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Introduction: Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA. Purpose: In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education. Methods: Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman’s Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes. Results and discussion: The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a disease which is widely diagnosed using (colour fundus) images. Efficiency and accuracy are critical in diagnosing DR as lack of timely intervention can lead to irreversible visual impairment. In this paper, we examine strategies for scrutinizing images which affect diagnostic performance of medical practitioners via an eye-tracking study. A total of 56 subjects with 0 to 18 years of experience participated in the study. Every subject was asked to detect DR from 40 images. The findings indicate that practitioners use mainly two types of strategies characterized by either higher dwell duration or longer track length. The main findings of the study are that higher dwell-based strategy led to higher average accuracy (> 85%) in diagnosis, irrespective of the expertise of practitioner; whereas, the average obtained accuracy with a long-track length-based strategy was dependent on the expertise of the practitioner. In the second part of the paper, we use the experimental findings to recommend a scanning strategy for fast and accurate diagnosis of DR that can be potentially used by image readers. This is derived by combining the eye-tracking gaze maps of medical experts in a novel manner based on a set of rules. This strategy requires scrutiny of images in a manner which is consistent with spatial preferences found in human perception in general and in the domain of fundus images in particular. The Levenshtein distance-based assessment of gaze patterns also establish the effectiveness of the derived scanning pattern and is thus recommended for image readers. [ABSTRACT FROM AUTHOR]

Background: The prevalence of intimate partner violence (IPV) is high (54%) in Bangladesh. Moreover, female garment workers report higher rates of IPV and are also vulnerable to workplace violence (WPV). Experience of violence puts women at increased risk of developing depressive symptoms, which are related with low self-esteem, lower life satisfaction and lower productivity. To our knowledge, there has been no previous research on depression among female garment workers and its connections to IPV and WPV in Bangladesh. This paper aims to address this gap by studying the relationship of IPV, WPV and depression among female garment workers. Methods: The data for this paper comes from a cross-sectional survey of female garment workers (n = 800) conducted as baseline survey of a quasi-experimental study known as HERrespect. Survey data were collected during September-December, 2016 among randomly selected female garment workers from eight garment factories in and around Dhaka city. Structural equation modelling was conducted to explore the relationship among IPV, WPV and depression. Results: The findings show high rates of any IPV (69%); WPV (73%, experienced or witnessed) and depressive symptomatology (40%) among female garment workers. The analysis of pathways shows that IPV impacts a woman’s experience of WPV and work related stress leading to the development of depression; while WPV had direct and mediated pathways to depression. Experience of controlling by their husband leads to WPV and increased work related stress, and thus leads to depression. It also reveals that a worker’s ability to mobilize resources in emergency, however, increased self-esteem and reduced work related stress. Conclusion: This study shows the pathways through which experience of IPV and WPV lead to development of depressive symptoms among female garment workers. The link between women’s ability to mobilize resources with self-esteem and work related stress indicates the need for socio-economic empowerment of women and may suggest that combined intervention to address IPV and women’s empowerment could be successful in dealing with WPV and mental health. [ABSTRACT FROM AUTHOR]

This study presents first test results of a new performance-based, psychomotor method to measure anger expression and control, based on voice expression and physical force production in directional movement of arms and legs, called the Method of Stamp Strike Shout (MSSS). Recorded are the standardized impact of stamping on a force plate, hitting a punching bag, and the amplitude of shouting in a microphone at various force levels. The premise is, that these body behaviours stand for the ‘urge to act or shout’ that belongs to anger-related emotions. The MSSS is meant to be applied in addition to potentially biased self-report questionnaires and has been designed for diagnostic as well as therapeutic purposes in clinical practice. First, this paper focusses on the instrumentation, internal structure and reliability of the MSSS. An explorative study in a student sample (n = 104) shows correlation patterns between increasing and decreasing levels of force production within each subtest (Stamp, Strike and Shout) and between the three subtests. We found excellent internal consistency of the three subtests and high test-retest reliability. The parameters of increasing and decreasing force levels form the slopes of what we call a force pyramid. To adjust for the clustering within persons, aggregated outcomes were calculated: sum scores per subtest as an indication of total force produced, two linear contrast scores to indicate the rate of increase / decrease, and two quadratic contrast scores as measures of the curvature of the slopes. On all subtests, all aggregated scores showed differences between men and women, also when controlled for weight. To test the validity of the MSSS, the second part of the paper examines the relationship between force parameters and anger coping style, measured by the Self-Expression and Control Scale (SECS). The results suggest that the Shout subtest was the most sensitive indicator for anger coping style, showing negative correlations with Anger In, for women as well as men. For women, higher amplitude was also associated with higher Anger Out and lower amplitude with higher Anger Control. The Stamp subtest showed weak positive correlations with the Anger In subscales, whereas no correlations were found on the Strike subtest. Further, a more robust comparison was made between two groups of participants who reported to have an internalizing versus an externalizing anger coping style. Results indicated that internalizing women as well as men used less force than externalizing participants on all three subtests, especially on the Shout subtest. This was confirmed by lower mean sum scores on the Shout subtest for internalizing women compared with externalizing women. No differences in linear contrast scores were shown between internalizing and externalizing participants. The quadratic contrast scores suggested differences of the curvation of the slopes between women with more or less anger control when stamping, and men with more or less anger control when striking. As this is an explorative study, findings should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background: Rhythmic Auditory Stimulation (RAS) is an effective technique to improve gait and reduce freezing episodes for Persons with Parkinson’s Disease (PwPD). The BeatHealth system, which comprises a mobile application, gait sensors, and a website, exploits the potential of the RAS technique. This paper describes the tools used for co-designing and evaluating the system and discusses the results and conclusions. Methods: Personas, interviews, use cases, and ethnographic observations were used to define the functional requirements of the system. Low fidelity prototypes were created for iterative and incremental evaluation with end-users. Field trials were also performed with the final system. The process followed a user centered design methodology defined for this project with the aim of building a useful, usable, and easy-to-use system. Results: Functional requirements of the system were produced as a result of the initial exploration phase. Building upon these, mock-ups for the BeatHealth system were created. The mobile application was iterated twice, with the second version of it achieving a rating of 75 when assessed by participants through the System Usability Scale (SUS). After another iteration field trials were performed and the mobile application was rated with an average 78.6 using SUS. Participants rated two website mock-ups, one for health professionals and another for end-users, as good except from minor issues related to visual design (e.g. font size), which were resolved in the final version. Conclusion: The high ratings obtained in the evaluation of the BeatHealth system demonstrate the benefit of applying a user centered design methodology which involves stakeholders from the very beginning. Other important lessons were learned through the process of design and development of the system, such as the importance of motivational aspects, the techniques which work best, and the extra care that has to be taken when evaluating non-functional mock-ups with end users. [ABSTRACT FROM AUTHOR]

In this paper we investigate the changes in the functional connectivity intensity, and some related properties, in healthy people, across the life span and at resting state. For the explicit computation of the functional connectivity we exploit a recently proposed model, that bases not only on the correlations data provided by the acquisition equipment, but also on different parameters, such as the anatomical distances between nodes and their degrees. The leading purpose of the paper is to show that the proposed approach is able to recover the main aspects of resting state condition known from the available literature, as well as to suggest new insights, perspectives and speculations from a neurobiological point of view. Our study involves 133 subjects, both males and females of different ages, with no evidence of neurological diseases or systemic disorders. First, we show how the model applies to the sample, where the subjects are grouped into 28 different groups (14 of males and 14 of females), according to their age. This leads to the construction of two graphs (one for males and one for females), that can be realistically interpreted as representative of the neural network during the resting state. Second, following the idea that the brain network is better understood by focusing on specific nodes having a kind of centrality, we refine the two output graphs by introducing a new metric that favours the selection of nodes having higher degrees. As a third step, we extensively comment and discuss the obtained results. In particular, it is remarkable that, despite a great overlapping exists between the outcomes concerning males and females, some intriguing differences appear. This motivates a deeper local investigation, which represents the fourth part of the paper, carried out through a thorough statistical analysis. As a result, we are enabled to support that, for two special age groups, a few links contribute in differentiating the behaviour of males and females. In addition, we performed an average-based comparison between the proposed model and the traditional statistical correlation-based approach, then discussing and commenting the main outlined discrepancies. [ABSTRACT FROM AUTHOR]

