Self-testing for HIV: initial experience of the UK’s first kit
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This document summarizes the initial experience with the first HIV self-testing kit available in the UK. Over 27,000 kits have been sold since April 2015. Most buyers are male and located outside major cities. About half of buyers had never tested for HIV before. User feedback indicates the test is easy to use and results are easy to read. A small number of false positive and invalid tests were reported. While self-testing is proving popular, more data is still needed on access to care for reactive results and the impact on testing rates and behavior.
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RESEARCH ARTICLELong term effect of primary health care.docx
RESEARCH ARTICLELong term effect of primary health care.docxrgladys1 RESEARCH ARTICLE
Long term effect of primary health care
training on HIV testing: A quasi-experimental
evaluation of the Sexual Health in Practice
(SHIP) intervention
Kamla Pillay
1
, Melissa Gardner
2,3
, Allon Gould
4
, Susan Otiti
5
, Judith Mullineux
6
,
Till Bärnighausen
7,8,9,10
, Philippa Margaret Matthews
11,12*
1 Homerton Hospital, London, United Kingdom, 2 Sexual Health in Practice Community Interest Company,
London, United Kingdom, 3 Killick Street Health Centre, London, United Kingdom, 4 Whipps Cross Hospital,
London, United Kingdom, 5 Public Health, London Borough of Haringey, London, United Kingdom, 6 Sexual
Health Promotion, Birmingham, United Kingdom, 7 Africa Health Research Institute, Somkhele, South Africa,
8 Institute of Public Health, Heidelberg University, Heidelberg, Germany, 9 Infection and Population Health,
University College London, London, United Kingdom, 10 Department of Global Health and Population,
Harvard T.H. Chan School of Public Health, Boston, United States of America, 11 Division of Infection and
Immunity, University College London, London, United Kingdom, 12 Africa Health Research Institute,
Somkhele, South Africa
* [email protected]
Abstract
Background
To examine the effect of Sexual Health in Practice (SHIP) training for general practitioners
(GPs) on HIV testing rates in Haringey, a deprived area of London, UK, with a population of
over 250,000 and HIV prevalence of 0.7% (in 2014). SHIP is an educational intervention
delivering peer-developed and peer-led face-to-face training to improve quality of sexual
and reproductive health (SRH) care.
Methods
We carried out a quasi-experimental study of intervention effects across 52 GP practices
(2008–2016). We used time variation in SHIP intervention exposure for effect estimation,
controlling for practice and calendar month fixed effects in panel analysis. From 2008–2010,
baseline data were collected, and in the subsequent six-year period, 78 GPs in Haringey
(approximately 40% of all GPs) were SHIP trained. 46 Haringey practices (of 52) had at
least one trained doctor. Outcome measures were monthly HIV tests and results by practice
(obtained from the hospital laboratories).
Results
SHIP significantly increased HIV testing; for every GP trained, practice HIV testing rates
increased by 16% (testing rate ratio (TRR) 1.16, 95% confidence interval (CI) 1.05–1.28,
p value 0.004). This significant effect was demonstrated using an 8-year observation period,
PLOS ONE | https://doi.org/10.1371/journal.pone.0199891 August 1, 2018 1 / 13
a1111111111
a1111111111
a1111111111
a1111111111
a1111111111
OPEN ACCESS
Citation: Pillay K, Gardner M, Gould A, Otiti S,
Mullineux J, Bärnighausen T, et al. (2018) Long
term effect of primary health care training on HIV
testing: A quasi-experimental evaluation of the
Sexual Health in Practice (SHIP) intervention. PLoS
ONE 13(8): e0199891. https://doi.org/10.1371/
journal.pone.0199891
.
n engl j med 368;24 nejm.org june 13, 2013 2319s o u n d i.docx
n engl j med 368;24 nejm.org june 13, 2013 2319s o u n d i.docxrosemarybdodson23141 n engl j med 368;24 nejm.org june 13, 2013 2319
s o u n d i n g b o a r d
T h e n e w e n g l a n d j o u r n a l o f m e d i c i n e
How Point-of-Care Testing Could Drive Innovation
in Global Health
Ilesh V. Jani, M.D., Ph.D., and Trevor F. Peter, Ph.D., M.P.H.
