scholarly journals Spatial and temporal dynamics of superspreading events in the 2014–2015 West Africa Ebola epidemic

2017 ◽  
Vol 114 (9) ◽  
pp. 2337-2342 ◽  
Author(s):  
Max S. Y. Lau ◽  
Benjamin Douglas Dalziel ◽  
Sebastian Funk ◽  
Amanda McClelland ◽  
Amanda Tiffany ◽  
...  
Keyword(s):  
Spatial Information ◽  
Temporal Dynamics ◽  
Clinical Care ◽  
Infected Individual ◽  
Significant Proportion ◽  
Control Measures ◽  
Community Based ◽  
Infectious Individual ◽  
Targeted Interventions ◽  
Care Systems

The unprecedented scale of the Ebola outbreak in Western Africa (2014–2015) has prompted an explosion of efforts to understand the transmission dynamics of the virus and to analyze the performance of possible containment strategies. Models have focused primarily on the reproductive numbers of the disease that represent the average number of secondary infections produced by a random infectious individual. However, these population-level estimates may conflate important systematic variation in the number of cases generated by infected individuals, particularly found in spatially localized transmission and superspreading events. Although superspreading features prominently in first-hand narratives of Ebola transmission, its dynamics have not been systematically characterized, hindering refinements of future epidemic predictions and explorations of targeted interventions. We used Bayesian model inference to integrate individual-level spatial information with other epidemiological data of community-based (undetected within clinical-care systems) cases and to explicitly infer distribution of the cases generated by each infected individual. Our results show that superspreaders play a key role in sustaining onward transmission of the epidemic, and they are responsible for a significant proportion (∼61%) of the infections. Our results also suggest age as a key demographic predictor for superspreading. We also show that community-based cases may have progressed more rapidly than those notified within clinical-care systems, and most transmission events occurred in a relatively short distance (with median value of 2.51 km). Our results stress the importance of characterizing superspreading of Ebola, enhance our current understanding of its spatiotemporal dynamics, and highlight the potential importance of targeted control measures.

scholarly journals A prospect on the use of antiviral drugs to control local outbreaks of COVID-19

2020 ◽  
Author(s):  
Andrea Torneri ◽  
Pieter Libin ◽  
Joris Vanderlocht ◽  
Anne-Mieke Vandamme ◽  
Johan Neyts ◽  
...  
Keyword(s):  
Control Measure ◽  
Health Care Systems ◽  
Significant Proportion ◽  
Antiviral Drug ◽  
Control Measures ◽  
Contact Tracing ◽  
Final Size ◽  
Antiviral Compound ◽  
Intervention Measures ◽  
Care Systems

AbstractBackgroundCurrent outbreaks of COVID-19 are threatening the health care systems of several countries around the world. Control measures, based on isolation and quarantine, have been shown to decrease and delay the burden of the ongoing epidemic. With respect to the ongoing COVID-19 epidemic, recent modelling work shows that this intervention technique may be inadequate to control local outbreaks, even when perfect isolation is assumed. Furthermore, the effect of infectiousness prior to symptom onset combined with a significant proportion of asymptomatic infectees further complicates the use of contact tracing. Antivirals, which decrease the viral load and reduce the infectiousness, could be integrated in the control measures in order to augment the feasibility of controlling the epidemic.MethodsUsing a simulation-based model of viral transmission we tested the efficacy of different intervention measures for the control of COVID-19. For individuals that were identified through contact tracing, we evaluate two procedures: monitoring individuals for symptoms onset and testing of individuals. Moreover, we investigate the effect of a potent antiviral compound on the contact tracing process.FindingsThe use of an antiviral drug, in combination with contact tracing, quarantine and isolation, results in a significant decrease of the final size, the peak incidence, and increases the probability that the outbreak will fade out.InterpretationFor an infectious disease in which presymptomatic infections are plausible, an intervention measure based on contact tracing performs better when realized together with testing instead of monitoring, provided that the test is able to detect infections during the incubation period. In addition, in all tested scenarios, the model highlights the benefits of the administration of an antiviral drug in addition to quarantine, isolation and contact tracing. The resulting control measure, could be an effective strategy to control local and re-emerging out-breaks of COVID-19.

