Project description:ObjectiveTo establish criteria for the diagnosis of progressive multifocal leukoencephalopathy (PML).MethodsWe reviewed available literature to identify various diagnostic criteria employed. Several search strategies employing the terms "progressive multifocal leukoencephalopathy" with or without "JC virus" were performed with PubMed, SCOPUS, and EMBASE search engines. The articles were reviewed by a committee of individuals with expertise in the disorder in order to determine the most useful applicable criteria.ResultsA consensus statement was developed employing clinical, imaging, pathologic, and virologic evidence in support of the diagnosis of PML. Two separate pathways, histopathologic and clinical, for PML diagnosis are proposed. Diagnostic classification includes certain, probable, possible, and not PML.ConclusionDefinitive diagnosis of PML requires neuropathologic demonstration of the typical histopathologic triad (demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei) coupled with the techniques to show the presence of JC virus. The presence of clinical and imaging manifestations consistent with the diagnosis and not better explained by other disorders coupled with the demonstration of JC virus by PCR in CSF is also considered diagnostic. Algorithms for establishing the diagnosis have been recommended.
Project description:ObjectiveTo evaluate the evidence basis of single-domain cognitive tests frequently used by behavioral neurologists in an effort to improve the quality of clinical cognitive assessment.MethodsBehavioral Neurology Section members of the American Academy of Neurology were surveyed about how they conduct clinical cognitive testing, with a particular focus on the Neurobehavioral Status Exam (NBSE). In contrast to general screening cognitive tests, an NBSE consists of tests of individual cognitive domains (e.g., memory or language) that provide a more comprehensive diagnostic assessment. Workgroups for each of 5 cognitive domains (attention, executive function, memory, language, and spatial cognition) conducted evidence-based reviews of frequently used tests. Reviews focused on suitability for office-based clinical practice, including test administration time, accessibility of normative data, disease populations studied, and availability in the public domain.ResultsDemographic and clinical practice data were obtained from 200 respondents who reported using a wide range of cognitive tests. Based on survey data and ancillary information, between 5 and 15 tests in each cognitive domain were reviewed. Within each domain, several tests are highlighted as being well-suited for an NBSE.ConclusionsWe identified frequently used single-domain cognitive tests that are suitable for an NBSE to help make informed choices about clinical cognitive assessment. Some frequently used tests have limited normative data or have not been well-studied in common neurologic disorders. Utilizing standardized cognitive tests, particularly those with normative data based on the individual's age and educational level, can enhance the rigor and utility of clinical cognitive assessment.
Project description:BackgroundEthiopia signed the VISION 2020 Global Declaration and launched its eye health program in 2002. Since then, there has been limited systematic and comprehensive evaluation of the progress towards VISION 2020 goals in Ethiopia.ObjectiveTo evaluate Gurage Zone progress towards VISION 2020 targets and process indicators.MethodAn institutional-based cross-sectional study was conducted among all public and private eye health care facilities in the Gurage Zone within the Southern Nations, Nationalities, and People Region of Ethiopia. The evaluation protocol was adopted from the VISION 2020 situational analysis data collection tool. We used this structure to evaluate progress in terms of human resources for eye health, infrastructure, and service delivery at the zonal health office and health facilities. At the time of the study, Gurage Zone had a 1.7 million catchment area population. There were a total of five eye care centers, one of which was established by a non-governmental organization. Three of these facilities were secondary eye care centers with an operating theatre and two facilities were primary eye care centers. At the zonal level, there was no survey data available on the prevalence of blindness.ResultThere was no systemic evaluation of VISION 2020 process indicators. The budget allocation specific to eye health care was less than 0.7% of the total budget of the zonal health office. The human resources for eye health (HReH) in the catchment area were: one ophthalmologist, two cataract surgeons, five optometrists, and 12 ophthalmic nurses, which is below the VISION 2020 targets for HReH. In terms of equipment, neither primary eye care center had a slit lamp biomicroscope, and two of the three secondary eye care centers did not have intraocular pressure measuring equipment. Only one secondary eye care center was providing glaucoma surgical services, and no center provided emergency and elective pediatric surgery. The cataract surgical rate determined by the study was 1967.ConclusionGurage Zone showed significant improvement in terms of cataract surgical rate. But it had not achieved VISION 2020 goals in terms of critical HReH and service delivery. We recommend that the zonal health office carries out a focused and baseline evaluation of eye health care service achievements.
