scholarly journals A community-based validation of the International Alliance for the Control of Scabies Consensus Criteria by expert and non-expert examiners in Liberia

2020 ◽  
Vol 14 (10) ◽  
pp. e0008717 ◽  
Author(s):  
Stephen L. Walker ◽  
Shelui Collinson ◽  
Joseph Timothy ◽  
Samuel K. Zayzay ◽  
Karsor K. Kollie ◽  
...  
Keyword(s):  
Control Strategies ◽  
Population Level ◽  
Level Control ◽  
Community Based ◽  
Body Regions ◽  
International Alliance ◽  
Lesion Number ◽  
Criteria For Diagnosis ◽  
High Degree ◽  
Lesion Morphology

Background The International Alliance for the Control of Scabies (IACS) recently published expert consensus criteria for scabies diagnosis. Formal validation of these criteria is needed to guide implementation. We conducted a study to provide detailed description of the morphology and distribution of scabies lesions as assessed by dermatologists and validate the IACS criteria for diagnosis by both expert and non-expert examiners. Methods Participants from a community in Monrovia, Liberia, were independently assessed by two dermatologists and six non-expert examiners. Lesion morphology and distribution were documented based on the dermatologist examination. Diagnoses were classified by IACS criteria and the sensitivity and specificity of non-expert examiner assessments calculated. Results Papules were the most common lesions (97.8%). Burrows were found in just under half (46.7%) and dermatoscopy was positive in a minority (13.3%). Scabies lesions were found in all body regions but more than 90% of patients could have been diagnosed by an examination of only the limbs. Severity of itch was associated with lesion number (p = 0.003). The sensitivity of non-expert examiners to detect typical scabies ranged between 69–83% and specificity 70–96%. The sensitivity of non-expert examiners was higher in more extensive disease (78–94%). Conclusions The IACS criteria proved a valid tool for scabies diagnosis. For the purposes of implementation papules and burrows represent truly ‘typical’ scabies lesions. Non-expert examiners are able to diagnose scabies with a high degree of accuracy, demonstrating they could form a key component in population-level control strategies.

scholarly journals A community-based validation of the International Alliance for the Control of Scabies Consensus Criteria by expert and non-expert examiners in Liberia

2020 ◽  
Author(s):  
SL Walker ◽  
S Collinson ◽  
J Timothy ◽  
S Zayay ◽  
K Kollie ◽  
...  
Keyword(s):  
Low Income ◽  
Healthcare Workers ◽  
Control Strategies ◽  
Population Level ◽  
Skin Condition ◽  
English Summary ◽  
Level Control ◽  
Training Course ◽  
Body Regions ◽  
International Alliance

AbstractBackgroundThe International Alliance for the Control of Scabies (IACS) recently published expert consensus criteria for scabies diagnosis. Formal validation of these criteria is needed to guide implementation. We conducted a study to provide detailed description of the morphology and distribution of scabies lesions as assessed by dermatologists and validate the IACS criteria for diagnosis by both expert and non-expert examiners.MethodsParticipants from a community in Monrovia, Liberia, were independently assessed by two dermatologists and six mid-level healthcare workers. Lesion morphology and distribution were documented based on the dermatologist examination. Diagnoses were classified by IACS criteria and the sensitivity and specificity of MLHW assessments calculated.ResultsPapules were the most common lesions (97.8%). Burrows were found in just under half (46.7%) and dermatoscopy was positive in a minority (13.3%). Scabies lesions were found in all body regions but more than 90% of patients could have been diagnosed by an examination of only the limbs. Severity of itch was associated with lesion number (p=0.003). The sensitivity of MLHWs to detect typical scabies ranged between 69-83% and specificity 70-96%. The sensitivity of MLHWs was higher in more extensive disease (78-94%).ConclusionsThe IACS criteria proved a valid tool for scabies diagnosis. For the purposes of implementation papules and burrows represent truly ‘typical’ scabies lesions. MLHWs are able to diagnose scabies with a high degree of accuracy, demonstrating they could form a key component in population-level control strategies.Plain English SummaryScabies is a very common skin condition in both high- and low-income settings with hundreds of millions of people affected each year. Recently standardised criteria have been proposed to help improve the quality of scabies diagnosis, in particular in low income settings where the access to a skin specialist is very limited.In this study, conducted in Liberia, expert examiners conducted a thorough examination and recorded what different types of skin problems they found in participants with and with and without scabies. We then compared the accuracy of a diagnosis of scabies made by dermatologists to that made by non-specialist healthcare workers who had received a short training course over three days.We found that small bumps (papules) were the most common type of scabies lesion and were found in almost every single patient with scabies. A second type of skin lesion called a burrow was the next most common and was found in just under half of the participants. Other types of scabies lesions which have been described were rare in this study. We found that after the short training course the non-specialists were able to detect about the majority of the cases of scabies correctly.Our study has helped provide detailed data on exactly what types of skin changes are typical of scabies and demonstrated how short training programmes can help improve the skill of non-specialist examiners in diagnosing scabies.

