolic disorders, inflammatory diseases, osteoporosis and neurodegenerative diseases. However, the precise knowledge regarding involvement of ER stress in different disease processes is still debatable. Here we discuss the possible role of ER stress in various disorders on the basis of existing literature. An attempt has also been made to highlight the present knowledge of this field which may help to elucidate and conjure basic mechanisms and novel insights into disease processes which could assist in devising better future diagnostic and therapeutic strategies.
Aamer Mughal,Alok Prasad,Imran Ahmed,Farheen Ebrahim,Syed Mustafa Ali Ahmad Faculty of Medicine, Imperial College London, London, UKWe note with great interest the work of Kötter and Niebuhr,1 with ...regard to reducing examination-related stress in medical students through short-term coaching. We highly commend their efforts to provide an evidence base for techniques that have been suggested in the literature. We would however argue that the use of coaching such as wingwave® may perhaps be too impractical and expensive to be used on a regular basis, and that the long-term efficacy of the approach is unclear. We would encourage further work into other methods and would specifically welcome trials comparing these techniques to the coaching described by Kötter and Niebuhr.View the original paper by Kötter and Niebuhr.
Alok Prasad, Aamer Mughal, Imran Ahmed, Farheen Ebrahim, Syed Mustafa Ali AhmadFaculty of Medicine, Imperial College - London, London, UKWe note with great interest the article by Deane and Murphy1 ...exploring the learning drivers and strategies of medical students in a clinical rotation in obstetrics and gynecology. The article highlights key points about the motivation of medical students, and we strongly agree that extrinsic motivators, such as obtaining a good ranking to stand a better chance when applying for future jobs, are key learning drivers. We lament the relative unimportance of intrinsic motivators and we commend the authors' suggestion of considering strategies to foster more intrinsic drivers of student learning. We believe, however, that this will be difficult to implement with the intense competition prevalent at every stage of a medical career, with students' motivations more likely to be of the extrinsic nature. Furthermore, from a practical standpoint, aspirations relating to future careers are often volatile or, more commonly, uncertain. This creates an environment wherein intrinsic motivators may not be applicable, and so we would argue that medical educators should focus more on aiding students to find their given area of interest, allowing the intrinsic motivation to develop naturally.View the orignal paper by Deane and Murphy.
Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our ...knowledge, no comprehensive synthesis of this literature has been conducted to date.
To conduct a systematic review of systematic reviews of the benefits and harms ("effects") of SM tools and platforms (such as Twitter and Facebook) in public health and medicine. To perform a synthesis of this literature and create a 'living systematic review'.
Forty-two (42) high-quality SRs were examined. Overall, evidence of SM's effectiveness in public health and medicine was judged to be minimal. However, qualitative benefits for patients are seen in improved psychosocial support and psychological functioning. Health professionals benefited from better peer-to-peer communication and lifelong learning. Harms on all groups include the impact of SM on mental health, privacy, confidentiality and information reliability.
A range of negatives and positives of SM in public health and medicine are seen in the SR literature but definitive conclusions cannot be made at this time. Clearly better research designs are needed to measure the effectiveness of social technologies. For ongoing updates, see the wiki "Effective uses of social media in health: a living systematic review of systematic reviews". http://hlwiki.slais.ubc.ca/index.php/Effective_uses_of_social_media_in_healthcare:_a_living_systematic_review_of_reviews.
The powder of Ocimum Basilicum leaves was treated by zinc chloride (ZnCl2) and applied as a new and low-cost sorbent for extraction of permanganate anions (MnO4−) from liquid phase. The functional ...groups of the ring stretching vibration, –NH2 deformation, stretching of C-O, stretching of CH, and stretching of –NH were found in the sorbent of zinc chloride Ocimum basilicum leaves powder (ZCOBLP) at 1516.21, 1629.33, 1047.00, 2929.88, and 3294.93 cm−1, respectively. This adsorbent has 8.3 pHZPC, 117.27 m2·g−1 surface area, 0.00711 cc·g−1 pore volume and average pore diameter of 264.144 Å. The outcomes of sorption experiments designate the positive impact for temperature, time of agitation, and started concentration of MnO4− and negative impact for pH. The optimal conditions were 1300 mg·L−1 as started adsorbate concentration, 55°C as solution temperature, agitation time of 420 min, and pH of 1.5. The outcomes of the equilibrium and dynamic approve that this sorption is spontaneous and heat-absorbing process, and the obtained data were described well by isotherm model of Langmuir and 2nd-order dynamic model. The capacities of this sorption were 588.235, 625.000, 666.667, and 714.286 mg·g−1 at 25, 35, 45, and 55 (°C), respectively. The superior sorption capacities of the uncostly ZCOBLP will make it successfully used for MnO4− ions extraction from liquid phases.
Background: The cornerstone of the public health function is to identify healthcare needs, to influence policy development, and to inform change in practice. Current data management practices with ...paper-based recording systems are prone to data quality defects. Increasingly, healthcare organizations are using technology for the efficient management of data. The aim of this study was to compare the data quality of digital records with the quality of the corresponding paper-based records using a data quality assessment framework. Methodology: We conducted a desk review of paper-based and digital records over the study duration from April 2016 to July 2016 at six enrolled tuberculosis (TB) clinics. We input all data fields of the patient treatment (TB01) card into a spreadsheet-based template to undertake a field-to-field comparison of the shared fields between TB01 and digital data. Findings: A total of 117 TB01 cards were prepared at six enrolled sites, whereas just 50% of the records (n = 59; 59 out of 117 TB01 cards) were digitized. There were 1239 comparable data fields, out of which 65% (n = 803) were correctly matched between paper based and digital records. However, 35% of the data fields (n = 436) had anomalies, either in paper-based records or in digital records. The calculated number of data quality issues per digital patient record was 1.9, whereas it was 2.1 issues per record for paper-based records. Based on the analysis of valid data quality issues, it was found that there were more data quality issues in paper-based records (n = 123) than in digital records (n = 110). Conclusion: There were fewer data quality issues in digital records as compared with the corresponding paper-based records of tuberculosis patients. Greater use of mobile data capture and continued data quality assessment can deliver more meaningful information for decision making.
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