The investment in health services in low- and mid-
dle-income countries has increased substantially
in recent years.1 Such investment has been led by
unprecedented efforts to combat major diseases,
enabled by the availability of lower-cost and effec-
tive drug regimens for treatment and prophylaxis,
along with improved vector control. As health
services have expanded, so has the demand for
diagnostic tests that are essential in identifying
patients, determining prognosis, monitoring treat-
ment, and assessing the efficacy of prevention.2
Classic diagnostic technologies are not well
suited to meeting the expanded testing needs.
Laboratory tests require complex infrastructure,
skilled technicians, and a stable supply of elec-
tricity, all of which are scarce, particularly in
nonurban areas. Traditional testing is usually
performed in remote laboratories, which increas-
es the cost and inconvenience of accessing health
care and leads to a high number of patients who
leave the system before a diagnosis is established.3
These limitations are a critical barrier to equity
in health services. Microscopy requires less in-
frastructure and is more widely available, but it
can be inaccurate (e.g., sputum tests for tubercu-
losis) or slow and underutilized (e.g., smear tests
for malaria, schistosomiasis, and other parasitic
infections).4-6 Many patients with tuberculosis or
malaria are simply treated on the basis of a pre-
sumptive clinical diagnosis. Although convention-
al laboratory testing and microscopy will still be
needed, it is expected that faster and more ac-
curate point-of-care diagnostic tests that do not
require laboratory infrastructure will play an in-
creasing role in expanding health care in low- and
middle-income countries.7
T h e S h if t t o w a r d P o in t- o f - C a r e
T e s t in g
Rapid point-of-care testing for diabetes, anemia,
pregnancy, human immunodeficiency virus (HIV),
and malaria have long been available and have be-
come common diagnostic tools in both high- and
low-income countries (Fig. 1). The first generation
of point-of-care testing relied on easy-to-detect
biomarkers, such as antibodies, antigens, and sim-
ple biochemical reactions. Such biomarkers are
also increasingly used in point-of-care tests for a
wide range of infectious diseases (e.g., syphilis,
hepatitis, measles, schistosomiasis, and tricho-
moniasis) and for applications such as blood
typing.8-11
A second generation of point-of-care diagnos-
tics is now on the horizon, partly because of re-
cent industry and donor investment. These tests
detect more complex and less accessible biomark-
ers, such as nucleic acids and cell-surface markers,
an.
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RESEARCH ARTICLELong term effect of primary health care.docx
RESEARCH ARTICLELong term effect of primary health care.docxrgladys1 RESEARCH ARTICLE
Long term effect of primary health care
training on HIV testing: A quasi-experimental
evaluation of the Sexual Health in Practice
(SHIP) intervention
Kamla Pillay
1
, Melissa Gardner
2,3
, Allon Gould
4
, Susan Otiti
5
, Judith Mullineux
6
,
Till Bärnighausen
7,8,9,10
, Philippa Margaret Matthews
11,12*
1 Homerton Hospital, London, United Kingdom, 2 Sexual Health in Practice Community Interest Company,
London, United Kingdom, 3 Killick Street Health Centre, London, United Kingdom, 4 Whipps Cross Hospital,
London, United Kingdom, 5 Public Health, London Borough of Haringey, London, United Kingdom, 6 Sexual
Health Promotion, Birmingham, United Kingdom, 7 Africa Health Research Institute, Somkhele, South Africa,
8 Institute of Public Health, Heidelberg University, Heidelberg, Germany, 9 Infection and Population Health,
University College London, London, United Kingdom, 10 Department of Global Health and Population,
Harvard T.H. Chan School of Public Health, Boston, United States of America, 11 Division of Infection and
Immunity, University College London, London, United Kingdom, 12 Africa Health Research Institute,
Somkhele, South Africa
* [email protected]
Abstract
Background
To examine the effect of Sexual Health in Practice (SHIP) training for general practitioners
(GPs) on HIV testing rates in Haringey, a deprived area of London, UK, with a population of
over 250,000 and HIV prevalence of 0.7% (in 2014). SHIP is an educational intervention
delivering peer-developed and peer-led face-to-face training to improve quality of sexual
and reproductive health (SRH) care.
Methods
We carried out a quasi-experimental study of intervention effects across 52 GP practices
(2008–2016). We used time variation in SHIP intervention exposure for effect estimation,
controlling for practice and calendar month fixed effects in panel analysis. From 2008–2010,
baseline data were collected, and in the subsequent six-year period, 78 GPs in Haringey
(approximately 40% of all GPs) were SHIP trained. 46 Haringey practices (of 52) had at
least one trained doctor. Outcome measures were monthly HIV tests and results by practice
(obtained from the hospital laboratories).