scholarly journals Control Intervention Strategies for Within-Host, Between-Host and their Efficacy in the Treatment, Spread of COVID-19 : A Multi Scale Modeling Approach

2020 ◽  
Vol 8 (1) ◽  
pp. 198-210
Author(s):  
D. Bhanu Prakash ◽  
D. K. K. Vamsi ◽  
D. Bangaru Rajesh ◽  
Carani B Sanjeevi
Keyword(s):  
Reproduction Number ◽  
Control Strategies ◽  
Population Level ◽  
Scale Model ◽  
Disease Dynamics ◽  
Level Control ◽  
Multi Scale ◽  
Scale Modeling ◽  
Control Intervention ◽  
Combined Strategy

AbstractThe COVID-19 pandemic has resulted in more than 65.5 million infections and 15,14,695 deaths in 212 countries over the last few months. Different drug intervention acting at multiple stages of pathogenesis of COVID-19 can substantially reduce the infection induced, thereby decreasing the mortality. Also population level control strategies can reduce the spread of the COVID-19 substantially. Motivated by these observations, in this work we propose and study a multi scale model linking both within-host and between-host dynamics of COVID-19. Initially the natural history dealing with the disease dynamics is studied. Later comparative effectiveness is performed to understand the efficacy of both the within-host and population level interventions. Findings of this study suggest that a combined strategy involving treatment with drugs such as Arbidol, remdesivir, Lopinavir/Ritonavir that inhibits viral replication and immunotherapies like monoclonal antibodies, along with environmental hygiene and generalized social distancing proved to be the best and optimal in reducing the basic reproduction number and environmental spread of the virus at the population level.

Morphological peculiarities of seeds of some species of the genus Epipactis Zinn. (Orchidaceae Juss.) of Ukrainian flora

2019 ◽  
Vol 11 (1) ◽  
pp. 93-100
Author(s):  
T Ljubka ◽  
O Tsarenko ◽  
I Tymchenko
Keyword(s):  
Seed Coat ◽  
Cell Walls ◽  
Morphological Study ◽  
Population Level ◽  
Intercellular Spaces ◽  
Different Populations ◽  
Periclinal Walls ◽  
High Degree ◽  
Shape And Size ◽  
Generative Organs

