Network-based social capital and capacity-building programs: an example from Ethiopia

<p>Abstract</p> <p>Introduction</p> <p>Capacity-building programs are vital for healthcare workforce development in low- and middle-income countries. In addition to increasing human capital, participation in such programs may lead to new professional networks and access to social capital. Although network development and social capital generation were not explicit program goals, we took advantage of a natural experiment and studied the social networks that developed in the first year of an executive-education Master of Hospital and Healthcare Administration (MHA) program in Jimma, Ethiopia.</p> <p>Case description</p> <p>We conducted a sociometric network analysis, which included all program participants and supporters (formally affiliated educators and mentors). We studied two networks: the Trainee Network (all 25 trainees) and the Trainee-Supporter Network (25 trainees and 38 supporters). The independent variable of interest was out-degree, the number of program-related connections reported by each respondent. We assessed social capital exchange in terms of resource exchange, both informational and functional. Contingency table analysis for relational data was used to evaluate the relationship between out-degree and informational and functional exchange.</p> <p>Discussion and evaluation</p> <p>Both networks demonstrated growth and inclusion of most or all network members. In the Trainee Network, those with the highest level of out-degree had the highest reports of informational exchange, χ²(1, <it>N </it>= 23) = 123.61, p < 0.01. We did not find a statistically significant relationship between out-degree and functional exchange in this network, χ²(1, <it>N </it>= 23) = 26.11, p > 0.05. In the Trainee-Supporter Network, trainees with the highest level of out-degree had the highest reports of informational exchange, χ²(1, <it>N </it>= 23) = 74.93, p < 0.05. The same pattern held for functional exchange, χ²(1, <it>N </it>= 23) = 81.31, p < 0.01.</p> <p>Conclusions</p> <p>We found substantial and productive development of social networks in the first year of a healthcare management capacity-building program. Environmental constraints, such as limited access to information and communication technologies, or challenges with transportation and logistics, may limit the ability of some participants to engage in the networks fully. This work suggests that intentional social network development may be an important opportunity for capacity-building programs as healthcare systems improve their ability to manage resources and tackle emerging problems.</p

AI Workflow, External Validation, and Development in Eye Disease Diagnosis

Timely disease diagnosis is challenging due to limited clinical availability and growing burdens. Although artificial intelligence (AI) has shown expert-level diagnostic accuracy, a lack of downstream accountability, including workflow integration, external validation, and further development, continues to hinder its clinical adoption. To address gaps in the downstream accountability of medical AI through a case study on age-related macular degeneration (AMD) diagnosis and severity classification. This diagnostic study developed and evaluated an AI-assisted diagnostic and classification workflow for AMD. Four rounds of diagnostic assessments (accuracy and time) were conducted with 24 clinicians from 12 institutions. Each round was randomized and alternated between manual (clinician diagnosis) and manual plus AI (clinician assisted by AI diagnosis), with a 1-month washout period. In total, 2880 AMD risk features were evaluated across 960 images from 240 Age-Related Eye Disease Study patient samples, both with and without AI assistance. For further development, the original DeepSeeNet model was enhanced into the DeepSeeNet+ model using 39 196 additional images from the US population and tested on 3 datasets, including an external set from Singapore. Age-related macular degeneration risk features. The F1 score for accuracy (Wilcoxon rank sum test) and diagnostic time (linear mixed-effects model) were measured, comparing manual vs manual plus AI. For further development, the F1 score (Wilcoxon rank sum test) was again used. Among 240 patients (mean [SD] age, 68.5 [5.0] years; 127 female [53%]), AI assistance significantly improved accuracy for 23 of 24 clinicians, increasing the mean F1 score from 37.71 (95% CI, 27.83-44.17) to 45.52 (95% CI, 39.01-51.61), with some improvements exceeding 50%. Manual diagnosis initially took an estimated 39.8 seconds (95% CI, 34.1-45.6 seconds) per patient, whereas manual plus AI saved 10.3 seconds (95% CI, -15.1 to -5.5 seconds) and remained faster by 6.9 seconds (95% CI, 0.2-13.7 seconds) to 8.6 seconds (95% CI, 1.8-15.3 seconds) in subsequent rounds. However, combining manual and AI did not always yield the highest accuracy or efficiency, underscoring challenges in explainability and trust. The DeepSeeNet+ model performed better in 3 test sets, achieving a significantly higher F1 score than the Singapore cohort (52.43 [95% CI, 44.38-61.00] vs 38.95 [95% CI, 30.50-47.45]). In this diagnostic study, AI assistance was associated with improved accuracy and time efficiency for AMD diagnosis. Further development is essential for enhancing AI generalizability across diverse populations. These findings highlight the need for downstream accountability during early-stage clinical evaluations of medical AI