Project description:IntroductionIn 2015, most governments of the world committed to achieving 17 sustainable development goals (SDGs) by the year 2030. Efforts to improve eye health contribute to the advancement of several SDGs, including those not exclusively health-related. This scoping review will summarise the nature and extent of the published literature that demonstrates a link between improved eye health and advancement of the SDGs.Methods and analysisSearches will be conducted in MEDLINE, Embase and Global Health for published, peer-reviewed manuscripts, with no time period, language or geographic limits. All intervention and observational studies will be included if they report a link between a change in eye health and (1) an outcome related to one of the SDGs or (2) an element on a pathway between eye health and an SDG (eg, productivity). Two investigators will independently screen titles and abstracts, followed by full-text screening of potentially relevant articles. Reference lists of all included articles will be examined to identify further potentially relevant studies. Conflicts between the two independent investigators will be discussed and resolved with a third investigator. For included articles, data regarding publication characteristics, study details and SDG-related outcomes will be extracted. Results will be synthesised by mapping the extracted data to a logic model, which will be refined through an iterative process during data synthesis.Ethics and disseminationAs this scoping review will only include published data, ethics approval will not be sought. The findings of the review will be published in an open-access, peer-reviewed journal. A summary of the results will be developed for website posting, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health.
Project description:This themed issue on global health research has come at an opportune time in the middle of the ongoing global public health crisis arising from the coronavirus disease (COVID-19) pandemic which has claimed nearly 756,000 lives in 210 countries and territories around the world as of August 15, 2020. The public health crisis underscores the importance of global health research partnerships and collaborations to develop and evaluate the requisite health technologies to assist in containing COVID-19, other diseases, and health-related concerns that defy national borders. The 17 Sustainable Development Goals (SDGs), adopted by the member countries of the United Nations in September 2015, provide a framework for global development efforts including global health research. SDG3, which promotes health and well-being for the world populations across the age spectrum, highlights disease areas for special focus which can be adapted in specific global health research programs to serve local health needs. SDG17 promotes partnerships between high income (HIC) and low and middle-income countries (LMIC) for sustainable and equitable global development. However, given the wide disparities in fiscal and overall capacity for research between researchers in HIC and their counterparts in LMIC as well as the greater vulnerabilities of the LMIC communities when serving as research locations, a spotlight on the nature of such global health research partnerships in the context of the SDGs is desirable. This is to ensure that they are meaningful and mutually-beneficial partnerships which address local health concerns and promote long-term value for the communities involved. The objective of this commentary is, therefore, to provide a brief overview of the SDGs by way of context; explore the power differences at play when researchers from HIC are seeking research opportunities in LMIC; examine the social determinants of health and the disproportionate burden of global diseases carried by populations in LMIC to establish their vulnerability; discuss global research partnerships; and attempt to make a case for why community-based participatory research may be the preferred type of global health research partnership in the context of the SDGs.
Project description:We observed COVID-19 concern during goal pursuit data collection, where some undergraduates self-reported COVID-19 specific goals. Thus, we analyzed the individual difference in students who self-reported COVID-19 specific goals in this current exploratory study. The results revealed (N = 496) that there were no differences in those who reported COVID-19 goals with their self-reporting of the Five-Factor Model. Additionally, participant's most reported goal was to 1) not contract COVID-19, 2) be social during COVID-19, and 3) follow health and safety protocols. This study provides researchers with both qualitative and quantitative evidence about college students' concern with COVID-19.