Measles is a highly transmissible disease and is one of the leading causes of death among young children under 5 globally. While the use of ongoing surveillance data and—recently—dynamic models offer insight on measles dynamics, both suffer notable shortcomings when applied to measles outbreak prediction. In this paper, we apply the Sequential Monte Carlo approach of particle filtering, incorporating reported measles incidence for Saskatchewan during the pre-vaccination era, using an adaptation of a previously contributed measles compartmental model. To secure further insight, we also perform particle filtering on an age structured adaptation of the model in which the population is divided into two interacting age groups—children and adults. The results indicate that, when used with a suitable dynamic model, particle filtering can offer high predictive capacity for measles dynamics and outbreak occurrence in a low vaccination context. We have investigated five particle filtering models in this project. Based on the most competitive model as evaluated by predictive accuracy, we have performed prediction and outbreak classification analysis. The prediction results demonstrate that this model could predict measles outbreak evolution and classify whether there will be an outbreak or not in the next month (Area under the ROC Curve of 0.89). We conclude that anticipating the outbreak dynamics of measles in low vaccination regions by applying particle filtering with simple measles transmission models, and incorporating time series of reported case counts, is a valuable technique to assist public health authorities in estimating risk and magnitude of measles outbreaks. It is to be emphasized that particle filtering supports estimation of (via sampling from) the entire state of the dynamic model—both latent and observable—for each point in time. Such approach offers a particularly strong value proposition for other pathogens with little-known dynamics, critical latent drivers, and in the context of the growing number of high-velocity electronic data sources. Strong additional benefits are also likely to be realized from extending the application of this technique to highly vaccinated populations. [ABSTRACT FROM AUTHOR]

Food safety is a global public health issue, which often arises from asymmetric information between consumers and suppliers. With the development of information technology in human life, building a food traceability information sharing platform is viewed as one of the best ways to overcome the trust crisis and resolve the problem of information asymmetry in China. However, among the myriad information available from the food supply chain, there is a lack of knowledge on consumer preference. Based on the best-worst scaling approach, this paper investigated consumer preferences for vegetable, pork, and dairy product traceability information. Specifically, this paper measured the relative importance that consumers place on the traceable information. The results indicate that consumers have varying priorities for information in different cases. “Pesticide/veterinary use,” “picking/slaughtering date,” and “fertilizer/feed use” are the most preferred traceable information for Chinese consumers in the case of vegetables, while “picking/slaughtering date” and “history of illness and taking protective measures” are the most preferred information in the case of pork. In the case of dairy products, consumers prefer “processing information,” “environmental information of the origin,” and “traceable tag certification information” most. The results of this study call for the direct involvement of the Chinese government in the food safety information sharing system as following. First, given consumers’ diverse preferences, different types of traceable information should be recorded into the information sharing platform depending on food types. Second, the government could promote the step-by-step construction of such a platform based on the priority of consumers’ preferences. Third, new technology should be applied to guarantee the reliability of traceable information. Finally, local preferences in terms of the way consumers receive and understand information should be taken into consideration. [ABSTRACT FROM AUTHOR]

Research: The body composition model is closely related to the physiological characteristics of the human body. At the same time there can be a large number of physiological characteristics, many of which may be redundant or irrelevant. In existing human physiological feature selection algorithms, it is difficult to overcome the impact that redundancy and irrelevancy may have on human body composition modeling. This suggests a role for selection algorithms, where human physiological characteristics are identified using a combination of filtering and improved clustering. To do this, a feature filtering method based on Hilbert-Schmidt dependency criteria is first of all used to eliminate irrelevant features. After this, it is possible to use improved Chameleon clustering to increase the combination of sub-clusters amongst the characteristics, thereby removing any redundant features to obtain a candidate feature set for human body composition modeling. Method We report here on the use of an algorithm to filter the characteristic parameters in INBODY770 (this paper used INBODY 770 as body composition analyzer.) measurement data, which has three commonly-used impedance bands (1 kHZ, 250 kHZ, 500 kHZ). This algorithm is able to filter out parameters that have a low correlation with body composition BFM. The algorithm is also able to draw upon improved clustering techniques to reduce the initial feature set from 29 parameters to 10 parameters for any parameters of the 250 kHZ band that remain after filtering. In addition, we also examined the impact of different sample sizes on feature selection. Result: The proposed algorithm is able to remove irrelevant and redundant features and the resulting correlation between the model and the body composition (BFM which is a whole body fat evaluation can better assess the body's overall fat and muscle composition.) is 0.978, thereby providing an improved model for prediction with a relative error of less than 0.12. [ABSTRACT FROM AUTHOR]

Animal mobility is a common strategy to overcome scarcity of food and the related over-grazing of pastures. It is also essential to reduce the inbreeding rate of animal populations, which is known to have a negative impact on fertility and productivity. The present paper shows the geographic range of sheep provisioning in different phases of occupation at the Iron Age site of Turó de la Font de la Canya (7th to 3rd centuries BC). Strontium isotope ratios from 34 archaeological sheep and goat enamel, two archaeological bones and 14 modern tree leaves are presented. The isotopic results suggest that sheep and goats consumed at the site were reared locally (within a few kilometres radius) during the whole period of occupation. The paper discusses the isotopic results in light of the socio-political structure of this period, as complex, strongly territorial societies developed during the Iron Age in the north-east Iberian Peninsula. [ABSTRACT FROM AUTHOR]

Objective: There is a need for structure to achieve functional patient engagement within mental healthcare organizations, and for clarification on how to proceed on a strategic level. The aim of this paper is to shed light on the implementation of a strategic organizational structure for patient engagement in mental health by examining why and how to implement a structure, the organizational and environmental factors that facilitate or limit the process, and the perceived consequences of the implementation. Method: This paper evaluates the implementation of a strategic committee for patient engagement in a mental healthcare organization in Montreal (Quebec, Canada). The research was designed as a qualitative single case study using a deductive approach by means of a conceptual framework. Data sources consisted in ten semi-structured interviews, three focus groups, and organizational documents. Results: The strategic committee for patient engagement was implemented as a means to formalize patient partner participation, following the introduction of a vision of full citizenship. Important aspects of its implementation included its composition and role, the elaboration of a framework for patient partner participation, and finally, ongoing application and evaluation of the framework. Several facilitating factors were identified, including executive management support, leadership, and a vision behind the participation. Limiting factors mainly consisted of resistance towards patient participation and the existence of stigma. Consequences included increased and improved patient engagement, as well as reduced stigma within the organization. Conclusion: This study shows that the implementation of a strategic organizational structure for patient engagement is comprehensive. It further shows the importance of a vision and an articulate leadership involving several actors. Further research is needed regarding the impact of this type of strategic structure on a clinical level. [ABSTRACT FROM AUTHOR]