The use of integrated production modelling to assess network efficiency and production system optimisation

This paper investigates the use of integrated production models to apply a consistent and repeatable approach to assess petroleum production network efficiency and aid production system optimisation. Assessing network efficiency in the manner detailed in this paper allows petroleum professionals to define a maximum network production through the analysis of the pressure drop within a network. This is achieved by comparing the system base production to a simulation of theoretical wellhead water separation (for all inflows), larger diameters of all surface pipelines (double the diameter is used as a maximum case) and a combination of the two using integrated production modelling (IPM). The combination of water separation and larger diameter of all the pipelines represented the maximum network production possible for tangible projects. This allowed the definition of network efficiency value of a petroleum production system on a scale of 0% to 100%. At a screening level, the lower the Network Efficiency Metric (NEM) the greater the likelihood of an optimisation opportunity, prompting additional assessment of special cases. This method was applied to a network of 40 wells using IPM, and NEM values of 95.9% (water separation), 94.6% (double pipeline diameter) and 83.5% (combined) were obtained. These values of network efficiency also corresponded to incremental reserve difference of 4.3, 5.8 and 20.1 Bscf, respectively. The NEM was a crucial component of the screening process and demonstrated an alternative and efficient method for the identification of optimisation projects, which increased production and reserves. </jats:p

THE EFFECT OF ELECTIVE CATARACT EXTRACTION BY PHACOEMULSIFICATION IN EYES WITH VITREOMACULAR TRACTION SYNDROME

PURPOSE: To evaluate the effect of cataract extraction (CE) by phacoemulsification on the vitreomacular interface (VMI) of eyes with preexisting vitreomacular traction (VMT). METHODS: Retrospective, observational case series. Patients with VMT who elected to proceed with CE, before any vitreoretinal intervention, were studied. Eyes with at least a 12-month follow-up period were included. The status of the vitreomacular adhesion at different time points was assessed using spectral-domain optical coherence tomography. The best-corrected visual acuity was recorded at different time points. Other macular and systemic comorbidities were documented. RESULTS: Fifteen eyes from 15 phakic patients with symptomatic VMT were included. Six of them were male subjects. Seven patients had diabetes mellitus and two of them also had nonproliferative diabetic retinopathy. The preoperative macular comorbidities included macular hole in six eyes (Stage 1 in 3 eyes and Stage 2 or 3 in another 3 eyes), epiretinal membrane in five eyes, and cystoid macular edema in four eyes. After uncomplicated CE, the VMT was released in 5 eyes, whereas in 10 eyes, CE did not significantly change the status of the vitreomacular adhesion. Three of 3 eyes with preexisting full-thickness macular hole (Stage 2 or 3 macular hole) were found to have Stage 4 macular hole shortly after CE. In seven of seven patients with diabetes mellitus, the status of the vitreomacular interface did not change after CE. Eventually, 7 of 15 patients underwent additional pars plana vitrectomy. Compared with the baseline vision, and vision before other interventions, the visual acuity after CE improved in 5 patients, remained unchanged in 7 patients, and decreased in the 3 patients with Stage 2 or 3 macular hole. The mean preoperative and early postoperative visual acuity was 20/59 and 20/68, respectively (P &gt; 0.05). CONCLUSION: The effect of CE in phakic eyes with known VMT varies significantly. In the current case series, every eye with VMT and Stage 2 or 3 macular hole ended up with Stage 4 macular hole, although the VMT did not change significantly in the eyes of diabetic patients. Studies with larger sample size are needed to further elucidate the impact of elective CE on VMT