Implementing Cancer Exercise Rehabilitation: An Update on Recommendations for Clinical Practice

2019 ◽  
Vol 15 (2) ◽  
pp. 100-109 ◽  
Author(s):  
Kirsten Suderman ◽  
Carolyn McIntyre ◽  
Christopher Sellar ◽  
Margaret L. McNeely
Keyword(s):  
Cancer Survivors ◽  
Research Evidence ◽  
Clinical Care ◽  
Preliminary Evidence ◽  
Model Of Care ◽  
Community Based ◽  
Exercise Rehabilitation ◽  
Barriers To Exercise ◽  
Growing Body ◽  
After Cancer

A growing body of research evidence supports the benefit of exercise for cancer survivors both during and after cancer treatment. The purpose of this paper is to provide an update on our previously published review in 2006 on the state of the evidence supporting exercise for survivors of cancer as well as guidelines for integrating exercise programming in the cancer clinical setting. First, we provide a brief overview on the benefits of exercise as well as preliminary evidence supporting the implementation of community-based exercise programs. Second, we summarize the principles and goals of exercise, and the identified barriers to exercise among cancer survivors. Finally, we propose an interdisciplinary model of care for integrating exercise programming into clinical care including guidelines for medical and pre-exercise screening, exercise testing and programming considerations.

scholarly journals Acute symptoms of mild to moderate COVID-19 are highly heterogeneous across individuals and over time

2021 ◽  
Author(s):  
Thomas L Rodebaugh ◽  
Madelyn R Frumkin ◽  
Angela M Reiersen ◽  
Eric J Lenze ◽  
Michael S Avidan ◽  
...  
Keyword(s):  
Temporal Dynamics ◽  
Survey Methods ◽  
Clinical Care ◽  
Clinical Deterioration ◽  
Symptom Profiles ◽  
Fluctuating Course ◽  
The Common ◽  
Symptom Changes ◽  
Over Time

Abstract Background The symptoms of COVID-19 appear to be heterogenous, and the typical course of these symptoms is unknown. Our objectives were to characterize the common trajectories of COVID-19 symptoms and assess how symptom course predicts other symptom changes as well as clinical deterioration. Methods 162 participants with acute COVID-19 responded to surveys up to 31 times for up to 17 days. Several statistical methods were used to characterize the temporal dynamics of these symptoms. Because nine participants showed clinical deterioration, we explored whether these participants showed any differences in symptom profiles. Results Trajectories varied greatly between individuals, with many having persistently severe symptoms or developing new symptoms several days after being diagnosed. A typical trajectory was for a symptom to improve at a decremental rate, with most symptoms still persisting to some degree at the end of the reporting period. The pattern of symptoms over time suggested a fluctuating course for many patients. Participants who showed clinical deterioration were more likely to present with higher reports of severity of cough and diarrhea. Conclusion The course of symptoms during the initial weeks of COVID-19 is highly heterogeneous and is neither predictable nor easily characterized using typical survey methods. This has implications for clinical care and early-treatment clinical trials. Additional research is needed to determine whether the decelerating improvement pattern seen in our data is related to the phenomenon of patients reporting long-term symptoms, and whether higher symptoms of diarrhea in early illness presages deterioration.

scholarly journals EyeHealer: A large-scale anterior eye segment dataset with eye structure and lesion annotations

2021 ◽  
Author(s):  
Wenjia Cai ◽  
Jie Xu ◽  
Ke Wang ◽  
Xiaohong Liu ◽  
Wenqin Xu ◽  
...  
Keyword(s):  
Deep Learning ◽  
Large Scale ◽  
Image Annotation ◽  
Clinical Care ◽  
Significant Proportion ◽  
Anterior Segment ◽  
Future Research ◽  
Learning Models ◽  
Anterior Eye Segment ◽  
Segmentation Models