In clinical neuropsychology the cognitive abilities of neurological patients are commonly estimated using well-established paper-based tests. Typically, scores on some tests remain relatively well preserved, whilst others exhibit a significant and disproportionate decline. Scores on those tests that measure preserved cognitive functions (so-called ‘hold’ tests) may be used to estimate premorbid abilities, including scores in non-hold tests that would have been expected prior to the onset of cognitive impairment. Many hold tests entail word reading, with each word being graded as correctly or incorrectly pronounced. Inevitably, such tests are likely to contain words that provide little or no diagnostic power (i.e., can be eliminated without negatively affecting prediction accuracy). In this paper, a genetic algorithm is developed and demonstrated, using n = 92 neurologically healthy participants, to identify optimal word subsets from the National Adult Reading Test that minimize the mean error in predicting the most widely used clinical measure of IQ and cognitive ability, the Wechsler Adult Intelligence Scale Fourth Edition IQ. In addition to requiring only 17–20 of the original 50 words (suggesting that this test could be revised to be up to 66% shorter) and minimizing mean prediction error, the algorithm increases the proportion of the variance in the predicted variable explained in comparison to using all words (from r2 = 0.46 to r2 = 0.61). In a clinical setting this would improve estimates of premorbid cognitive function and, if an abbreviated revision to this test were to be adopted, reduce the arduousness of the test for patients. The proposed method is evaluated with jackknifing and leave one out cross validation. The general approach may be used to optimize the relationship between any two psychological tests by finding the question subset in one test that minimizes the prediction error in a second test by training the genetic algorithm using data collected from participants upon whom both tests have been administered. This approach may also be used to develop new predictive tests, since it provides a method to identify an optimal subset of a set of candidate questions (for which empirical data have been collected) that maximizes prediction accuracy and the proportion of variance in the predicted variable that can be explained. [ABSTRACT FROM AUTHOR]

In this paper the possibility of classification of X-ray images of the cervical vertebrae is studied. The images should be classified into one of the following classes—the images of healthy vertebrae and the images of vertebrae with syndesmophytes. The vertebra contours, described unambiguously by using the generalized shape language, are the basis of the analysis. As a result, the contour is represented as a chain of sinquads that determine switches. The found switches are the characteristic points of the analyzed contour. In these points additional features of the contour are determined. On the basis of these features two aforementioned classes of images are defined as fuzzy sets. Such an approach allows us to create a hierarchical algorithm of classification based on the syntactic and fuzzy description of the contour. [ABSTRACT FROM AUTHOR]

In recent years, finding the cause of pathogenesis is expected by observing the cell images. In this paper, we propose a cell particle detection method in cell images. However, there are mainly two kinds of problems in particle detection in cell image. The first is the different properties between cell images and standard images used in computer vision researches. Edges of cell particles are ambiguous, and overlaps between cell particles are often occurred in dense regions. It is difficult to detect cell particles by simple detection method using a binary classifier. The second is the ground truth made by cell biologists. The number of training samples for training a classifier is limited, and incorrect samples are included by the subjectivity of observers. From the background, we propose a cell particle detection method to address those problems. In our proposed method, we predict the center of a cell particle from the peripheral regions by convolutional neural network, and the prediction results are voted. By using the obvious peripheral edges, we can robustly detect overlapped cell particles because all edges of overlapping cell particles are not ambiguous. In addition, voting from peripheral views enables reliable detection. Moreover, our method is useful in practical applications because we can prepare many training samples from a cell particle. In experiments, we evaluate our detection methods on two kinds of cell detection datasets. One is challenging dataset for synthetic cells, and our method achieved the state-of-the-art performance. The other is real dataset of lipid droplets, and our method outperformed the conventional detector using CNN with binary outputs for particles and non-particles classification. [ABSTRACT FROM AUTHOR]

Introduction: Vector Borne Diseases (VBDs) have a major impact on public health and socio-economic development. Inter-sectoral collaboration was recommended as one of the key elements of Integrated Vector Management (IVM), however limited evidence measures the effect and contribution of intersectoral approaches including but not only IVM. This systematic review aims to assess the existing evidence on all forms of inter-sectoral collaboration in VBD control and prevention, identify any gaps and develop a framework from a global perspective. Methods: Articles were identified through a search of PUBMED, Science of Direct, Web of Knowledge, Google Scholar and WHO archives using key words and excluded duplications (n = 2,034). The exclusion of non-VBDs control and prevention interventions resulted in 194 eligible titles/abstract/keywords for full text assessment. Further exclusion of non-peer reviewed articles, non-declaration of ethical clearance, reviews and expert opinion articles resulted in 50 articles finally being included for analysis with the extraction of data on outcome, factor/s influencing the effectiveness, indicators of collaboration and sustainability. Results: Of the 50 articles included in the analysis, 19 articles were categorized as of moderate-strong quality. All articles compared pre- and post-intervention outcomes against disease or vector variables. Three papers included outcome variables on intersectoral collaboration and participation indicator. However, no paper undertook component analysis by different sectors or different activities. Only one paper compared cost data for community-intersectoral intervention for IRS and traditional “vertical” IRS. Six factors were identified as influencing the effectiveness of inter-sectoral collaboration. Five of six factors are the main ones, namely the approach (37/47), resources (34/47), relationships (33/47), management (29/47) and shared vision (20/47) factors. A conceptual framework has been developed based on this review. Conclusion: This review shows the importance of inter-sectoral collaboration to reduce VBDs or vector densities. However, very few studies measured how much inter-sectoral collaboration contributes to the impact. Further high-quality studies using inter-sectoral collaboration indicators are recommended to be undertaken. [ABSTRACT FROM AUTHOR]

Drug response prediction is a critical step for personalized treatment of cancer patients and ultimately leads to precision medicine. A lot of machine-learning based methods have been proposed to predict drug response from different types of genomic data. However, currently available methods could only give a “point” prediction of drug response value but fail to provide the reliability and distribution of the prediction, which are of equal interest in clinical practice. In this paper, we proposed a method based on quantile regression forest and applied it to the CCLE dataset. Through the out-of-bag validation, our method achieved much higher prediction accuracy of drug response than other available tools. The assessment of prediction reliability by prediction intervals and its significance in personalized medicine were illustrated by several examples. Functional analysis of selected drug response associated genes showed that the proposed method achieves more biologically plausible results. [ABSTRACT FROM AUTHOR]

Background: Antenatal period is an opportunity for reaching pregnant women with vital interventions. In fact, antenatal care (ANC) coverage was an indicator for assessing progress towards the Millennium Development Goals. This paper applies a novel index of service coverage using ANC, which accounts for every ANC visit. An index of service coverage gap is also proposed. These indices are additively decomposable by population groups and they are sensitive to the receipt of more ANC visits below a defined threshold. These indices have also been generalised to account for the quality of services. Methods: Data from recent rounds of the Demographic and Health Survey (DHS) are used to reassess ANC service coverage in 35 sub-Saharan African countries. An index of ANC coverage was estimated. These countries were ranked, and their ranks are compared with those based on attaining at least four ANC visits (ANC4+). Findings: The index of ANC coverage reflected the level of service coverage in countries. Further, disparities exist in country ranking as some countries, e.g. Cameroon, Benin Republic and Nigeria are ranked better using the ANC4+ indicator but poorly using the proposed index. Also, Rwanda and Malawi are ranked better using the proposed index. Conclusion: The proposed ANC index allows for the assessment of progressive realisation, rooted in the move towards universal health coverage. In fact, the index reflects progress that countries make in increasing service coverage. This is because every ANC visit counts. Beyond ANC coverage, the proposed index is applicable to assessing service coverage generally including quality education. [ABSTRACT FROM AUTHOR]

Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development. Participants’ reports of HBRs acting as a point of commonality between patient and provider offer an explanation for their perceptions of improved communication and patient-centered care, and enhanced engagement and empowerment during pregnancy and childcare. Healthcare providers and nurses reported that the home-based record increased their feeling of connection with their patients. Although there were concerns around electronic records and confidentiality, there were no specific concerns reported for paper records. Mothers and other caregivers see home based records as having a pivotal role in facilitating primary care visits and enhancing healthcare for their families. The records’ potential could be limited by users concerns over confidentiality of electronic home-based records, or shortcomings in their design. Health systems should seize the opportunity HBRs provide in empowering women, especially in the contexts of lower literacy levels and weak health care delivery systems. [ABSTRACT FROM AUTHOR]