Results
SHIP significantly increased HIV testing; for every GP trained, practice HIV testing rates
increased by 16% (testing rate ratio (TRR) 1.16, 95% confidence interval (CI) 1.05–1.28,
p value 0.004). This significant effect was demonstrated using an 8-year observation period,
PLOS ONE | https://doi.org/10.1371/journal.pone.0199891 August 1, 2018 1 / 13
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OPEN ACCESS
Citation: Pillay K, Gardner M, Gould A, Otiti S,
Mullineux J, Bärnighausen T, et al. (2018) Long
term effect of primary health care training on HIV
testing: A quasi-experimental evaluation of the
Sexual Health in Practice (SHIP) intervention. PLoS
ONE 13(8): e0199891. https://doi.org/10.1371/
journal.pone.0199891
.
n engl j med 368;24 nejm.org june 13, 2013 2319s o u n d i.docx
n engl j med 368;24 nejm.org june 13, 2013 2319s o u n d i.docxrosemarybdodson23141 n engl j med 368;24 nejm.org june 13, 2013 2319
s o u n d i n g b o a r d
T h e n e w e n g l a n d j o u r n a l o f m e d i c i n e
How Point-of-Care Testing Could Drive Innovation
in Global Health
Ilesh V. Jani, M.D., Ph.D., and Trevor F. Peter, Ph.D., M.P.H.
The investment in health services in low- and mid-
dle-income countries has increased substantially
in recent years.1 Such investment has been led by
unprecedented efforts to combat major diseases,
enabled by the availability of lower-cost and effec-
tive drug regimens for treatment and prophylaxis,
along with improved vector control. As health
services have expanded, so has the demand for
diagnostic tests that are essential in identifying
patients, determining prognosis, monitoring treat-
ment, and assessing the efficacy of prevention.2
Classic diagnostic technologies are not well
suited to meeting the expanded testing needs.
Laboratory tests require complex infrastructure,
skilled technicians, and a stable supply of elec-
tricity, all of which are scarce, particularly in
nonurban areas. Traditional testing is usually
performed in remote laboratories, which increas-
es the cost and inconvenience of accessing health
care and leads to a high number of patients who
leave the system before a diagnosis is established.3
These limitations are a critical barrier to equity
in health services. Microscopy requires less in-
frastructure and is more widely available, but it
can be inaccurate (e.g., sputum tests for tubercu-
losis) or slow and underutilized (e.g., smear tests
for malaria, schistosomiasis, and other parasitic
infections).4-6 Many patients with tuberculosis or
malaria are simply treated on the basis of a pre-
sumptive clinical diagnosis. Although convention-
al laboratory testing and microscopy will still be
needed, it is expected that faster and more ac-
curate point-of-care diagnostic tests that do not
require laboratory infrastructure will play an in-
creasing role in expanding health care in low- and
middle-income countries.7
T h e S h if t t o w a r d P o in t- o f - C a r e
T e s t in g
Rapid point-of-care testing for diabetes, anemia,
pregnancy, human immunodeficiency virus (HIV),
and malaria have long been available and have be-
come common diagnostic tools in both high- and
low-income countries (Fig. 1). The first generation
of point-of-care testing relied on easy-to-detect
biomarkers, such as antibodies, antigens, and sim-
ple biochemical reactions. Such biomarkers are
also increasingly used in point-of-care tests for a
wide range of infectious diseases (e.g., syphilis,
hepatitis, measles, schistosomiasis, and tricho-
moniasis) and for applications such as blood
typing.8-11
A second generation of point-of-care diagnos-
tics is now on the horizon, partly because of re-
cent industry and donor investment. These tests
detect more complex and less accessible biomark-
ers, such as nucleic acids and cell-surface markers,
an.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, B...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, B...Oleg Kshivets METHODS: We analyzed data of 786 consecutive LCP (age=57.7±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2025 (m=674, f=112; upper lobectomies=284, lower lobectomies=180, middle lobectomies=18, bilobectomies=46, pneumonectomies=258, mediastinal lymph node dissection=786; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=199; only surgery-S=629, adjuvant chemoimmunoradiotherapy-AT=157: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=328, T2=260, T3=137, T4=61; N0=528, N1=133, N2=125, M0=786; G1=199, G2=248, G3=339; squamous=423, adenocarcinoma=313, large cell=50; early LC=221, invasive LC=565; right LC=422, left LC=364; central=298; peripheral=488. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2245.9±1741.5 days and cumulative 5-year survival (5YS) reached 73.4%, 10 years – 65.2%, 20 years – 42.5%. 516 LCP lived more than 5 years (LS=3118.2±1527.7 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.2% vs.63.5%, P=0.00001 by log-rank test). AT significantly improved 5YS (65.6% vs. 34.8%) (P=0.00001 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, AT, blood cell circuit, prothrombin index, age, bilirubin, procedure type (P=0.000-0.044). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), healthy cells/CC (4), eosinophils/CC (5), erythrocytes/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); stick neutrophils (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) p
Gastric Cancer: Artificial Intelligence, Synergetics, Complex System Analysis...