Abstract Anterior segment eye diseases account for a significant proportion of presentations to eye clinics worldwide, including diseases associated with corneal pathologies, anterior chamber abnormalities (e.g. blood or inflammation) and lens diseases. The construction of an automatic tool for the segmentation of anterior segment eye lesions will greatly improve the efficiency of clinical care. With research on artificial intelligence progressing in recent years, deep learning models have shown their superiority in image classification and segmentation. The training and evaluation of deep learning models should be based on a large amount of data annotated with expertise, however, such data are relatively scarce in the domain of medicine. Herein, the authors developed a new medical image annotation system, called EyeHealer. It is a large-scale anterior eye segment dataset with both eye structures and lesions annotated at the pixel level. Comprehensive experiments were conducted to verify its performance in disease classification and eye lesion segmentation. The results showed that semantic segmentation models outperformed medical segmentation models. This paper describes the establishment of the system for automated classification and segmentation tasks. The dataset will be made publicly available to encourage future research in this area.

scholarly journals Willingness of Greek general population to get a COVID-19 vaccine

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Georgia Kourlaba ◽  
Eleni Kourkouni ◽  
Stefania Maistreli ◽  
Christina-Grammatiki Tsopela ◽  
Nafsika-Maria Molocha ◽  
...  
Keyword(s):  
Public Health ◽  
General Population ◽  
Data Collection ◽  
Sample Size ◽  
Significant Proportion ◽  
Control Measures ◽  
Systematic Sampling ◽  
Computer Assisted ◽  
Public Health Officials ◽  
To Receive

Abstract Background Epidemiological data indicate that a large part of population needs to be vaccinated to achieve herd immunity. Hence, it is of high importance for public health officials to know whether people are going to get vaccinated for COVID-19. The objective of the present study was to examine the willingness of adult residents in Greece to receive a COVID-19 vaccine. Methods A cross-sectional was survey conducted among the adult general population of Greece between April 28, 2020 to May 03, 2020 (last week of lockdown), using a mixed methodology for data collection: Computer Assisted Telephone Interviewing (CATI) and Computer Assisted web Interviewing (CAWI). Using a sample size calculator, the target sample size was found to be around 1000 respondents. To ensure a nationally representative sample of the urban/rural population according to the Greek census 2011, a proportionate stratified by region systematic sampling procedure was used to recruit particpants. Data collection was guided through a structured questionnaire. Regarding willingness to COVID-19 vaccination, participants were asked to answer the following question: “If there was a vaccine available for the novel coronavirus, would you do it?” Results Of 1004 respondents only 57.7% stated that they are going to get vaccinated for COVID-19. Respondents aged > 65 years old, those who either themselves or a member of their household belonged to a vulnerable group, those believing that the COVID-19 virus was not developed in laboratories by humans, those believing that coronavirus is far more contagious and lethal compared to the H1N1 virus, and those believing that next waves are coming were statistically significantly more likely to be willing to get a COVID-19 vaccine. Higher knowledge score regarding symptoms, transmission routes and prevention and control measures against COVID-19 was significantly associated with higher willingness of respondents to get vaccinated. Conclusion A significant proportion of individuals in the general population are unwilling to receive a COVID-19 vaccine, stressing the need for public health officials to take immediate awareness-raising measures.

scholarly journals Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Paibul Suriyawongpaisal ◽  
Samrit Srithamrongsawad ◽  
Pongsakorn Atiksawedparit ◽  
Khanisthar Phooseemungkun ◽  
Krongkan Bunchaiyai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Care ◽  
Patient Outcomes ◽  
Prehospital Care ◽  
Clinical Care ◽  
Mixed Methods Approach ◽  
Time Flow ◽  
Care Systems ◽  
Pay System ◽  
Made In

Introduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results. EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion. It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.

scholarly journals Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics

2021 ◽  
Vol 18 (7) ◽  
pp. 3437
Author(s):  
Francisco Cartujano-Barrera ◽  
Michelle Lee D’Abundo ◽  
Evelyn Arana-Chicas ◽  
Surina Chock ◽  
Pamela Valera ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Barriers And Facilitators ◽  
Mental Health Stigma ◽  
People Living With Hiv ◽  
Community Based ◽  
Care Community ◽  
Targeted Interventions ◽  
Community Based Organizations ◽  
The Individual ◽  
Living With Hiv

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions.