Objective: To explore intersections of social determinants of maternal healthcare utilization using the Classification and Regression Trees (CART) algorithm which is a machine-learning method used to construct prediction models. Methods: Institutional review board approval for this study was granted from Public Health Service—Ethical Review Board (PHS-ERB) and from the Health Ministry Screening Committee (HMSC) facilitated by Indian Council for Medical Research (ICMR). IRB review and approval for the current analyses was obtained from University of California, San Diego. Cross-sectional data were collected from women with children aged 0–11 months (n = 5,565) from rural households in 25 districts of Uttar Pradesh, India. Participants were surveyed on maternal healthcare utilization including registration of pregnancy (model-1), receipt of antenatal care (ANC) during pregnancy (model-2), and delivery at health facilities (model -3). Social determinants of health including wealth, social group, literacy, religion, and early age at marriage were captured during the survey. The Classification and Regression Tree (CART) algorithm was used to explore intersections of social determinants of healthcare utilization. Results: CART analyses highlight the intersections, particularly of wealth and literacy, in maternal healthcare utilization in Uttar Pradesh. Model-1 documents that women who are poorer, illiterate and Muslim are less likely to have their pregnancies registered (71.4% vs. 86.0% in the overall sample). Model-2 documents that poorer, illiterate women had the lowest ANC coverage (37.7% vs 45% in the overall sample). Model-3, developed for deliveries at health facilities, highlighted that illiterate and poor women have the lowest representation among facility deliveries (59.6% vs. 69% in the overall sample). Conclusion: This paper explores the interactions between determinants of maternal healthcare utilization indicators. The findings in this paper highlights that the interaction of wealth and literacy can play a very strong role in accentuating or diminishing healthcare utilization among women. The study also reveals that religion and women’s age at marriage also interact with wealth and literacy to create substantial disparities in utilization. The study provides insights into the effect of intersections of determinants, and highlights the importance of using a more nuanced understanding of the impact of co-occurring forms of marginalization to effectively tackle inequities in healthcare utilization. [ABSTRACT FROM AUTHOR]

Accurate estimation of motion field in respiration-correlated 4DCT images, is a precondition for the analysis of patient-specific breathing dynamics and subsequent image-supported treatment planning. However, the lung motion estimation often suffers from the sliding motion. In this paper, a novel lung motion method based on the non-rigid registration of point clouds is proposed, and the tangent-plane distance is used to represent the distance term, which describes the difference between two point clouds. Local affine transformation model is used to express the non-rigid deformation of the lung motion. The final objective function is expressed in the Frobenius norm formation, and matrix optimization scheme is carried out to find out the optimal transformation parameters that minimize the objective function. A key advantage of our proposed method is that it alleviates the requirement that the source point cloud and the reference point cloud should be in one-to-one corresponding relationship, and the requirement is difficult to be satisfied in practical application. Furthermore, the proposed method takes the sliding motion of the lung into consideration and improves the registration accuracy by reducing the constraint of the motion along the tangent direction. Non-rigid registration experiments are carried out to validate the performance of the proposed method using popi-model data. The results demonstrate that the proposed method outperforms the traditional method with about 20% accuracy increase. [ABSTRACT FROM AUTHOR]

Background: Recent advances in targeted therapies have raised expectations that the clinical application of biomarkers would improve patient’s health outcomes and potentially save costs. However, the cost-effectiveness of biomarkers remains unclear irrespective of the cost-effectiveness of corresponding therapies. It is thus important to determine whether biomarkers for targeted therapies provide good value for money. This study systematically reviews economic evaluations of biomarkers for targeted therapies in metastatic colorectal cancer (mCRC) and assesses the cost-effectiveness of predictive biomarkers in mCRC. Methods: A literature search was performed using Medline, Embase, EconLit, NHSEED. Papers published from 2000 until June 2018 were searched. All economic evaluations assessing biomarker-guided therapies with companion diagnostics in mCRC were searched. To make studies more comparable, cost-effectiveness results were synthesized as per biomarker tests and corresponding therapies. Methodological quality was assessed using the Quality of Health Economic Studies (QHES) instrument. Results: Forty-six studies were included in this review. Of these, 17 studies evaluated the intrinsic value of cancer biomarkers, whereas the remaining studies focused on assessing the cost-effectiveness of corresponding drugs. Most studies indicated favourable cost-effectiveness of biomarkers for targeted therapies in mCRC. Some studies reported that biomarkers were cost-effective, while their corresponding therapies were not cost-effective. A considerable number of economic evaluations were conducted in pre-defined genetic populations and thus, often failed to fully capture the biomarker’s clinical and economic values. The average QHES score was 73.6. Conclusion: Cancer biomarkers for targeted therapies in mCRC were mostly found to be cost-effective; otherwise, they at least improved the cost-effectiveness of targeted therapies by saving some costs. However, this did not necessarily make their corresponding therapies cost-effective. While companion biomarkers reduced therapy costs, the savings were not sufficient to make the corresponding agents cost-effective. Evaluation of biomarkers was often restricted to the cost of tests and did not consider their clinical values or biomarker prevalence. [ABSTRACT FROM AUTHOR]

Small-holding farmers in the developing world suffer from sub-optimal crop yields because they lack a soil diagnostic system that is affordable, usable, and actionable. This paper details the fabrication and characterization of an integrated point-of-use soil-testing system, comprised of disposable ion-selective electrode strips and a handheld electrochemical reader. Together, the strips and reader transduce soil ion concentrations into to an alphanumeric output that can be communicated via text message to a central service provider offering immediate, customized fertilizer advisory. The solid-state ion-selective electrode (SS-ISE) strips employ a two-electrode design with screen-printable carbon nanotube ink serving as the electrical contacts for the working and reference electrodes. The working electrode comprises a plasticizer-free butyl acrylate ion-selective membrane (ISM), doped with an ion-selective ionophore and lipophilic salt. Meanwhile, the reference electrode includes a screen-printed silver-silver chloride ink and a polyvinyl-butyral membrane, which is doped with sodium chloride for stable reference potentials. As a proof of concept, potassium-selective electrodes are studied, given potassium’s essential role in plant growth and reproduction. The ISE-based system is reproducibly manufactured to yield a Nernstian response with a sub-micromolar detection limit (pK+ of 5.18 ± 0.08) and near-Nernstian sensitivity (61 mV/decade) in the presence of a 0.02 M strontium chloride extraction solution. Analysis of soil samples using the printed electrodes and reader yielded a correlation coefficient of 푅2 = 0.89 with respect to values measured via inductively coupled plasma atomic emission spectroscopy (ICP-AES). The reliable performance of this system is encouraging toward its deployment for soil nutrient management in resource-limited environments. [ABSTRACT FROM AUTHOR]

Background: Partnerships in global health and development governance have been firmly established as a tool to achieve effective outcomes. Botswana implements Safe Male Circumcision (SMC) for HIV prevention through a North-South partnership comprising the local Ministry of Health, US Centers for Disease Control and Prevention (funded by PEPFAR) and Africa Comprehensive HIV/AIDS Partnership (funded by the Bill and Melinda Gates Foundation). The SMC partnership experienced significant antagony and the aim of this paper is to illuminate the actions and processes in the SMC program that contributed to that antagony. Methods: Methods used to gather data include observation of the partners’ planning and strategic meeting in 2012, in-depth interviews with lead officers at national level, focus group discussions with district officers and implementers, younger male officers and old community members as recipients of the service. Results: The findings reveal that the partnership experienced antagony during operational processes and as the ultimate outcome. Target setting, financial power of the North, superficial ownership given to the South, ignoring local traditional realities results in antagony. Three roots of antagony have been identified: 1. therapeutic domination–medical expertise given with arrogance; 2.iatrogenic violence–good intentions that cause unintended harm; 3. the Trojan horse–Reckless acceptance of the gift as well as deceptive power positioned under the pretext of benevolence. Conclusion: The three roots of antagony; therapeutic domination, iatrogenic violence and the Trojan horse, constitute attitudes, hidden intentions and unintended consequences that influence program implementation and cause harm at different levels. Examples of therapeutic domination and the Trojan horse have highlighted the need for vigilance at the stage of establishing a partnership, to prevent more powerful partners from developing and applying hidden agendas and to strengthen accountability from the local partner. Iatrogenic violence has highlighted the need for partnership interventions to prevent good partner intentions accidentally producing bad outcomes. [ABSTRACT FROM AUTHOR]

Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability. [ABSTRACT FROM AUTHOR]

In palynology, the visual classification of pollen grains from different species is a hard task which is usually tackled by human operators using microscopes. Its complete automatization would save a high quantity of resources and provide valuable improvements especially for allergy-related information systems, but also for other application fields as paleoclimate reconstruction, quality control of honey based products, collection of evidences in criminal investigations or fabric dating and tracking. This paper presents three state-of-the-art deep learning classification methods applied to the recently published POLEN23E image dataset. The three methods make use of convolutional neural networks: the first one is strictly based on the idea of transfer learning, the second one is based on feature extraction and the third one represents a hybrid approach, combining transfer learning and feature extraction. The results from the three methods are indeed very good, reaching over 97% correct classification rates in images not previously seen by the models, where other authors reported around 70. [ABSTRACT FROM AUTHOR]

Background: Prognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival estimates, but have only reported the accuracy of estimates on patients with a cancer diagnosis. Objectives: To examine the accuracy of clinicians’ estimates of survival and to determine if any clinical profession is better at doing so than another. Data Sources: MEDLINE, Embase, CINAHL, and the Cochrane Database of Systematic Reviews and Trials. All databases were searched from the start of the database up to June 2015. Reference lists of eligible articles were also checked. Eligibility Criteria: Inclusion criteria: patients over 18, palliative population and setting, quantifiable estimate based on real patients, full publication written in English. Exclusion criteria: if the estimate was following an intervention, such as surgery, or the patient was artificially ventilated or in intensive care. Study Appraisal and Synthesis Methods: A quality assessment was completed with the QUIPS tool. Data on the reported accuracy of estimates and information about the clinicians were extracted. Studies were grouped by type of estimate: categorical (the clinician had a predetermined list of outcomes to choose from), continuous (open-ended estimate), or probabilistic (likelihood of surviving a particular time frame). Results: 4,642 records were identified; 42 studies fully met the review criteria. Wide variation was shown with categorical estimates (range 23% to 78%) and continuous estimates ranged between an underestimate of 86 days to an overestimate of 93 days. The four papers which used probabilistic estimates tended to show greater accuracy (c-statistics of 0.74–0.78). Information available about the clinicians providing the estimates was limited. Overall, there was no clear “expert” subgroup of clinicians identified. Limitations: High heterogeneity limited the analyses possible and prevented an overall accuracy being reported. Data were extracted using a standardised tool, by one reviewer, which could have introduced bias. Devising search terms for prognostic studies is challenging. Every attempt was made to devise search terms that were sufficiently sensitive to detect all prognostic studies; however, it remains possible that some studies were not identified. Conclusion: Studies of prognostic accuracy in palliative care are heterogeneous, but the evidence suggests that clinicians’ predictions are frequently inaccurate. No sub-group of clinicians was consistently shown to be more accurate than any other. Implications of Key Findings: Further research is needed to understand how clinical predictions are formulated and how their accuracy can be improved. [ABSTRACT FROM AUTHOR]

This paper proposes a method to predict fluctuations in the prices of cryptocurrencies, which are increasingly used for online transactions worldwide. Little research has been conducted on predicting fluctuations in the price and number of transactions of a variety of cryptocurrencies. Moreover, the few methods proposed to predict fluctuation in currency prices are inefficient because they fail to take into account the differences in attributes between real currencies and cryptocurrencies. This paper analyzes user comments in online cryptocurrency communities to predict fluctuations in the prices of cryptocurrencies and the number of transactions. By focusing on three cryptocurrencies, each with a large market size and user base, this paper attempts to predict such fluctuations by using a simple and efficient method. [ABSTRACT FROM AUTHOR]

Traditional methods for monitoring influenza are haphazard and lack fine-grained details regarding the spatial and temporal dynamics of outbreaks. Twitter gives researchers and public health officials an opportunity to examine the spread of influenza in real-time and at multiple geographical scales. In this paper, we introduce an improved framework for monitoring influenza outbreaks using the social media platform Twitter. Relying upon techniques from geographic information science (GIS) and data mining, Twitter messages were collected, filtered, and analyzed for the thirty most populated cities in the United States during the 2013–2014 flu season. The results of this procedure are compared with national, regional, and local flu outbreak reports, revealing a statistically significant correlation between the two data sources. The main contribution of this paper is to introduce a comprehensive data mining process that enhances previous attempts to accurately identify tweets related to influenza. Additionally, geographical information systems allow us to target, filter, and normalize Twitter messages. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this paper is to conduct a thorough and systematic review of the empirical and practitioner research on executive, leadership and business coaching to assess the current empirical evidence for the effectiveness of coaching and the mechanisms underlying it. Background: Organisations are increasingly using business coaching as an intervention to improve the productivity and performance of their senior personnel. A consequence of this increased application is the demand for empirical data to understand the process by which it operates and its demonstrable efficacy in achieving pre-set goals. Method: This paper is a systematic review of the academic and practitioner literature pertaining to the effectiveness of business and executive coaching as a developmental intervention for organisations. It focuses on published articles, conference papers and theses that cover business, leadership or executive coaching within organisations over the last 10 years. Conclusions: The main findings show that coaching is an effective tool that benefits organisations and a number of underlying facets contribute to this effectiveness. However, there is deficiency and scope for further investigation in key aspects of the academic research and we identify several areas that need further research and practitioner attention. ​ [ABSTRACT FROM AUTHOR]

Background: HIV transmitted drug resistance (TDR) remains at moderate level in Latin America and the Caribbean (LAC). However, different epidemiologic scenarios could influence national and sub-regional TDR levels and trends. Methods and Findings: We performed a systematic review of currently available publications on TDR in antiretroviral treatment-naïve adults in LAC. Ninety-eight studies published between January 2000 and June 2015 were included according to critical appraisal criteria and classified by sub-region: Brazil (50), Mesoamerica (17), Southern Cone (16), Andean (8) and Caribbean (7). From these, 81 studies encompassing 11,441 individuals with data on DR mutation frequency were included in a meta-analysis. Overall TDR prevalence in LAC was 7.7% (95% CI: 7.2%-8.2%). An increasing trend was observed for overall TDR when comparing 2000–2005 (6.0%) and 2006–2015 (8.2%) (p<0.0001), which was associated with significant NNRTI TDR increase (p<0.0001). NRTI TDR decreased (4.5% vs. 2.3%, p<0.0001). NNRTI TDR increase was associated mainly with K101E, K103N and G190A. NRTI TDR decrease was associated mainly with M184V, K70R and T215Y. All sub-regions reached moderate overall TDR levels. The rapid increase in TDR to all antiretroviral classes in the Caribbean is notable, as well as the significant increase in NNRTI TDR reaching moderate levels in the Southern Cone. NRTI TDR was dominant in 2000–2005, mainly in the Caribbean, Mesoamerica and Brazil. This dominance was lost in 2006–2015 in all sub-regions, with the Southern Cone and the Caribbean switching to NNRTI dominance. PI TDR remained mostly constant with a significant increase only observed in the Caribbean. Conclusions: Given the high conceptual and methodological heterogeneity of HIV TDR studies, implementation of surveys with standardized methodology and national representativeness is warranted to generate reliable to inform public health policies. The observed increasing trend in NNRTI TDR supports the need to strengthen TDR surveillance and programme monitoring and evaluation in LAC. [ABSTRACT FROM AUTHOR]