Gastric Cancer: Artificial Intelligence, Synergetics, Complex System Analysis...Oleg Kshivets METHODS: We analyzed data of 806 consecutive GCP (age=57.1±9.5 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2025 (m=563, f=243; distal gastrectomies (G)=463, proximal (G)=166, total (G)=177, combined G with resection of pancreas, liver, diaphragm, duodenum, colon transversum, jejunum, cholecystectomy, splenectomy=341; T1=242, T2=223, T3=184, T4=157; N0=443, N1=109, N2=254; G1=225, G2=165, G3=416; early GC=168, invasive=638; only surgery=630, adjuvant chemoimmunotherapy-AT=176: 5-FU+thymalin/taktivin). Variables selected for prognosis study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 2146.8±2350.4 days and cumulative 5-year survival (5YS) reached 58.6%, 10 years – 52.5%, 20 years – 40.2%, 30 years – 28%. 322 GCP lived more than 5 years (LS=4337.4±2377.7 days), 172 GCP – more than 10 years (LS=5966.5±2159.7 days). 291 GCP died because of GC (LS=649.9±347.1 days). AT significantly improved 5YS (67.5% vs. 56.9%) (P=0.047 by log-rank test). Cox modeling displayed that 5YS of GCP significantly depended on: phase transition (PT) in terms of synergetics N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G, prothrombin index, residual nitrogen, blood cells subpopulations, age, sex, GC cell dynamics, histology, tumor growth, bilirubin, chlorides, procedure type (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), PT early—invasive cancer (2); erythrocytes/CC (3), PT N0--N12 (4); leucocytes/CC (5), lymphocytes/CC (6), thrombocytes/CC (7), monocytes/CC (8), segmented neutrophils/CC (9), eosinophils/CC (10); stick neutrophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of GCP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC cell dynamics; 9) GC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
PLEURA & IT'S RECESSES -Prof.Dr.N.Mugunthan.pdf
PLEURA & IT'S RECESSES -Prof.Dr.N.Mugunthan.pdfKanyakumari Medical Mission Research Center, Muttom he pleura is a thin, double-layered membrane that surrounds the lungs and lines the inside of the chest cavity. It has two layers:
Visceral pleura: covers the surface of the lungs.
Parietal pleura: lines the chest wall, diaphragm, and mediastinum.
Between these two layers is the pleural cavity, a small space filled with a thin film of lubricating fluid that reduces friction during breathing movements. The pleura helps protect the lungs and allows them to expand and contract smoothly within the chest.
Artificial Intelligence in Oncology: Transforming Cancer Carepptx
Artificial Intelligence in Oncology: Transforming Cancer CarepptxNEIGRIHMS, SHILLONG Artificial Intelligence (AI) is transforming oncology by enabling faster, more accurate, and personalized cancer care. AI uses technologies like machine learning (ML), deep learning (DL), and natural language processing (NLP) to analyze complex medical data, helping doctors make better decisions at every stage of cancer care.
Key Applications of AI in Oncology:
Cancer Detection & Diagnosis:
AI analyzes radiology (CT, MRI, mammography) and pathology images to detect tumors early and accurately.
Tools like PathAI, Aidoc, and DeepMind are used in clinical imaging.
Precision Medicine & Genomics:
AI interprets genetic mutations to match patients with targeted therapies.
Platforms like Tempus and OncoKB support personalized cancer treatment.
