•to support mHealth implementing organizations understand the strengths and weaknesses found in the available mHealth decision support tools.•to assist mHealth App designers to develop an App that ...will include the strengths from the available Apps and reduce the weaknesses which are already in the Available Apps.
The introduction of a paper-based Community Case Management (CCM) in Malawi has contributed to a reduction of child morbidity and mortality rates. In addition, the introduction of electronic Community Case Management (eCCM) (smartphones with built in CCM apps) may help to reduce the under-five mortality rates even further.
It is not uncommon for Apps with a similar area of interest to develop different features to assist the end users. Such differences between Apps may have a significant role to play in its overall adoption and integration. The purpose of this research was to explore end users perspectives of two eCCM decision support tools developed and implemented by the Supporting LIFE project (SL eCCM App) and D-Tree International’s (Mangologic eCCM App)in Northern Malawi.
A mixed methods approach was applied, involving a survey of 109 users (106 Health Surveillance Assistants (HSAs), and 3 Integrated Management of Childhood Il6lnesses (IMCI) coordinators). This was followed up with semi-structured interviews with 34 respondents (31 HSAs, and 3 IMCI coordinators). Quantitative data was analyzed using SPSS version 20 where descriptive statistics and Chi-Squared tests were generated. Qualitative data were analyzed based on thematic analysis.
Participants reported that both Apps could assist the HSAs in the management of childhood illnesses. However, usability differed between the two apps where the Supporting LIFE eCCM App was found to be easier to use (61%) compared to the Mangologic eCCM App (4%). Both Apps were perceived to provide credible and accurate information.
It is essential that the quality of the data within Mobile Health (mHealth) Apps is high, however even Apps with excellent levels of data quality may not succeed if the overall usability of the App is low. Therefore it is essential that the Apps has high levels of data quality, usability and credibility. The results of this study will help inform mobile Health (mHealth) App designers in developing future eCCM Apps as well as researchers and policy makers when considering the adoption of mHealth solutions in the future in Malawi and other LMICs.
The objectives of this study were to evaluate the rates of chemotherapy and radiotherapy delivery in the treatment of uterine serous carcinoma in the Medicare population and to compare clinical ...outcomes in treated and untreated patients.
The linked Surveillance, Epidemiology, and End Results and Medicare databases were queried to identify patients with a diagnosis of uterine serous carcinoma between 1992 and 2009. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model.
A total of 2188 patients met study eligibility criteria. Stages I, II, III, and IV diseases accounted for 890 (41%), 174 (8%), 470 (21%), and 654 (30%) of the study population, respectively. Chemotherapy, radiotherapy, both, or none, were administered as adjuvant therapy in 635 (29%), 536 (24%), 308 (14%), and 709 (32%) of the study population, respectively. Use of chemotherapy became more frequent over time. Over the study period, and after adjusting for race, time of diagnosis, SEER registry, marital status, stage, age, surgery, lymph node dissection, socioeconomic status, and comorbidity index, there was an association between receipt of radiotherapy alone (hazard ratio HR, 1.3; 95% CI, 1.04-1.67) and not receiving any treatment (HR, 1.5; 95% CI, 1.2-2.01) and worst survival. Survival was not improved over time.
Although adjuvant chemotherapy and combination treatment with chemotherapy and radiation were associated with improved survival in our model, there was no significant improvement in survival over time.
Our understanding of compulsive hoarding as a phenomenon is still certainly in development, though its visibility as a reality for people gives it a particular concreteness that allows us to develop ...ideas in relation to it. This paper considers hoarding in relation to the activity whereby material is contained, with reference to both what contains (the home, in part standing in for the mind) and what is contained (the hoard and all it designates psychologically). The paper attends to the hoarder’s struggle with the contents of the hoard, itself an unsatisfactory though also satisfying, would-be solution to basic problems of life. Four facets of hoarding, corresponding to particular versions of the hoard, are presented—the treasure hoard, the fortress hoard, the compensation hoard and the imposed hoard. Some clinical material is included.
Organic iodides have been shown to induce thyroid hypertrophy and increase alterations in colloid in rats, although the mechanism involved in this toxicity is unclear. To evaluate the effect that ...free iodide has on thyroid toxicity, we exposed rats for 2 weeks by daily gavage to sodium iodide (NaI). To compare the effects of compounds with alternative mechanisms (increased thyroid hormone metabolism and decreased thyroid hormone synthesis, respectively), we also examined phenobarbital (PB) and propylthiouracil (PTU) as model thyroid toxicants. Follicular cell hypertrophy and pale-staining colloid were present in thyroid glands from PB-treated rats, and more severe hypertrophy/colloid changes along with diffuse hyperplasia were present in thyroid glands from PTU-treated rats. In PB- and PTU-treated rats, thyroid-stimulating hormone (TSH) levels were significantly elevated, and both thyroxine and triiodothyronine hormone levels were significantly decreased. PB induced hepatic uridine diphosphate-glucuronyltransferase (UDPGT) activity almost 2-fold, whereas PTU reduced hepatic 5′-deiodinase I (5′-DI) activity to < 10% of control in support of previous reports regarding the mechanism of action of each chemical. NaI also significantly altered liver weights and UDPGT activity but did not affect thyroid hormone levels or thyroid pathology. Thyroid gene expression analyses using Affymetrix U34A GeneChips, a regularized t-test, and Gene Map Annotator and Pathway Profiler demonstrated significant changes in rhodopsin-like G-protein-coupled receptor transcripts from all chemicals tested. NaI demonstrated dose-dependent changes in multiple oxidative stress-related genes, as also determined by principal component and linear regression analyses. Differential transcript profiles, possibly relevant to rodent follicular cell tumor outcomes, were observed in rats exposed to PB and PTU, including genes involved in Wnt signaling and ribosomal protein expression.