The investigation of macro- and micromorphological peculiarities of seeds of four species of genus Epipactis (Orchidaceae) of Ukrainian flora were carried out. The genus Epipactis is difficult in the in in taxonomic terms and for its representatives are characterized by polymorphism of morphological features of vegetative and generative organs of plants and ability of species to hybridize. The aim of the research was to perform a comparative morphological study of seeds of E. helleborine, E. albensis, E. palustris, E. purpurata and to determine carpological features that could more accurately identify species at the stage of fruiting. A high degree of variation in the shape of the seeds in different populations within the species and overlap of most quantitative carpological characteristics of studied species are noted. There were no significant differences in micromorphological features of the structure of the testa at species or population level. The reticulate surface of the testa is characteristic of all species, the cells of testa are mostly elongated, penta-hexagonal, individual cells almost isodiametric-pentagonal. From the micropillary to the chalasal end, a noticeable change in the shape and size of the seed coat cells is not observed. There are no intercellular spaces, the anticlinal walls of adjacent cells are intergrown and the boundaries between them become invisible. The outer periclinal walls have a single, mainly longitudinal thin ribbed thickenings. Anticlinal cell walls are thick, dense, smooth. The longitudinal Anticlinal walls are almost straight, transverse - straight or sometimes curved in some cells. Epicuticular deposits on the periclinal walls are absent. It is concluded that the use of macro and micromorphological characteristics of seeds of these species for clearer diagnosis at the stage of fruiting is low informative.

Control Strategies for a Highly Loaded Biological Ammonia Elimination Process

1993 ◽  
Vol 28 (11-12) ◽  
pp. 531-538 ◽  
Author(s):  
B. Teichgräber
Keyword(s):  
Closed Loop ◽  
Control Strategies ◽  
Level Control ◽  
Sludge Dewatering ◽  
Loop Control ◽  
Reject Water ◽  
Line Measurement ◽  
Control Pattern ◽  
On Line ◽  
Treatment Facilities

A nitrification/denitrification process was applied to reject water treatment from sludge dewatering at Bottrop central sludge treatment facilities of the Emschergenossenschaft. On-line monitoring of influent and effluent turbidity, closed loop control of DO and pH, and on-line monitoring of nitrogen compounds were combined to a three level control pattern. Though on-line measurement of substrate and product showed substantial response time it could be used to operate nitrification/denitrification within process boundaries.

scholarly journals A 3D hydrodynamic flow-focusing device for cell sorting

2021 ◽  
Vol 25 (3) ◽  
Author(s):  
Xiaofei Yuan ◽  
Andrew Glidle ◽  
Hitoshi Furusho ◽  
Huabing Yin
Keyword(s):  
Cell Sorting ◽  
Control Strategies ◽  
Three Dimensional ◽  
Hydrodynamic Flow ◽  
Proof Of Concept ◽  
Flow Focusing ◽  
Hydrodynamic Focusing ◽  
Cell Handling ◽  
Fluid Flow Control ◽  
High Degree

AbstractOptical-based microfluidic cell sorting has become increasingly attractive for applications in life and environmental sciences due to its ability of sophisticated cell handling in flow. The majority of these microfluidic cell sorting devices employ two-dimensional fluid flow control strategies, which lack the ability to manipulate the position of cells arbitrarily for precise optical detection, therefore resulting in reduced sorting accuracy and purity. Although three-dimensional (3D) hydrodynamic devices have better flow-focusing characteristics, most lack the flexibility to arbitrarily position the sample flow in each direction. Thus, there have been very few studies using 3D hydrodynamic flow focusing for sorting. Herein, we designed a 3D hydrodynamic focusing sorting platform based on independent sheath flow-focusing and pressure-actuated switching. This design offers many advantages in terms of reliable acquisition of weak Raman signals due to the ability to precisely control the speed and position of samples in 3D. With a proof-of-concept demonstration, we show this 3D hydrodynamic focusing-based sorting device has the potential to reach a high degree of accuracy for Raman activated sorting.

scholarly journals Relationship between sensation seeking, alcohol problems and bulimic symptoms: a community-based, longitudinal study

2021 ◽  
Author(s):  
Leon Hirvelä ◽  
Pyry N. Sipilä ◽  
Anna Keski-Rahkonen
Keyword(s):  
Sensation Seeking ◽  
Early Adulthood ◽  
Scoring Systems ◽  
Population Level ◽  
Alcohol Problems ◽  
Community Based ◽  
Level Of Evidence ◽  
Bulimic Symptoms ◽  
Clinical Scoring ◽  
Sensation Seeking Scale