Radiation Oncology:
AI automates contouring, treatment planning, and dose optimization.
Reduces planning time and improves consistency in radiation delivery.
Drug Discovery & Clinical Trials:
AI helps discover new cancer drugs and match patients to trials.
Companies like BenevolentAI and Insilico Medicine lead this space.
Prognostics & Monitoring:
AI predicts survival, recurrence, and side effects using patient data.
Wearables and mobile apps track symptoms and alert doctors in real time.
Benefits of AI in Oncology:
Early and accurate diagnosis
Faster workflows and reduced workload
Personalized treatments
Improved patient outcomes
Challenges:
Data privacy and bias
Lack of clinical validation
Interpretability of AI decisions
Integration into hospital systems
Conclusion:
AI is not replacing oncologists but empowering them with better tools to diagnose, plan, and treat cancer more effectively. With ongoing research and responsible use, AI will play a crucial role in the future of oncology.
The Physiology of Central Nervous System - Sensory Pathways
The Physiology of Central Nervous System - Sensory PathwaysMedicoseAcademics Learning Objectives:
1. Enumerate the sensory pathways
2. Enlist the sensations carried by the Dorsal Column Medial Lemniscus (DCML) system
3. Trace the DCML tract
4. Describe the characteristics of DCML system
5. Enlist the sensations carried by the Spinothalamic tract/Anterolateral System (ALS)
6. Trace the Spinothalamic tract/Anterolateral system
7. Compare the characteristics of DCML and ALS
8. Correlate the functions of DCML and ALS with the sensory loss seen in Brown-Sequard syndrome
BIOMECHANICS & KINESIOLOGY OF THEHIP COMPLEX.pptx
BIOMECHANICS & KINESIOLOGY OF THEHIP COMPLEX.pptxdrnidhimnd The cuplike concave socket of the hip joint is called the acetabulum and is located on the lateral aspect of the pelvic bone (innominate or os coxa).
Until full ossification of the pelvis occurs between 20 and 25 years of age.
The periphery of the acetabulum (lunate surface) is covered with hyaline cartilage.
This horseshoe-shaped area of cartilage articulates with the head of the femur and allows for contact stress to be uniformly distributed.
The inferior aspect of the lunate surface (the base of the horseshoe) is interrupted by a deep notch called the acetabular notch.
The acetabular notch is spanned by a fibrous band, the transverse acetabular ligament, that connects the two ends of the horseshoe.
The acetabulum is deepened by the fibrocartilaginous acetabular labrum, which surrounds the periphery of the acetabulum. The acetabular fossa is non-articular; the femoral head does not contact this surface.
The acetabular fossa contains fibroelastic fat covered with synovial membrane.
Terminologies of adverse medication related events , Regulatory terminologies.
Terminologies of adverse medication related events , Regulatory terminologies.Dr. Koppala R.V.S. Chaitanya Terminologies of adverse medication related events , Regulatory terminologies, Glossary of pharmacovigilance topics and its terminologies
Common Male Sexual Problems | Best Sexologist in Patna, Bihar | Dr. Sunil Dubey
Common Male Sexual Problems | Best Sexologist in Patna, Bihar | Dr. Sunil DubeySexologist Dr. Sunil Dubey - Dubey Clinic Hello friends, welcome to Dubey Clinic!
If you are a male and looking for a sexologist doctor for personal treatment or medicine then this information is helpful for you. As we know a sexologist doctor is a specialist in his medical faculty to treat patients who are suffering from any kind of sexual problems. He is a specialist in the study of sexuality, sexology, sexual dysfunction, sexual desire, behavior, gender-identity, anatomy and reproductive health issues. He practices in a clinic or hospital to provide his treatment and medicine privileges.
World renowned Ayurvedacharya Dr. Sunil Dubey is the best sexologist doctor in Patna, Bihar who provides his comprehensive treatment for married and unmarried people at Dubey Clinic. He is a highly qualified Ayurvedic doctor who is an expert in sexology medicine and therapy. In his treatment, he uses the entire branches of Ayurveda (modern, traditional, specific and others) to treat his sexual patients. He is also a successful researcher in this Ayurvedic sexologist profession who has successfully done his research on various sexual diseases in men and women.