Juvenile White Sharks (Carcharodon carcharias) typically aggregate along coastal beaches; however, high levels of recruitment and shifting oceanographic conditions may be causing habitat use ...expansions. Telemetry data indicate increased habitat use at the Northern Channel Islands (California, USA) by juvenile White Shark that may be in response to increased population density at aggregation locations, or anomalous oceanographic events that impact habitat use or expand available habitat. Findings illustrate the need for long-term movement monitoring and understanding drivers of habitat use shifts and expansion to improve ecosystem management. This article is protected by copyright. All rights reserved.
The objective of this paper is to explore the perceptions of key stakeholders involved and/or affected by existing paper-based decision support guidelines (known as Community Case Management (CCM)) ...and a proposed digitised mobile clinical decision support system (CDSS) of CCM in rural settings of Malawi, Africa. Data was collected using field notes and semi-structured interviews with 17 key stakeholders (i.e. clinical, technical, development aid support (NGO), government and community health workers both in Malawi, Europe and USA). Stakeholders provide a rich insight into the variety of both perceived benefits and challenges of the existing guidelines and the proposed electronic CDSS. It was found that all stakeholders believe that the CDSS will improve adherence to guidelines and subsequently result in better care for children. It is further envisioned that the time needed for administration with the current paper-based approach could be reduced using electronic, as opposed to manual, collation and sending of records. This paper acts to underpin the rationale and motivation for the development and rollout of an electronic CDSS to support community health workers in their assessment, classification and treatment of young children in rural settings in Malawi, Africa.
In the striatum many neurotransmitters including GABA, glutamate, acetylcholine, dopamine, nitric oxide and adenosine interact to regulate synaptic transmission. Dopamine release in the striatum is ...regulated by a number of pre- and postsynaptic receptors including adenosine. We have recently shown using isolated rat striatal slices, and the technique of fast cyclic voltammetry, that adenosine A1 receptor-mediated inhibition of dopamine release is modulated by dopamine D1 receptors. In the present study we have investigated the influence of NMDA and GABA receptor activation on the modulation of electrically stimulated dopamine release by adenosine. Application of the adenosine A1 receptor agonist, N⁶-cyclopentyladenosine (CPA), concentration-dependently inhibited dopamine release to a maxiumum of 50%. Perfusion of the glutamate receptor agonist, NMDA, in low magnesium, caused a rapid and concentration-dependent inhibition of dopamine release. Prior perfusion with the adenosine A₁ receptor antagonist, DPCPX, significantly reduced the effect of 5 mM and 10 mM NMDA on dopamine release. The GABA
receptor agonist, isoguvacine, had a significant concentration-dependent inhibitory effect on dopamine release which was reversed by prior application of the GABA
receptor antagonist, picrotoxin, but not DPCPX. Finally inhibition of dopamine release by CPA (1mM) was significantly enhanced by prior perfusion with picrotoxin. These data demonstrate an important role for GABA, NMDA and adenosine in the modulation of dopamine release.
The attempt to recover gambling losses by continuing to gamble ('chasing') has featured prominently in accounts of excessive gambling. This research represents the first attempt to operationalize and ...measure chasing in terms of its cognitive (behavioral intention), emotive (urges) and behavioral components, and to investigate the role of chasing in relation to impaired control over gambling. Two survey samples of 84 male off-course (betting shop) race gamblers (mean age 41, SD = 15) and 137 gaming machine players (73 females, mean age 48, SD = 15 and 64 males, mean age 43, SD = 16) were recruited at gambling venues. Respondents completed a structured questionnaire that investigated retrospective report of chasing and an impaired control scale ("The Scale of Gambling Choices"). It was found that the various components of chasing formed a composite measure with high internal reliability that was strongly related to indicators of excessive gambling (e.g. time spent gambling, expenditure as a proportion of income) and to impaired control scores. Reacting to large wins by further betting was almost as strongly related to impaired control as was persistence after losing. Those who returned later to chase had significantly higher impaired control scores than those who only chased within a session. Alcohol-related chasing was associated with impaired control over gambling. Chasing of losses and impaired control appear to be generic processes in evidence across both forms of gambling and gender (most format and sex differences were of minor significance).
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