Introduction: This paper studies the relationship between the risk of child social exclusion, as measured by the Child Social Exclusion (CSE) index and its individual domains, and child health outcomes at the small area level in Australia. The CSE index is Australia’s only national small-area index of the risk of child social exclusion. It includes five domains that capture different components of social exclusion: socio-economic background, education, connectedness, housing and health services. Methods: The paper used data from the National Centre for Social and Economic Modelling (NATSEM), University of Canberra for the CSE Index and its domains and two key Australian Institute of Health and Welfare (AIHW) data sources for the health outcome measures: the National Hospital Morbidity Database and the National Mortality Database. Results: The results show positive associations between rates of both of the negative health outcomes: potentially preventable hospitalisations (PPH) and avoidable deaths, and the overall risk of child social exclusion as well as with the index domains. This analysis at the small-area level can be used to identify and study areas with unexpectedly good or bad health outcomes relative to their estimated risk of child social exclusion. We show that children’s health outcomes are worse in remote parts of Australia than what would be expected solely based on the CSE index. Conclusions: The results of this study suggest that developing composite indices of the risk of child social exclusion can provide valuable guidance for local interventions and programs aimed at improving children’s health outcomes. They also indicate the importance of taking a small-area approach when conducting geographic modelling of disadvantage. [ABSTRACT FROM AUTHOR]

Background: Toxoplasma gondii is one of the most widespread parasites in humans and can cause severe illness in immunocompromised individuals. However, its role in healthy people is probably under-appreciated. The complex epidemiology of this protozoan recognizes several infection routes but consumption of contaminated food is likely to be the predominant one. Among food, consumption of raw and undercooked meat is a relevant route of transmission, but the role of different meat producing animal species and meats thereof is controversial. Objectives: The aim of the present work is to summarize and analyse literature data reporting prevalence estimates of T. gondii in meat animals/meats. Data Sources: We searched Medline, Web of Science, Science Direct (last update 31/03/2015). Eligibility Criteria: Relevant papers should report data from primary studies dealing with the prevalence of T. gondii in meat from livestock species as obtained through direct detection methods. Meta-analysis and meta-regression were performed. Results: Of 1915 papers screened, 69 papers were included, dealing mainly with cattle, pigs and sheep. Pooled prevalences, based on random-effect models, were 2.6% (CI95 [0.5–5.8]) for cattle, 12.3% (CI95 [7.6–17.8]) for pigs and 14.7% (CI95 [8.9–21.5]) for sheep. Due to the high heterogeneity observed, univariable and multivariable meta-regression models were fitted showing that the geographic area for cattle (p = 0.032), the farming type for pigs (p = 0.0004) and the sample composition for sheep (p = 0.03) had significant effects on the prevalences of Toxoplasma detected/estimated. Moreover, the role of different animal species was dependent on the geographic location of animals’ origin. Limitations: Limitations were due mainly to a possible publication bias. Conclusions and Implications: The present work confirms the role of meat, including beef, as T. gondii sources, and highlights the need for a control system for this parasite to be implemented along the meat production chain. Moreover, consumer knowledge should be strengthened in order to reduce the impact of disease. [ABSTRACT FROM AUTHOR]

It is a major challenge to search for survivors after chemical or nuclear leakage or explosions. At present, biological radar can be used to achieve this goal by detecting the survivor’s respiration signal. However, owing to the random posture of an injured person at a rescue site, the radar wave may directly irradiate the person’s head or feet, in which it is difficult to detect the respiration signal. This paper describes a multichannel-based antenna array technology, which forms an omnidirectional detection system via 24-GHz Doppler biological radar, to address the random positioning relative to the antenna of an object to be detected. Furthermore, since the survivors often have random body movement such as struggling and twitching, the slight movements of the body caused by breathing are obscured by these movements. Therefore, a method is proposed to identify random human-body movement by utilizing multichannel information to calculate the background variance of the environment in combination with a constant-false-alarm-rate detector. The conducted outdoor experiments indicate that the system can realize the omnidirectional detection of random human-body movement and distinguish body movement from environmental interference such as movement of leaves and grass. The methods proposed in this paper will be a promising way to search for survivors outdoors. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A) treatment on gait in children with a diagnosis of spastic cerebral palsy (CP), based on three-dimensional gait analysis (3DGA) data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in children with CP is summarized. Methods: Part 1—Intervention studies on BTX-A treatment in children with CP between 4–18 years that used 3DGA data as an outcome measure and were written in English, were identified through a broad systematic literature search. Reported kinematic and kinetic gait features were extracted from the identified studies. Part 2—A retrospective sample of 53 children with CP (6.1 ± 2.3years, GMFCS I-III) received 3DGA before and after multilevel BTX-A injections. The effect of BTX-A on gait was interpreted by comparing the results of paired samples t-tests on the kinematic gait features that were identified from literature to the results of statistical parametric mapping analysis on the kinematic waveforms of the lower limb joints. Results: Part 1–53 kinematic and 33 kinetic features were described in literature. Overall, there is no consensus on which features should be evaluated after BTX-A treatment as 49 features were reported only once or twice. Part 2—Post-BTX-A, both statistical approaches found increased ankle dorsiflexion throughout the gait cycle. Statistical parametric mapping analyses additionally found increased knee extension during terminal stance. In turn, feature analyses found increased outtoeing during stance after BTX-A. Conclusion: This study confirms that BTX-A injections are a valuable treatment option to improve gait function in children with CP. However, different statistical approaches may lead to different interpretations of treatment outcome. We suggest that a clear, definite hypothesis should be stated a priori and a commensurate statistical approach should accompany this hypothesis. [ABSTRACT FROM AUTHOR]

Malaria elimination efforts are hampered by the lack of sensitive tools to detect infections with low-level parasitemia, usually below the threshold of standard diagnostic methods, microscopy and rapid diagnostic tests. Isothermal nucleic acid amplification assays such as the loop-mediated isothermal amplification (LAMP), are well suited for field use as they do not require thermal cyclers to run the test. However, the use of specialized equipment, as described by many groups, reduces the versatility of the LAMP technique as a simple tool for use in endemic countries. In this study, the use of the malachite green (MG) dye, as a visual endpoint readout, together with a simple mini heat block was evaluated for the detection of malaria parasites. The assay was performed for 1 hour at 63°C and the results scored by 3 independent human readers. The limit of detection of the assay was determined using well-quantified Plasmodium spp. infected reference samples and its utility in testing clinical samples was determined using 190 pre-treatment specimens submitted for reference diagnosis of imported malaria in the United States. Use of a simplified boil and spin methods of DNA extraction from whole blood and filter paper was also investigated. We demonstrate the accurate and sensitive detection of malaria parasites using this assay with a detection limit ranging between 1–8 parasites/μL, supporting its applicability for the detection of infections with low parasite burden. This assay is compatible with the use of a simple boil and spin sample preparation method from both whole blood and filter papers without a loss of sensitivity. The MG-LAMP assay described here has great potential to extend the reach of molecular tools to settings where they are needed. [ABSTRACT FROM AUTHOR]

Birth registration and obtaining physical birth certificates impose major challenges in developing countries, with impact on child and community health, education, planning, and all levels of development. However despite initiatives, universal registration is elusive, leading to calls for new approaches to understanding the decisions of parents. In this paper, we report results of a survey of students in grades six to eight (age ~12–16) in an under-registered area of Kenya regarding their own understanding of registration issues and their suggestions for improvement. These students were selected because they themselves were also nearing the age for high school enrollment/entrance examinations, which specifically requires possession of a birth certificate. This assessment was also a companion to our previous representative survey of adults in the same Kenyan region, allowing for parent-child comparison. Results supported previous research, showing that only 43% had birth certificates. At the same time, despite these low totals, students were themselves quite aware of registration factors and purposes. The students also made quite prescient sources for understanding their households’ motivations, with many of their suggestions—for focus on communication of pragmatic benefits, or automatic measures shifting responsibility from parents—mirroring our own previous suggestions, and showing a level of pragmatism not witnessed when surveying their parents. This paper therefore adds evidence to the discussion of registration policy planning. More generally, it also builds on an important trend regarding the treatment of children as stakeholders and important sources of information, and raising an intriguing new avenue for future research. [ABSTRACT FROM AUTHOR]

