Typicality of Level Change (TLC) as an Additional Effect Measure to NAP and Tau-U in Single Case Research.

Single case research is a viable way to obtain evidence for social and psychological interventions on an individual level. Across single case research studies various analysis strategies are employed, varying from visual analysis to the calculation of effect sizes. To calculate effect sizes in studies with few measurements per time period (<40 data points with a minimum of five data points in each phase), non-parametric indices such as Nonoverlap of All Pairs (NAP) and Tau-U are recommended. However, both indices have restrictions. This article discusses the restrictions of NAP and Tau-U and presents the description, calculation, and benefits of an additional effect size, called the Typicality of Level Change (TLC) index. In comparison to NAP and Tau-U, the TLC index is more aligned to visual analysis, not restricted by a ceiling effect, and does not overcompensate for problematic trends in data. The TLC index is also sensitive to the typicality of an effect. TLC is an important addition to ease the restrictions of current nonoverlap methods when comparing effect sizes between cases and studies.

How to Evaluate a Tailor-made Social Work Intervention? Some Practice-Based Solutions with Single-Case Designs.

PURPOSE: With the increased attention to the principles of evidence-based practice (EBP), social workers are challenged to adapt their daily interventions accordingly when treating clients. They usually work with individual clients, all with their own specificities. Single-Case Experimental Designs (SCEDs) can be used to inform a social worker about the effectiveness of an intervention at the individual client level. In everyday social work practice, however, it is difficult to meet methodological requirements of SCEDs to find causal explanations. A concern is that repeated measurements prior to an intervention are required in most situations. This study aims to provide researchers with alternatives to repeated measurement when using the logic of SCED to apply EBP in their everyday practice. METHODS: In this study, we reviewed published single-case designs between January 1 and December 31, 2019, on types of SCEDs in the social domain, and how is dealt with baseline conditions. RESULTS: SCEDs and quasi-experimental alternatives are hardly published in situations when baseline data are not available. Four underused quasi-experimental strategies that can be employed when repeated measurement during baseline is not possible are as follows: retrospective baselines, theoretical inference, multiraters, and triangulation with qualitative data. DISCUSSION AND CONCLUSION: The suggestions to work with single-case designs with quasi-experimental elements are meant to enable social workers to evaluate their interventions in a way that enhances mere narrative evaluations of the experiences of an intervention.

Metapolystoma ohlerianum n. sp. (Monogenea: Polystomatidae) from Aglyptodactylus madagascariensis (Anura: Mantellidae).

PURPOSE: Despite Madagascar's high amphibian diversity of more than 400 species, only a few polystome species are known from the island. The dissection of frogs from museum collections, together with amphibian and parasite surveys conducted in Madagascar led to the discovery of an undescribed polystome infecting Aglyptodactylus madagascariensis. The purpose of this study is to formally describe this species. METHODS: Polystomes recovered from A. madagascariensis were stained (Acetocarmine) and mounted (Canada balsam) to facilitate morphometrics and taxonomic drawings. Some specimens were fixed in absolute alcohol, a Bayesian tree inferred from the analysis of concatenated 18S, 28S and COI gene sequences was constructed and pairwise distances were calculated. Parasites collected from archived hosts in museums were used for histology and scanning electron microscopy (SEM). RESULTS: Polystomes recovered from A. madagascariensis display characteristics of the genus Metapolystoma and morphologically differed from all other known metapolystomes. The Bayesian phylogeny shows that Metapolystoma n. sp. ex. A. madagascariensis and M. falcatum are sister species with high Bayesian posterior probability. Histological and SEM investigations contributed to morphological descriptions. CONCLUSIONS: Morphological examination supported by phylogenetic analysis and genetic divergences revealed distinct differences from all known metapolystome species, supporting the description of a new species. Differences between the life cycles of Metapolystoma and Polystoma provided additional evidence for the validity of that genus as taxon. Whereas Polystoma may display ovoviviparity on rare occasions after incomplete egg expulsion towards the end of the breeding season, Metapolystoma displays true ovoviviparity. We emphasize the need for parasite surveys in Madagascar and recommended for museum material to be examined for polystomes to provide supplementary material and localities for further field investigation.

Exploring rural hospital admissions for diarrhoeal disease, malaria, pneumonia, and asthma in relation to temperature, rainfall and air pollution using wavelet transform analysis.

