Routine Paediatric Sickle Cell Disease (SCD) Outpatient Care in a Rural Kenyan Hospital: Utilization and Costs

Background

More than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya.

Objective

To estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital.

Methods

We collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate.

Results

We estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229.

Conclusion

This study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts.     

Thrombin-induced platelet microparticles improved the aggregability of cryopreserved platelets

Platelets were activated with freezing/thawing and thrombin stimulation, and platelet microparticles generated following platelet activation were isolated with ultracentrifugation. The effects of platelet microparticles on platelet activation were studied with annexin V assay, protein tyrosine phosphorylation, and platelet aggregation. Freezing-induced platelet microparticles decreased but thrombin-induced platelet microparticles increased platelet annexin V binding and aggregation. Freshly washed platelets were cryopreserved using epinephrine and dimethyl sulfoxide (Me(2)SO) as combined cryoprotectants, and stimulated with thrombin-induced platelet microparticles. Following incubation of thrombin-induced platelet microparticles, the reaction time of platelets to agonists decreased but the percentages of aggregation increased, such as washed platelets from 44% +/- 30 to 92% +/- 7, p < 0.001, and cryopreserved platelets from 66% +/- 10 to 77% +/- 7, p < 0.02. By increasing platelet aggregability, platelet microparticles recovered after thrombin stimulation improved platelet function for transfusion. A 53-kDa platelet microparticle protein showed little phosphorylation if it was released from resting platelets or platelets stimulated with ADP, epinephrine, propyl gallate or dephosphorylation if it was derived from ionophore A 23187-stimulated platelets. However, the same protein released from frozen platelets showed significant tyrosine phosphorylation. Since a microparticle protein with 53 kDa was compatible with protein tyrosine phosphatase-1B (PTP-1B), its phosphorylation suggests the inhibition of enzyme activity. The microparticle proteins derived from thrombin-stimulated platelets were significantly phosphorylated at 64 kDa and pp60c-src, suggesting that the activation of tyrosine kinases represents a possible mechanism of thrombin-induced platelet microparticles to improve platelet aggregation.     

Rangewide microsatellite phylogeography of the endangered tidewater goby, <Emphasis Type="Italic">Eucyclogobius newberryi</Emphasis> (Teleostei: Gobiidae), a genetically subdivided coastal fish with limited marine dispersal

The federally endangered tidewater goby, Eucyclogobius newberryi, is the most locally differentiated vertebrate with marine dispersal on the California Coast. It inhabits seasonally closed estuaries along the California coast; a habitat heavily impacted by anthropogenic filling and artificial opening, and exhibits varied metapopulation behavior as a consequence of hydrologic variation and anthropogenic impact. We describe 19 taxon-specific microsatellite loci, and assess genetic variation across the taxon range relative to genetic subdivision. A highly divergent southern clade, with reduced genetic variation, now confined to Northern San Diego County, appears to merit status as a separate species. The mid-coast is subdivided into regional groups with overall similarity to, and minor differences from previous mitochondrial sequence based clades. The northernmost region, although locally differentiated, forms a star phylogeny with limited geographic structure which we attribute to dispersal during Pleistocene/Holocene sea-level rise followed by increasing isolation during the Holocene. Bottleneck/founder events are evident in some habitats thought to have experienced (anthropogenic) extirpation. Further work with more, and larger, samples will be required to assess local and regional differences. Analytical methods employed include Analysis of Molecular Variance (AMOVA), Neighbor-Joining, Bayesian/STRUCTURE analysis and Principle Components Analysis (PCA).     

Laser-based single-axon transection for high-content axon injury and regeneration studies

The investigation of the regenerative response of the neurons to axonal injury is essential to the development of new axoprotective therapies. Here we study the retinal neuronal RGC-5 cell line after laser transection, demonstrating that the ability of these cells to initiate a regenerative response correlates with axon length and cell motility after injury. We show that low energy picosecond laser pulses can achieve transection of unlabeled single axons in vitro and precisely induce damage with micron precision. We established the conditions to achieve axon transection, and characterized RGC-5 axon regeneration and cell body response using time-lapse microscopy. We developed an algorithm to analyze cell trajectories and established correlations between cell motility after injury, axon length, and the initiation of the regeneration response. The characterization of the motile response of axotomized RGC-5 cells showed that cells that were capable of repair or regrowth of damaged axons migrated more slowly than cells that could not. Moreover, we established that RGC-5 cells with long axons could not recover their injured axons, and such cells were much more motile. The platform we describe allows highly controlled axonal damage with subcellular resolution and the performance of high-content screening in cell cultures.     