Motor control is a challenging task for the central nervous system, since it involves redundant degrees of freedom, nonlinear dynamics of actuators and limbs, as well as noise. When an action is carried out, which factors does your nervous system consider to determine the appropriate set of muscle forces between redundant degrees-of-freedom? Important factors determining motor output likely encompass effort and the resulting motor noise. However, the tasks used in many previous motor control studies could not identify these two factors uniquely, as signal-dependent noise monotonically increases as a function of the effort. To address this, a recent paper introduced a force control paradigm involving one finger in each hand that can disambiguate these two factors. It showed that the central nervous system considers both force noise and amplitude, with a larger weight on the absolute force and lower weights on both noise and normalized force. While these results are valid for the relatively low force range considered in that paper, the magnitude of the force shared between the fingers for large forces is not known. This paper investigates this question experimentally, and develops an appropriate Markov chain Monte Carlo method in order to estimate the weightings given to these factors. Our results demonstrate that the force sharing strongly depends on the force level required, so that for higher force levels the normalized force is considered as much as the absolute force, whereas the role of noise minimization becomes negligible. [ABSTRACT FROM AUTHOR]

Background & Aims: Extended esophageal endoscopic submucosal dissection (ESD) is highly responsible for esophageal stricture. We conducted a comparative study in a porcine model to evaluate the effectiveness of adipose tissue-derived stromal cell (ADSC) double cell sheet transplantation. Methods: Twelve female pigs were treated with 5 cm long hemi-circumferential ESD and randomized in two groups. ADSC group (n = 6) received 4 double cell sheets of allogenic ADSC on a paper support membrane and control group (n = 6) received 4 paper support membranes. ADSC were labelled with PKH-67 fluorophore to allow probe-based confocal laser endomicroscopie (pCLE) monitoring. After 28 days follow-up, animals were sacrificed. At days 3, 14 and 28, endoscopic evaluation with pCLE and esophagography were performed. Results: One animal from the control group was excluded (anesthetic complication). Animals from ADSC group showed less frequent alimentary trouble (17% vs 80%; P = 0.08) and higher gain weight on day 28. pCLE demonstrated a compatible cell signal in 4 animals of the ADSC group at day 3. In ADSC group, endoscopy showed that 1 out of 6(17%) animals developed a severe esophageal stricture comparatively to 100% (5/5) in the control group; P = 0.015. Esophagography demonstrated a decreased degree of stricture in the ADSC group on day 14 (44% vs 81%; P = 0.017) and day 28 (46% vs 90%; P = 0.035). Histological analysis showed a decreased fibrosis development in the ADSC group, in terms of surface (9.7 vs 26.1 mm²; P = 0.017) and maximal depth (1.6 vs 3.2 mm; P = 0.052). Conclusion: In this model, transplantation of allogenic ADSC organized in double cell sheets after extended esophegeal ESD is strongly associated with a lower esophageal stricture’s rate. [ABSTRACT FROM AUTHOR]

Background: The use of food supplements containing botanicals is increasing in European markets. Although intended to maintain the health status, several cases of adverse effects to Plant Food Supplements (PFS) have been described. Objectives: To describe the self-reported adverse effects collected during the European PlantLIBRA PFS Consumer Survey 2011–2012, with a critical evaluation of the plausibility of the symptomatology reported using data from the literature and from the PlantLIBRA Poisons Centers' survey. Subjects/Setting: From the total sample of 2359 consumers involved in the consumers' survey, 82 subjects reported adverse effects due to a total of 87 PFS. Results: Cases were self-reported, therefore causality was not classified on the basis of clinical evidence, but by using the frequency/strength of adverse effects described in scientific papers: 52 out of 87 cases were defined as possible (59.8%) and 4 as probable (4.6%). Considering the most frequently cited botanicals, eight cases were due to Valeriana officinalis (garden valerian); seven to Camellia sinensis (tea); six to Ginkgo biloba (Maidenhair tree) and Paullinia cupana (guarana). Most adverse events related to the gastrointestinal tract, nervous and cardiovascular systems. Conclusions: Comparing the data from this study with those published in scientific papers and obtained by the PlantLIBRA Poisons Centers' survey, some important conclusions can be drawn: severe adverse effects to PFS are quite rare, although mild or moderate adverse symptoms can be present. Data reported in this paper can help health professionals (and in particular family doctors) to become aware of possible new problems associated with the increasing use of food supplements containing botanicals. [ABSTRACT FROM AUTHOR]

Background: Research investigating cognition and behaviour in Sotos syndrome has been sporadic and to date, there is no published overview of study findings. Method: A systematic review of all published literature (1964–2015) presenting empirical data on cognition and behaviour in Sotos syndrome. Thirty four journal articles met inclusion criteria. Within this literature, data relating to cognition and/or behaviour in 247 individuals with a diagnosis of Sotos syndrome were reported. Ten papers reported group data on cognition and/or behaviour. The remaining papers employed a case study design. Results: Intelligence quotient (IQ) scores were reported in twenty five studies. Intellectual disability (IQ < 70) or borderline intellectual functioning (IQ 70–84) was present in the vast majority of individuals with Sotos syndrome. Seven studies reported performance on subscales of intelligence tests. Data from these studies indicate that verbal IQ scores are consistently higher than performance IQ scores. Fourteen papers provided data on behavioural features of individuals with Sotos syndrome. Key themes that emerged in the behavioural literature were overlap with ASD, ADHD, anxiety and high prevalence of aggression/tantrums. Conclusion: Although a range of studies have provided insight into cognition and behaviour in Sotos syndrome, specific profiles have not yet been fully specified. Recommendations for future research are provided. [ABSTRACT FROM AUTHOR]

Introduction: The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. Methods: A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. Results: Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. Conclusions: The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary. [ABSTRACT FROM AUTHOR]

Q is a semi-qualitative methodology to identify typologies of perspectives. It is appropriate to address questions concerning diverse viewpoints, plurality of discourses, or participation processes across disciplines. Perspectives are interpreted based on rankings of a set of statements. These rankings are analysed using multivariate data reduction techniques in order to find similarities between respondents. Discussing the analytical process and looking for progress in Q methodology is becoming increasingly relevant. While its use is growing in social, health and environmental studies, the analytical process has received little attention in the last decades and it has not benefited from recent statistical and computational advances. Specifically, the standard procedure provides overall and arguably simplistic variability measures for perspectives and none of these measures are associated to individual statements, on which the interpretation is based. This paper presents an innovative approach of bootstrapping Q to obtain additional and more detailed measures of variability, which helps researchers understand better their data and the perspectives therein. This approach provides measures of variability that are specific to each statement and perspective, and additional measures that indicate the degree of certainty with which each respondent relates to each perspective. This supplementary information may add or subtract strength to particular arguments used to describe the perspectives. We illustrate and show the usefulness of this approach with an empirical example. The paper provides full details for other researchers to implement the bootstrap in Q studies with any data collection design. [ABSTRACT FROM AUTHOR]

Specific memory might be stored in a subnetwork consisting of a small population of neurons. To select neurons involved in memory formation, neural competition might be essential. In this paper, we show that excitable neurons are competitive and organize into two assemblies in a recurrent network with spike timing-dependent synaptic plasticity (STDP) and axonal conduction delays. Neural competition is established by the cooperation of spontaneously induced neural oscillation, axonal conduction delays, and STDP. We also suggest that the competition mechanism in this paper is one of the basic functions required to organize memory-storing subnetworks into fine-scale cortical networks. [ABSTRACT FROM AUTHOR]