An Experimental Animal Model of Photodynamic Optic Nerve Head Injury (PONHI)

Purpose: Anterior ischemic optic neuropathy (AION) is the most common cause of non-glaucomatous optic nerve head (ONH) injury among older adults. AION results from a sudden ischemic insult to the proximal portion of the optic nerve, typically leading to visual impairment. Here, we present an experimental model of photodynamically induced ONH injury that can be used to study neuroprotective modalities. Methods: Intraperitoneal injection of mesoporphyrin IX was followed by photodynamic treatment of the ONH in one eye of Brown-Norway rats; the fellow eye received the reverse sequence as a sham control. Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), and visual evoked potential (VEP) recordings were performed at different time points following laser treatment. Immunohistochemistry was used to monitor apoptotic cell death (TUNEL) and macrophage infiltration (CD68). Cytokine levels were evaluated using enzyme-linked immunosorbent assay (ELISA). Results: FA showed early hyperfluorescence and late leakage of the ONH, while SD-OCT revealed optic nerve edema. No leakage or other abnormalities were detected in control eyes. VEPs were significantly reduced in amplitude and showed prolonged responses compared to sham eyes. The number of apoptotic retinal ganglion cells was elevated one day after laser treatment (13.77 ± 4.49, p &lt; 0.01) and peaked on day 7 (57.22 ± 11.34, p &lt; 0.01). ONH macrophage infiltration also peaked on day 7 (101.8 ± 9.8, p &lt; 0.05). ELISAs performed showed upregulation of macrophage chemoattractant protein-1 and macrophage inflammatory protein-2 on days 3 and 1, respectively. Conclusions: Photodynamic treatment of the ONH after administration of mesoporphyrin IX leads to macroscopic, histologic, and physiologic evidence of ONH injury. Given the long half-life of mesoporphyrin IX and the ease of intraperitoneal injections, this new model of photodynamically induced ONH injury may be a useful tool for studying optic nerve injury and possible neuroprotective treatments. © 2016 Taylor &amp; Francis

Membrane-bound and soluble Fas ligands have opposite functions in photoreceptor cell death following separation from the retinal pigment epithelium

Fas ligand (FasL) triggers apoptosis of Fas-positive cells, and previous reports described FasL-induced cell death of Fas-positive photoreceptors following a retinal detachment. However, as FasL exists in membrane-bound (mFasL) and soluble (sFasL) forms, and is expressed on resident microglia and infiltrating monocyte/macrophages, the current study examined the relative contribution of mFasL and sFasL to photoreceptor cell death after induction of experimental retinal detachment in wild-type, knockout (FasL−/−), and mFasL-only knock-in (ΔCS) mice. Retinal detachment in FasL−/− mice resulted in a significant reduction of photoreceptor cell death. In contrast, ΔCS mice displayed significantly more apoptotic photoreceptor cell death. Photoreceptor loss in ΔCS mice was inhibited by a subretinal injection of recombinant sFasL. Thus, Fas/FasL-triggered cell death accounts for a significant amount of photoreceptor cell loss following the retinal detachment. The function of FasL was dependent upon the form of FasL expressed: mFasL triggered photoreceptor cell death, whereas sFasL protected the retina, indicating that enzyme-mediated cleavage of FasL determines, in part, the extent of vision loss following the retinal detachment. Moreover, it also indicates that treatment with sFasL could significantly reduce photoreceptor cell loss in patients with retinal detachment