Final report of Breast Cancer Care Registry at the Kenyatta National Hospital, Nairobi.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12552-e12552
Author(s):  
Nicholas Anthony Othieno-Abinya ◽  
Alice Musibi ◽  
Catherine Nyongesa ◽  
Benjamin Njihia ◽  
Andrew Gachii ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Disease ◽  
Ductal Carcinoma ◽  
Clinical Care ◽  
Significant Proportion ◽  
Relative Survival ◽  
Final Report ◽  
Early Disease ◽  
National Hospital ◽  
Kenyatta National Hospital

e12552 Background: Breast cancer is the commonest cancer among women in Kenya. We wanted to examine breast cancer seen at the Kenyatta National Hospital in relation to local factors that influence prognosis and quality of life, local variations in treatment and outcomes; describe the clinical care patterns, monitor the safety of the therapies provided to patients in a routine clinic setting. Methods: A prospective study of patients with breast cancer between 11.08.2011 and 11.09.2014 inclusive. Data included demographic details, diagnostic and staging procedures, stage, treatment and outcome. Estimates of relative survival used period approach. hi-square tests and analysis of variance (ANOVA) were utilised to make comparisons. Cross sectional data are presented in proportions, means and medians. Results: Four hundred patients were included, age range 20 to 83, median 49 years. Out 312, 65 (20.8%) were obese. Eight of 397 (2%) were smokers and 22(5.5%) took alcohol. Early disease was diagnosed in 269 out of 354 (76%) and metastatic disease in 85(24%). Breast lump presented in 388 out of 400 (97%), breast pain in 104 out of 388 (26.8%). Fifteen of 394 (3.8%) had second breast cancer, 4 (1%) had had ovarian cancer and 9 (2.3%) had had had other malignancy. History of breast cancer in first and second-degree relative was elicited in 41 out of 394 (10.4%). Ductal carcinoma NOS was commonest in 343 (88.2%), lobular carcinoma in 9(2.5%). Cases by T stage were T1 - 25(7.2%), T2 -130(37.4%), T3 - 96(27.6%), T4 - 87(25%). Of 322 cases, 187(58.1%) were ER positive and 175 (54.4%) PR positive. Her2 positive cases were 78 out of 322 (24.2%). Neo adjuvant and adjuvant chemotherapy mainly consisted of combinations of cyclophosphamide and doxorubicin [AC] +/- a taxane[AC→T] ( mainly by medical oncologists) or AC+ 5-FU [CAF] (mainly by clinical oncologists). Of 305 cases 272 (89.2%) completed adjuvant therapy, 8(2.6%) died during treatment. Median overall survival was 57.1 months (95% CI; 55.6 to 59.5 months). For metastatic disease, median PFS was worse for patients < 40 years. Conclusions: Pathology and biology mirrored global situation, over 75% of patients had non metastatic disease. A significant proportion of early disease patients did not complete treatment.

scholarly journals Knowledge, attitude and practices regarding malaria among residents of rural Mangalore, India

2018 ◽  
Vol 7 (1) ◽  
pp. 231
Author(s):  
Animesh Gupta ◽  
Aishwarya Bhat
Keyword(s):  
Preventive Measures ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Control Measures ◽  
Basic Knowledge ◽  
Parasitic Diseases ◽  
Health Seeking ◽  
Community Based ◽  
Cross Sectional ◽  
Structured Questionnaire

Background: Malaria is one of the most prevalent parasitic diseases worldwide and India has fourth highest number of malaria cases and deaths in the world. Prevention of the disease through better knowledge and awareness is the appropriate way to keep the disease away and remain healthy. Thus, the present study was aimed to assess the knowledge, attitude and practices regarding malaria among residents of Mangalore.Methods: Community based cross sectional study was conducted among residents in Mangalore. The data was collected by using pre-tested semi-structured questionnaire which include socio-demographic data, basic knowledge about malaria, transmission and preventive measures and health seeking behaviour regarding malaria through interview method.Results: Almost 98.4% respondents heard of malaria disease and 96% respondents had knowledge that malaria is caused by mosquito bite. Even, majority (72%) of respondents knew that malaria can be fatal. Regarding the symptoms of malaria, 52.4% respondents mentioned fever with chills and 11.6% respondents don’t know about malarial symptoms.Conclusions: Majority of the respondents were familiar with the malaria symptoms, mode of transmission and vector control measures. They had good knowledge of malaria disease and good practices of malaria control measures.

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