Common Sexual Problems in men:
Based on his daily practice, treatments and research; he says that both married and unmarried men can struggle with their sexual problems. He says that men struggle with erectile dysfunction, premature ejaculation, lack of sexual desire, culture-specific syndromes, ejaculation disorders, sexually transmitted infections, performance anxiety disorder and other sexual problems. Various factors are responsible for sexual problems and among them; physical, psychological, lifestyle, hormonal, medical conditions and emotional factors play a vital role in leading a person to sexual problems.
Ayurvedic Treatment for Overall Male Sexual Problems:
Dr. Sunil Dubey says that Ayurveda has infallible solutions to deal with all sexual problems of men. The approach of Ayurveda focuses on balancing the doshas in the body, which are the cause of sexual disorders. It has a natural system to cure problems, which is the basis of all medicines. He provides his comprehensive treatment to each and every sexual patient with the help of Ayurveda.
First, he identifies the underlying medical conditions (diabetes, cardiac problems, kidney disease and chronic illness) that play a vital role in this sexual problem. He also helps in identifying psychological factors (stress, depression, anxiety, relationship issues and emotional factors) that indirectly affect sexual health. Providing a holistic approach of treatment, he provides clinically proven Ayurvedic medicine, herbal remedies, quality-proven Ayurvedic Bhasma and vital guidance of sexual wellness.
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Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound...
Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound...Dr. Damian Lastra Copello Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound, Imeka Neuronavigator and MRI for excision of low-grade Astrocytoma in Sharab Hospital. Case Report.
Fontes C1; Sama Y2; Sulayman S 3; BaldehS 4; Ceesay A5; Copello DL6
1. Carlos Fontes. Licensed Nurse in Anesthesiology and Resuscitation. Master's Degree in Emergencies, Assistant Professor University of Medical Sciences of Camaguey. Cuba. Anesthesiology Service, Sharab Hospital. Republic of The Gambia.
2. Sama Yamundaw. Nurse Anesthesiologist Nurse. Anesthesiology Service at Sharab Hospital. Republic of The Gambia
3. Sulayman Sima. Sharab Hospital Surgery Service. Republic of The Gambia.
4. Sanna Baldeh. Scrubs Nurse. Sharab Hospital Surgery Service. Republic of The Gambia.
5. 5 Abdoulie Ceesay. Scrubs Nurse. Sharab Hospital Surgery Service. Republic of The Gambia
6. Dr.Damian Lastra Copello. Consultant Neurosurgeon.MD. Emergency and Critical Care Fellowship. Neuro-Oncology and Spine Surgeon, Lecturer, Researcher, Santiago de Cuba Medical Sciences University, Havana University, Cuba. Neurosurgery Service Sharab Hospital. The Gambia.
ORCID: 0000-0002-9393-1933
Abstract
Low-grade astrocytomas are considered low-grade gliomas. Low-grade gliomas are brain tumors that grow slowly and require specialized care.
They are a group of tumors that include: fibrillary astrocytoma, protoplasmic astrocytoma and gemistocytic astrocytoma. They differ from their counterpart high-grade astrocytomas, because they have a better prognosis and longer survival, although each of them is a different disease with a different course and prognosis.As a group, they represent 26.6% of all tumors derived from glial cells in the brain.Separated by age, they represent approximately 15% of intracranial tumors in adults and 25% in children. (1 -8)
The age of presentation of these tumors in adults is around the 4th decade of life. The frontal lobe is the most frequent location, followed by the temporal and parietal lobes.
Currently, technology has increased the safety of surgical procedures, with the arrival of techniques such as neuronavigation, stereotaxy, transoperative brain mapping, transoperative ultrasound or ultrasonic aspirator; all of them in contemporary times must be used with reasoning for the greater benefit of the patient.
A craniotomy is a complex neurological procedure that involves opening the skull, performing the necessary operation, and closing the skull, securing the bone in its original position. (4 -10)
Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive. These are most commonly speech and motor areas. In all sedation-anesthesia techniques, the patients are awake and able to speak and/or move during the mapping phase.
It is a technique used to improve perioperative outcomes, achieving a faster recovery of the patient with a reduction in the percentage of postoperative complications.
LDMMIA Reiki Yoga S4 Bonus S2 Clearing Chi
LDMMIA Reiki Yoga S4 Bonus S2 Clearing ChiLDM Mia eStudios A 4TH FREE WORKSHOP/
BONUS SESSION 2
Reiki Yoga “Clearing”
Our Sessions 1-3 are available for download notes. Thx for Reading.