Project description:The World Health Organization has identified vaccine hesitancy as one of its top ten global health threats for 2019. Efforts are underway to define the factors responsible for reductions in vaccine confidence. However, as global measles cases accelerated beginning in 2018, it became evident that additional factors were promoting measles re-emergence, including war, political and socio-economic collapse, shifting poverty, and vulnerability to weather events and climate change. Accordingly, we propose a Global Vaccine Risk Index (VRI) to consider these variables as a more comprehensive means to identify vulnerable nations where we might expect measles and other vaccine-preventable diseases to emerge or re-emerge. In Sub-Saharan African and Middle Eastern nations, conflict and political instability predominated as the basis for high vaccine risk scores, whereas in Southeast Asian countries, the major reasons included climate variability, current levels of measles vaccination coverage, and economic and educational disparities. In Europe, low vaccine confidence and refugee movements predominated, while in the Americas, economic disparities and vaccine confidence were important. The VRI may serve as a useful indicator and predictor for international agencies committed to childhood immunizations and might find relevance for accelerating future COVID19 vaccination programs.
Project description:Across the lifespan, humans are biased to look first at what is easy to see, with a handful of well-documented visual saliences shaping our attention (e.g., Itti & Koch, 2001). These attentional biases may emerge from the contexts in which moment-tomoment attention occurs, where perceivers and their social partners actively shape bottom-up saliences, moving their bodies and objects to make targets of interest more salient. The goal of the present study was to determine the bottom-up saliences present in infant egocentric images and to provide evidence on the role that infants and their mature social partners play in highlighting targets of interest via these saliences. We examined 968 unique scenes in which an object had purposefully been placed in the infant's egocentric view, drawn from videos created by one-year-old infants wearing a head camera during toy-play with a parent. To understand which saliences mattered in these scenes, we conducted a visual search task, asking participants (n = 156) to find objects in the egocentric images. To connect this to the behaviors of perceivers, we then characterized the saliences of objects placed by infants or parents compared to objects that were otherwise present in the scenes. Our results show that body-centric properties, such as increases in the centering and visual size of the object, as well as decreases in the number of competing objects immediately surrounding it, both predicted faster search time and distinguished placed and unplaced objects. The present results suggest that the bottom-up saliences that can be readily controlled by perceivers and their social partners may most strongly impact our attention. This finding has implications for the functional role of saliences in human vision, their origin, the social structure of perceptual environments, and how the relation between bottom-up and top-down control of attention in these environments may support infant learning.
Project description:BackgroundFour initiatives have estimated the value of aid for reproductive, maternal, newborn, and child health (RMNCH): Countdown to 2015, the Institute for Health Metrics and Evaluation (IHME), the Muskoka Initiative, and the Organisation for Economic Co-operation and Development (OECD) policy marker. We aimed to compare the estimates, trends, and methodologies of these initiatives and make recommendations for future aid tracking.MethodsWe compared estimates of aid for RMNCH from the four initiatives for all years available at the time of our analysis (1990-2016). We used publicly available datasets for IHME and Countdown. We produced estimates for Muskoka and the OECD policy marker using data in the OECD Creditor Reporting System. We sought to explain differences in estimates by critically comparing the methods used by each approach to identify and analyse aid, and quantifying the effects of these choices on estimates.FindingsAll four approaches indicated substantial increases over time in global aid for RMNCH, but estimates of aid amounts and year-on-year trends differed substantially, especially for individual donors and recipient countries. Muskoka (US$ 13·0 billion in 2013, constant 2015 US$) and Countdown's RMNCH estimates ($13·1 billion in 2013) tended to be the highest and most similar, although they often indicated different year-on-year trends. IHME produced lower estimates ($10·8 billion in 2013), which often indicated different trends from the other approaches. The OECD policy marker produced by far the lowest estimates ($2·0 billion in 2013) because half of bilateral donors did not report on it consistently and those who did tended to apply it narrowly. Estimates differed across approaches primarily because of differences in methods for distinguishing aid for RMNCH from aid for other purposes; adjustments for inflation, exchange rates, and under-reporting; whether donors were credited for their support to multilateral institutions; and the handling of aid to unspecified recipients.InterpretationThe four approaches are likely to lead to different conclusions about whether individual donors and recipient countries have fulfilled their obligations and commitments and whether aid was sufficient, targeted to countries with greater need, or effective. We recommend that efforts to track aid for the Sustainable Development Goals reflect their multisectoral and interconnected nature and make analytical choices that are appropriate to their objectives, recognising the trade-offs between simplicity, timeliness, precision, accuracy, efficiency, flexibility, replicability, and the incentives that different metrics create for donors.FundingSubgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.