Primary stability of cementless stem in THA improved with reduced interfacial gaps

Large interfacial gaps between the stem and the bone in cementless total hip arthroplasty may prevent successful bone ingrowth at the sites, and can also be a passage for wear particles. Furthermore, interfacial gaps between the stem and the bone are believed to compromise the primary stability of the implant. Thus, a broaching method that serves to reduce gaps is expected to give clinically preferable results. A modified broach system with a canal guide is introduced to enhance the accuracy of femoral canal shaping in comparison with the conventional broach system for a Versys fibermetal taper stem. The primary stability of the hip systems and the ratios of the stem surface in contact with the femur were measured in a composite femur model. With the conventional method, an average of 67% of the stem surface was shown to be in contact with the bone, and an average stem micromotion/migration of 35 microm 290 microm was observed under 1000 cycles of stair climbing loads. With the modified method, the stem-bone contact ratio significantly increased to 82% (p<0.05), and the average micromotion/migration reduced to 29 microm 49 microm, respectively (p<0.05 for migration). Our finite element models of the hip systems supported that the difference in micromotion could be attributed to the difference in interfacial contact. Interfacial gaps occurring with the conventional broach system were effectively reduced by the proposed method, resulting in improved primary stability.     

Identification of archaeobotanical Pistacia L. fruit remains: implications for our knowledge on past distribution and use in prehistoric Cyprus

Vegetation History and Archaeobotany - Pistacia spp. remains are common finds among archaeobotanical assemblages in prehistoric sites in Southwest Asia, both in the form of endocarps and charcoal...     

Emergence of seedlings of sugar beet (Beta vulgaris L.) as affected by the size,roughness and position of aggregates in the seedbed

Laboratory and field experiments were carried out to quantify the effects of the size and roughness of aggregates placed in the seedling path of sugar beet, in order to help in decision making for soil tillage and sowing operations. Graded aggregates (10, 15, 20, 30, 40, 50, 60 and 70 mm longest axis) were either laid on the soil surface or included in the soil over the seeds. The percent emergence decreased exponentially with aggregate size over 10 mm when the aggregates were included in the seedbed. The result was the same with aggregates laid on the soil surface, but for aggregates over 30 mm (mass>10 g). Aggregates on the soil surface could be lifted by the seedlings until their weight exceeded the seedling emergence force. Larger aggregates or aggregates in the soil layer could not be moved. Seedlings which did not emerge remained blocked in small cavities in the aggregate surface. No seedlings were blocked under smooth aggregates or glass beads. The experimental results fits with a model giving the probability to meet a hole according the distance covered and the diameter and density of holes. The results obtained under controlled conditions were similar to those obtained in field experiments for a wide range of aggregate sizes. These results will be incorporated into a computerised seedbed generator to simulate the effects of seedbed structure on seedling emergence.     

Analysis of Pulsatile Retinal Movements by Spectral-Domain Low-Coherence Interferometry: Influence of Age and Glaucoma on the Pulse Wave

Recent studies have shown that ocular hemodynamics and eye tissue biomechanical properties play an important role in the pathophysiology of glaucoma. Nevertheless, better, non-invasive methods to assess these characteristics in vivo are essential for a thorough understanding of degenerative mechanisms. Here, we propose to measure ocular tissue movements induced by cardiac pulsations and study the ocular pulse waveform as an indicator of tissue compliance. Using a novel, low-cost and non-invasive device based on spectral-domain low coherence interferometry (SD-LCI), we demonstrate the potential of this technique to differentiate ocular hemodynamic and biomechanical properties. We measured the axial movement of the retina driven by the pulsatile ocular blood flow in 11 young healthy individuals, 12 older healthy individuals and 15 older treated glaucoma patients using our custom-made SD-OCT apparatus. The cardiac pulse was simultaneously measured through the use of an oximeter to allow comparison. Spectral components up to the second harmonic were obtained and analyzed. For the different cohorts, we computed a few parameters that characterize the three groups of individuals by analyzing the movement of the retinal tissue at two locations, using this simple, low-cost interferometric device. Our pilot study indicates that spectral analysis of the fundus pulsation has potential for the study of ocular biomechanical and vascular properties, as well as for the study of ocular disease.     

A molecular phylogeny of the Canidae based on six nuclear loci

We have reconstructed the phylogenetic relationships of 23 species in the dog family, Canidae, using DNA sequence data from six nuclear loci. Individual gene trees were generated with maximum parsimony (MP) and maximum likelihood (ML) analysis. In general, these individual gene trees were not well resolved, but several identical groupings were supported by more than one locus. Phylogenetic analysis with a data set combining the six nuclear loci using MP, ML, and Bayesian approaches produced a more resolved tree that agreed with previously published mitochondrial trees in finding three well-defined clades, including the red fox-like canids, the South American foxes, and the wolf-like canids. In addition, the nuclear data set provides novel indel support for several previously inferred clades. Differences between trees derived from the nuclear data and those from the mitochondrial data include the grouping of the bush dog and maned wolf into a clade with the South American foxes, the grouping of the side-striped jackal (Canis adustus) and black-backed jackal (Canis mesomelas) and the grouping of the bat-eared fox (Otocyon megalotis) with the raccoon dog (Nycteruetes procyonoides). We also analyzed the combined nuclear + mitochondrial tree. Many nodes that were strongly supported in the nuclear tree or the mitochondrial tree remained strongly supported in the nuclear + mitochondrial tree. Relationships within the clades containing the red fox-like canids and South American canids are well resolved, whereas the relationships among the wolf-like canids remain largely undetermined. The lack of resolution within the wolf-like canids may be due to their recent divergence and insufficient time for the accumulation of phylogenetically informative signal.