BACKGROUND: Climate variables impact human health and in an era of climate change, there is a pressing need to understand these relationships to best inform how such impacts are likely to change. OBJECTIVES: This study sought to investigate time series of daily admissions from two public hospitals in Limpopo province in South Africa with climate variability and air quality. METHODS: We used wavelet transform cross-correlation analysis to monitor coincidences in changes of meteorological (temperature and rainfall) and air quality (concentrations of PM2.5 and NO2) variables with admissions to hospitals for gastrointestinal illnesses including diarrhoea, pneumonia-related diagnosis, malaria and asthma cases. We were interested to disentangle meteorological or environmental variables that might be associated with underlying temporal variations of disease prevalence measured through visits to hospitals. RESULTS: We found preconditioning of prevalence of pneumonia by changes in air quality and showed that malaria in South Africa is a multivariate event, initiated by co-occurrence of heat and rainfall. We provided new statistical estimates of time delays between the change of weather or air pollution and increase of hospital admissions for pneumonia and malaria that are addition to already known seasonal variations. We found that increase of prevalence of pneumonia follows changes in air quality after a time period of 10 to 15 days, while the increase of incidence of malaria follows the co-occurrence of high temperature and rainfall after a 30-day interval. DISCUSSION: Our findings have relevance for early warning system development and climate change adaptation planning to protect human health and well-being.

First record of Metapolystoma (Monogenea: Polystomatidae) from Boophis tree frogs in Madagascar, with the description of five new species.

Although Madagascar has more than 350 frog species of which all but two are endemic to the island, the known polystome (Monogenea: Polystomatidae) diversity parasitizing Malagasy frogs is low, encompassing five species of Madapolystoma, one species of Kankana and one Metapolystoma. Investigating the parasite diversity of frog parasites at selected Malagasy localities led to the discovery of undescribed polystomes. Five treefrogs, Boophis albilabris, Boophis doulioti, Boophis luteus, Boophis madagascariensis and Boophis occidentalis were found to be infected and are reported here as hosts for new Metapolystoma species. Morphological investigation, combining examination of body length, haptor length, genital bulb width, genital crown diameter, genital spine number, genital spine length, ovary length, egg length, hamulus length, hamulus guard length and hamulus hook length, revealed five distinct morphotypes. Phylogenetic analysis and genetic divergences obtained for three of the five morphotypes, support the distinction of new species. Metapolystoma ansuanum n. sp. is described from B. luteus, Metapolystoma falcatum n. sp. from B. doulioti, Metapolystoma multiova n. sp. from B. occidentalis, Metapolystoma theroni n. sp. from B. madagascareniensis and Metapolystoma vencesi n. sp. from B. albilabris. Finally, although the validity of Metapolystoma as taxon is not fully resolved yet, the phylogenetic position of the described species and their morphology provide clear evidence for new metapolystome taxa.

Major climate change-induced risks to human health in South Africa.

There are many climatic changes facing South Africa which already have, or are projected to have, a detrimental impact on human health. Here the risks to health due to several alterations in the climate of South Africa are considered in turn. These include an increase in ambient temperature, causing, for example, a significant rise in morbidity and mortality; heavy rainfall leading to changes in the prevalence and occurrence of vector-borne diseases; drought-associated malnutrition; and exposure to dust storms and air pollution leading to the potential exacerbation of respiratory diseases. Existing initiatives and strategies to prevent or reduce these adverse health impacts are outlined, together with suggestions of what might be required in the future to safeguard the health of the nation. Potential roles for the health and non-health sectors as well as preparedness and capacity development with respect to climate change and health adaptation are considered.

First record of viviparity in polystomatid flatworms (Monogenea: Polystomatidae) with the description of two new species of Madapolystoma from the Madagascan anuran hosts Blommersia domerguei and Mantella expectata.

Two frog species, Blommersia domerguei and Mantella expectata, are reported as hosts for new species of Madapolystoma. Phylogenetic analyses and genetic divergences observed in the genus supported the distinction of two morphotypes infesting selectively each host species and morphological investigation combining marginal hooklet morphometrics, genital spine number and measurements further showed that polystomes from the two host species differed from each other and from all other known polystomes. Madapolystoma magnahami n. sp. and Madapolystoma isaloensis n. sp. are therefore described as two new species. Advanced in utero development was illustrated in both polystome species following the observation of well developed hamuli and two pairs of haptoral suckers in developing embryos. Inside some of these in utero embryos a F2 generation embryo was also observed. This is the first report of true viviparity among polystomatid flatworms.

