Assessment of improvement on quality of life among patients undergoing surgery for treatment of degenerative lumbar spine in Quang Ngai General Hospital

Objectives: To compare quality of life of patients before and one- month after spinal surgery and to identify factors affecting improvement on their quality of life. Materials and Methods: A longitudinal study was conducted in 60 patients who were diagnosed with complicated degenerative lumbar spine and scheduled for surgery of spine at Quang Ngai General Hospital. The SF-36 scale was used to evaluate quality of life of the patients. Results: Findings showed that quality of life after surgery of patients was improved significantly in all components. The better change was found in items of bodily paint and social functioning while the least improvement was reported in physical functioning and role physical. Conclusion: Factors affecting improvement on quality of life of patients after degenerative lumbar surgery were age, BMI and accompanied diseases Key words: degenerative lumbar disease, surgery, quality of life, SF-36, Quang Ngai

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

Background Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making it widely available in Kenya, but its use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings.Methods This was an exploratory qualitative study and data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; and desk review of guidelines, job aides and policy documents. The Capability , Opportunity and Motivation (COM-B) framework was used to interpret emerging themes.Results At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes & patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological) , motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices & beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological) , motivation (reflective & automatic) and opportunity (physical).Conclusion We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries.

On the instability of an internal gravity wave

The linear stability of an internal gravity wave of arbitrary amplitude in an unbounded stratified inviscid Boussinesq fluid is considered mathematically. The instability is shown to be governed by a Floquet system and treated by a generalization of the method of normal modes. Some properties of the Floquet system, and in particular those of its parametric instability, are analysed. The parametric instability is related to the theory of resonant wave interactions; and the surface of marginal stability in the control space of the amplitude and wavenumbers is shown to be describable by the catastrophe theory of Thom. Finally some results of numerical calculations of the marginal surface are shown. The main physical conclusion is to confirm that the internal gravity wave is unstable always, even when its amplitude is small and so its local Richardson number is large everywhere for all time. It is suggested, by various illustrations and arguments, that the methods developed in this paper are applicable to the instability of many symmetric nonlinear waves.