Introduction: From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods: This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings: The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions: Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors. [ABSTRACT FROM AUTHOR]

Although inequalities in health and socioeconomic status have an important influence on childhood educational performance, the interactions between these multiple factors relating to variation in educational outcomes at micro-level is unknown, and how to evaluate the many possible interactions of these factors is not well established. This paper aims to examine multi-dimensional deprivation factors and their impact on childhood educational outcomes at micro-level, focusing on geographic areas having widely different disparity patterns, in which each area is characterised by six deprivation domains (Income, Health, Geographical Access to Services, Housing, Physical Environment, and Community Safety). Traditional health statistical studies tend to use one global model to describe the whole population for macro-analysis. In this paper, we combine linked educational and deprivation data across small areas (median population of 1500), then use a local modelling technique, the Takagi-Sugeno fuzzy system, to predict area educational outcomes at ages 7 and 11. We define two new metrics, “Micro-impact of Domain” and “Contribution of Domain”, to quantify the variations of local impacts of multidimensional factors on educational outcomes across small areas. The two metrics highlight differing priorities. Our study reveals complex multi-way interactions between the deprivation domains, which could not be provided by traditional health statistical methods based on single global model. We demonstrate that although Income has an expected central role, all domains contribute, and in some areas Health, Environment, Access to Services, Housing and Community Safety each could be the dominant factor. Thus the relative importance of health and socioeconomic factors varies considerably for different areas, depending on the levels of each of the other factors, and therefore each component of deprivation must be considered as part of a wider system. Childhood educational achievement could benefit from policies and intervention strategies that are tailored to the local geographic areas' profiles. [ABSTRACT FROM AUTHOR]

Psychotic disorders are among the most complex medical conditions. Longitudinal cohort studies may offer further insight into determinants of functional outcome after a psychotic episode. This paper describes the Psychosis Recent Onset in GRoningen Survey (PROGR-S) that currently contains data on 1076 early-episode patients with psychosis, including symptoms, personality, cognition, life events and other outcome determinants. Our goal in this report is to give an overview of PROGR-S, as a point of reference for future publications on the effect of cognition, personality and psychosocial functioning on outcomes. PROGR-S contains an extensive, diagnostic battery including anamnesis, biography, socio-demographic characteristics, clinical status, drug use, neuropsychological assessment, personality questionnaires, and physical status tests. Extensive follow-up data is available on psychopathology, physical condition, medication use, and care consumption. Sample characteristics were determined and related to existing literature. PROGR-S (period 1997–2009, n = 718) included the majority of the expected referrals in the catchment area. The average age was 27 (SD = 8.6) and two-thirds were male. The average IQ was lower than that in the healthy control group. The majority had been diagnosed with a psychotic spectrum disorder. A substantial number of the patients had depressive symptoms (479/718, 78%) and current cannabis or alcohol use (465/718, 75%). The level of community functioning was moderate, i.e. most patients were not in a relationship and were unemployed. The PROGR-S database contains a valuable cohort to study a range of aspects related to symptomatic and functional outcomes of recent onset psychosis, which may play a role in the treatment of this complex and disabling disorder. Results reported here show interesting starting points for future research. Thus, we aim to investigate long-term outcomes on the basis of cognition, personality, negative symptoms and physical health. Ultimately, we hope that this paper will contribute improving the health of patients with psychotic disorders. [ABSTRACT FROM AUTHOR]

Today, while many researchers focus on the improvement of the regularization term in IR algorithms, they pay less concern to the improvement of the fidelity term. In this paper, we hypothesize that improving the fidelity term will further improve IR image quality in low-dose scanning, which typically causes more noise. The purpose of this paper is to systematically test and examine the role of high-fidelity system models using raw data in the performance of iterative image reconstruction approach minimizing energy functional. We first isolated the fidelity term and analyzed the importance of using focal spot area modeling, flying focal spot location modeling, and active detector area modeling as opposed to just flying focal spot motion. We then compared images using different permutations of all three factors. Next, we tested the ability of the fidelity terms to retain signals upon application of the regularization term with all three factors. We then compared the differences between images generated by the proposed method and Filtered-Back-Projection. Lastly, we compared images of low-dose in vivo data using Filtered-Back-Projection, Iterative Reconstruction in Image Space, and the proposed method using raw data. The initial comparison of difference maps of images constructed showed that the focal spot area model and the active detector area model also have significant impacts on the quality of images produced. Upon application of the regularization term, images generated using all three factors were able to substantially decrease model mismatch error, artifacts, and noise. When the images generated by the proposed method were tested, conspicuity greatly increased, noise standard deviation decreased by 90% in homogeneous regions, and resolution also greatly improved. In conclusion, the improvement of the fidelity term to model clinical scanners is essential to generating higher quality images in low-dose imaging. [ABSTRACT FROM AUTHOR]

Background: Knowledge of tuberculosis incidence and associated factors is required for the development and evaluation of strategies to reduce the burden of HIV-associated tuberculosis. Methods: Systematic literature review and meta-analysis of tuberculosis incidence rates among HIV-infected individuals taking combination antiretroviral therapy. Results: From PubMed, EMBASE and Global Index Medicus databases, 42 papers describing 43 cohorts (32 from high/intermediate and 11 from low tuberculosis burden settings) were included in the qualitative review and 33 in the quantitative review. Cohorts from high/intermediate burden settings were smaller in size, had lower median CD4 cell counts at study entry and fewer person-years of follow up. Tuberculosis incidence rates were higher in studies from Sub-Saharan Africa and from World Bank low/middle income countries. Tuberculosis incidence rates decreased with increasing CD4 count at study entry and duration on combination antiretroviral therapy. Summary estimates of tuberculosis incidence among individuals on combination antiretroviral therapy were higher for cohorts from high/intermediate burden settings compared to those from the low tuberculosis burden settings (4.17 per 100 person-years [95% Confidence Interval (CI) 3.39–5.14 per 100 person-years] vs. 0.4 per 100 person-years [95% CI 0.23–0.69 per 100 person-years]) with significant heterogeneity observed between the studies. Conclusions: Tuberculosis incidence rates were high among individuals on combination antiretroviral therapy in high/intermediate burden settings. Interventions to prevent tuberculosis in this population should address geographical, socioeconomic and individual factors such as low CD4 counts and prior history of tuberculosis. [ABSTRACT FROM AUTHOR]

Brucellosis is a bacterial disease caused by brucella; mainly spread by direct contact transmission through the brucella carriers, or indirect contact transmission by the environment containing large quantities of bacteria discharged by the infected individuals. At the beginning of 21st century, the epidemic among dairy cows in Zhejiang province, began to come back and has become a localized prevalent epidemic. Combining the pathology of brucellosis, the reported positive data characteristics, and the feeding method in Zhejiang province, this paper establishes an dynamic model to excavate the internal transmission dynamics, fit the real disease situation, predict brucellosis tendency and assess control measures in dairy cows. By careful analysis, we give some quantitative results as follows. (1) The external input of dairy cows from northern areas may lead to high fluctuation of the number of the infectious cows in Zhejiang province that can reach several hundreds. In this case, the disease cannot be controlled and the infection situation cannot easily be predicted. Thus, this paper encourages cows farms to insist on self-supplying production of the dairy cows. (2) The effect of transmission rate of brucella in environment to dairy cattle on brucellosis spreading is greater than transmission rate of the infectious dairy cattle to susceptible cattle. The prevalence of the epidemic is mainly aroused by environment transmission. (3) Under certain circumstances, the epidemic will become a periodic phenomenon. (4) For Zhejiang province, besides measures that have already been adopted, sterilization times of the infected regions is suggested as twice a week, and should be combined with management of the birth rate of dairy cows to control brucellosis spread. [ABSTRACT FROM AUTHOR]

Objectives: Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods: A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings: Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion: There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. [ABSTRACT FROM AUTHOR]