Abstract Purpose The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems. Methods Finnish men (N = 2000) and women (N = 2467) born between 1974–1979 completed Zuckerman’s sensation seeking scale (SSS) at age 18. Alcohol problems (Malmö-modified Michigan alcoholism screening test (Mm-MAST) and bulimic symptoms [eating disorder inventory-2, bulimia subscale (EDI-Bulimia), population and clinical scoring systems] were defined at age 22–27. We examined relationships between SSS, Mm-MAST, and EDI-Bulimia using Pearson’s correlation coefficient (r) and linear regression. Results Alcohol problems were moderately correlated with sensation seeking and bulimic symptoms (population scoring) among women and men (r = 0.21–0.31). The correlation between sensation seeking and bulimic symptoms (population scoring) was weak among men (r = 0.06, p = 0.006) and even weaker and non-significant among women (r = 0.03, p = 0.214). Adjustment for alcohol problems removed the association between sensation seeking and bulimic symptoms among men. Furthermore, there were no significant correlations between sensation seeking and bulimic symptoms when assessing EDI-Bulimia clinical scoring. Conclusion Sensation seeking and bulimic symptoms were not associated among women. The association between sensation seeking and bulimic symptoms among men was entirely attributable to increased alcohol problems among those with higher sensation seeking. While this association may be important on the population level, its clinical significance may be minor. Level of evidence Level III, well-designed cohort study.

Evaluation of Clinical Competence: The Gap Between Expectation and Performance

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. 179-184
Author(s):  
Bahman Joorabchi ◽  
Jeffrey M. Devries
Keyword(s):  
Descriptive Analysis ◽  
Data Gathering ◽  
Community Based ◽  
Resident Performance ◽  
Faculty Expectations ◽  
Clinical Evaluations ◽  
Pediatric Residency ◽  
Objective Structured Clinical Examinations ◽  
And Performance ◽  
High Degree

Objective. To evaluate a 3-year experience with the Objective Structured Clinical Examinations (OSCEs) and to compare faculty expectations with resident performance. Design. Descriptive analysis of measures of resident performance. Setting. Community-based pediatric residency program in Michigan. Participants. One hundred twenty-six pediatric residents at all levels of training. Methods. The three examinations consisted of 36 to 42 5-minute stations, testing skills in physical examination, history, counseling, telephone management, and test interpretation. A committee of faculty and chief residents predetermined minimum pass levels for each resident level. Results were compared with other indices of resident performance. Results. There was evidence for content, construct, and concurrent validity, as well as a high degree of reliability. However, 40% to 96% of residents scored below the minimum pass levels for their levels. In each examination, third-year residents had the highest failure rates, yet they scored well on the American Board of Pediatrics in-training examination and on their monthly clinical evaluations. Furthermore, for residents at all levels, the scores reflecting application of data were significantly lower than those assessing data gathering. Conclusions. The gaps between expectations and performance, and between data gathering and application, have important implications for institutional educational philosophy, suggesting a shift toward more clinically oriented and learner-directed strategies in the design of instructional and evaluation methods.

Gas Carry-Under in GLCC for Separated and Recombined Outlet Configurations

2018 ◽  
Author(s):  
Srinivas Swaroop Kolla ◽  
Ram S. Mohan ◽  
Ovadia Shoham
Keyword(s):  
Volume Fraction ◽  
Swirling Flow ◽  
Control Strategies ◽  
Flow Behavior ◽  
Jet Impingement ◽  
Test Facility ◽  
Experimental Investigations ◽  
Level Control ◽  
Complex Flow ◽  
Control Configuration