Regional Projections of Extreme Apparent Temperature Days in Africa and the Related Potential Risk to Human Health.

Regional climate modelling was used to produce high resolution climate projections for Africa, under a "business as usual scenario", that were translated into potential health impacts utilizing a heat index that relates apparent temperature to health impacts. The continent is projected to see increases in the number of days when health may be adversely affected by increasing maximum apparent temperatures (AT) due to climate change. Additionally, climate projections indicate that the increases in AT results in a moving of days from the less severe to the more severe Symptom Bands. The analysis of the rate of increasing temperatures assisted in identifying areas, such as the East African highlands, where health may be at increasing risk due to both large increases in the absolute number of hot days, and due to the high rate of increase. The projections described here can be used by health stakeholders in Africa to assist in the development of appropriate public health interventions to mitigate the potential health impacts from climate change.

Nonopioid pharmacological management of malignant bowel obstruction: a New Zealand-wide survey.

BACKGROUND: Malignant bowel obstruction (MBO) is a common condition among palliative patients and has limited management options. There is a paucity of widely accepted national and international evidence-based guidelines to direct the management of MBO in palliative patients. OBJECTIVE: The aim of this study was to survey current practice in New Zealand of nonopioid pharmacological management of MBO and compare it with the available literature. METHODS: The study utilized a survey consisting of three scenarios: probable incomplete malignant bowel obstruction (PIMBO), incomplete malignant bowel obstruction (IMBO), and complete malignant bowel obstruction (CMBO). An online survey was conducted over 2 months targeting palliative medicine practitioners working in a hospital, hospice inpatient unit, or community setting in New Zealand. RESULTS: Forty-eight doctors responded. Of the respondents, 56.3% used guidelines to manage MBO; however, 88.9% of the guidelines used were locally generated at the doctor's institution. Metoclopramide was the drug of choice in treating PIMBO, whereas haloperidol and hyoscine butylbromide (HB) were the preferred drugs as the severity of bowel obstruction increased. Dexamethasone was accepted as standard practice for managing all severities of MBO. A variation in the preferred starting and maximum dose of all the drugs was seen. There was a decrease in the use of laxatives and enemas as the severity of MBO increased. CONCLUSION: Variation in practice for managing MBO was evident among doctors in New Zealand. There is a need for national and international evidence-based guidelines to help define best management for the differing severities of this problematic condition.

An international multicentre validation study of a pain classification system for cancer patients.

PURPOSE: The study's primary objective was to assess predictive validity of the Edmonton Classification System for Cancer Pain (ECS-CP) in a diverse international sample of advanced cancer patients. We hypothesised that patients with problematic pain syndromes would require more time to achieve stable pain control, more complicated analgesic regimens and higher opioid doses than patients with less complex pain syndromes. METHODS: Patients with advanced cancer (n=1100) were recruited from 11 palliative care sites in Canada, USA, Ireland, Israel, Australia and New Zealand (100 per site). Palliative care specialists completed the ECS-CP for each patient. Daily patient pain ratings, number of breakthrough pain doses, types of pain adjuvants and opioid consumption were recorded until study end-point (i.e. stable pain control, discharge and death). RESULTS: A pain syndrome was present in 944/1100 (86%). In univariate analysis, younger age, neuropathic pain, incident pain, psychological distress, addictive behaviour and initial pain intensity were significantly associated with more days to achieve stable pain control. In multivariate analysis, younger age, neuropathic pain, incident pain, psychological distress and pain intensity were independently associated with days to achieve stable pain control. Patients with neuropathic pain, incident pain, psychological distress or higher pain intensity required more adjuvants and higher final opioid doses; those with addictive behaviour required only higher final opioid doses. Cognitive deficit was associated with fewer days to stable pain control, lower final opioid doses and fewer pain adjuvants. CONCLUSION: The replication of previous findings suggests that the ECS-CP can predict pain complexity in a range of practice settings and countries.