Gas Carry-Under (GCU) is one of the undesirable phenomena that exists in the GLCC©1 even within the Operational Envelope (OPEN) for liquid carry-over. Few studies that are available on GLCC© GCU have been carried out when the GLCC© is operated in a metering loop configuration characterized by recombined outlets. In such configurations the gas and the liquid outlets of the GLCC are recombined downstream which acts as passive level control. However, studies have shown that the GLCC© OPEN increases significantly when active control strategies are employed. There has not been a systematic study aimed at analyzing the effect of control on the GCU in the GLCC. This study compares the previously published GLCC GCU swirling flow mechanism under recombination outlet configuration with data taken under the separated outlet configuration (control configuration). Experimental investigations for GCU are conducted in a state-of-the-art test facility for air-water and air-oil flow incorporating pressure and level control configurations. The experiments are carried out using a 3″ diameter GLCC© equipped with 3 sequential trap sections to measure simultaneously the Gas Volume Fraction (GVF) and gas evolution in the lower part of the GLCC. Also, gas trap sections are installed in the liquid leg of the GLCC© to measure simultaneously the overall GCU. The liquid level was controlled at 6″ below the GLCC© inlet for all experiments using various control strategies. Tangential wall jet impingement is the cause for entrainment of gas, thereby leading to GCU. 3 different flow mechanisms have been identified in the lower part of the GLCC and have significant effect on the GCU. Viscosity and surface tension are observed to affect the GCU. The extensive acquired data shed light on the complex flow behavior in the lower part of the GLCC© and its effect on the GCU of the GLCC©.

Modeling Cyclic Variability in Spark-Assisted HCCI

2008 ◽  
Vol 130 (5) ◽  
Author(s):  
C. Stuart Daw ◽  
K. Dean Edwards ◽  
Robert M. Wagner ◽  
Johney B. Green
Keyword(s):  
Control Strategies ◽  
Experimental Studies ◽  
Mode Switching ◽  
Load Range ◽  
Gasoline Engines ◽  
Cyclic Variability ◽  
Hcci Combustion ◽  
Quantitative Understanding ◽  
Low Dimensional ◽  
High Degree

Spark assist appears to offer considerable potential for increasing the speed and load range over which homogeneous charge compression ignition (HCCI) is possible in gasoline engines. Numerous experimental studies of the transition between conventional spark-ignited (SI) propagating-flame combustion and HCCI combustion in gasoline engines with spark assist have demonstrated a high degree of deterministic coupling between successive combustion events. Analysis of this coupling suggests that the transition between SI and HCCI can be described as a sequence of bifurcations in a low-dimensional dynamic map. In this paper, we describe methods for utilizing the deterministic relationship between cycles to extract global kinetic rate parameters that can be used to discriminate multiple distinct combustion states and develop a more quantitative understanding of the SI-HCCI transition. We demonstrate the application of these methods for indolene-containing fuels and point out an apparent HCCI mode switching not previously reported. Our results have specific implications for developing dynamic combustion models and feedback control strategies that utilize spark assist to expand the operating range of HCCI combustion.

scholarly journals A narrative review on HPV vaccination among boys and men

2020 ◽  
pp. 9-12
Author(s):  
Vinod K Ramani ◽  
Radheshyam Naik
Keyword(s):  
Hpv Vaccine ◽  
Hpv Vaccination ◽  
Herd Immunity ◽  
Population Level ◽  
Hpv Infection ◽  
Level Control ◽  
Anogenital Warts ◽  
Indian Context ◽  
Present Generation ◽  
The Cost

Apart from cervical cancer, Human papillomavirus (HPV) infection is associated with head and neck as well as other anogenital cancers such as vulva, vagina, anus, and penis. HPV vaccine provides specific protection against the disease and its subsequent manifestations.Vaccination programs for men tend to improve population-level control of HPV infection and directly prevent HPV related disease such as anogenital warts and oropharyngeal cancers in males. HPV vaccine does not treat existing infection or lesions/cancer and is intended for individuals before initiation fo sexual activity or any other form of exposure to HPV.Many programs across the globe do not include vaccination for boys because of the cost and little recognition of the emerging epidemic of HPV associated cancers in men. In the Indian context, as screening is not feasible for non-cervical HPV associated cancers, its incidence mostly among men will continue to rise until the present generation of vaccinated adolescents reaches their middle-age.Vaccination will reduce transmission rates and increase herd immunity. This in-turn, will prevent not just cervical cancers but also other HPV-associated malignancies among men and women.

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