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Celebrating my 49th Bday.
A Taurus Sun, Born early May 3rd, “76”.
Also A Gemini Moon/Rising. I follow Both signs.
Welcome to the 2nd Bonus Session.
Beyond Basics - Good Vibes Only:
—Review - Good Vibes Only:
— For me, within both Reiki and Yoga sessions the essentials boost the energy. Energy can also be called Vibrations and Frequency. So many coaches are specializing within Frequency topics. They can coach entire themes using Frequency success stories. This shows how little we think of energy? We need our coaches to boost our wisdom? To boost the vibes? For Reiki & Yoga Therapy, using ‘Props’ can assist, protect, and heal energies - faster/better. Let’s Explore more.
(See Presentation for all sections, THX)
Clear Your Energy Pt 1…(See Presentation)
Clear Your Energy - Pt 2
I know we operate busy schedules. Sometimes I will yoga stretch, do warm ups, Fuse Qigong, and clear my chakras. It can be therapy or for energy boosts. So many things within our activities will leave behind energy. This can be positive or negative. We assume these energies naturally drop off. But, not always the case. Some energies latch on longterm. This all depends on your moods, emotions, and lifestyle. Hope it makes sense. We have to monitor our energy intake/out-take.
Repost:
Taking breaks, pausing, relaxing, are common things ppl struggle with. Including at times, myself. Reiki requires chill hours or meditations. We often believe our schedules are badges to display for social/approval? This is a generational society belief. It takes courage to bold/quietly declare - the opposite.
(Old Matrix Systems)
Energy Monitoring-The Media/News
A Perm bonus section I wanted to keep. This is about The media and news. Now, I understand it’s hard to avoid all news. Especially when we need our global, local, weather, and economic updates. Some news are important while others are extremely negative. Anything hosting bad vibes can be draining. I have seen this occur within distant/visual updates like news or gossip. We have to keep what we need. Then leave behind what we don’t. The intuitive coaching/Tarot rules.
There’s a lot going on for every country. So now is the time to practice calming methods for daily life or emergencies.
(See Presentation for all, new topics, THX)
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2025 lobotomy vs nasal surgery comparison
2025 lobotomy vs nasal surgery comparisonyilef94631 Modern day nasal surgeries are similar to the past day lobotomies in terms of the total destruction of the human health and reduction of quality of life to nothing
Primary Care at the Center of RSV Prevention: Community-Focused Strategies to...
Primary Care at the Center of RSV Prevention: Community-Focused Strategies to...PVI, PeerView Institute for Medical Education
Terminologies of adverse medication related events , Regulatory terminologies.
Terminologies of adverse medication related events , Regulatory terminologies.Dr. Koppala R.V.S. Chaitanya
Common Male Sexual Problems | Best Sexologist in Patna, Bihar | Dr. Sunil Dubey
Common Male Sexual Problems | Best Sexologist in Patna, Bihar | Dr. Sunil DubeySexologist Dr. Sunil Dubey - Dubey Clinic
Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound...
Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound...Dr. Damian Lastra Copello
Self-testing for HIV: initial experience of the UK’s first kit
- 1. Self-‐testing for HIV: initial experience of the UK’s first kit Dr Michael Brady Medical Director, Terrence Higgins Trust Consultant in Sexual Health & HIV, Kings College Hospital
- 2. Context — HIV testing rates in the UK remain unacceptably low — 17% of those living with HIV remain undiagnosed1 — Mathematical modelling data (MSM) show: — Increasing testing rates would reduce HIV incidence2 — HIV testing (with other prevention strategies) could nearly half the expected infections between now and 20203 — There are well recognised barriers to testing and services do not have capacity to manage increased volumes of testing — HIV self testing may address these issues 1 HIV in the United Kingdom. 2015 report. PHE 2 Philips A et al Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM. 2015 Sep 10;29(14):1855-‐62 3 Punyacharoensin et al (2016) Effect of pre-‐exposure prophylaxis and combination HIV prevention for men who have sex with men in the UK: a mathematical modelling study. Lancet Online January 13 2016
- 3. HIV self testing — Legalised in the UK in April 2014 — Biosure HIV self-‐testing kit licensed in April 2015 — Finger-‐prick 2nd generation blood test (2.5µl) — Result read in 15 minutes — Post Marketing Surveillance data — April 2015 – February 2016 Disclosure: I have no financial relationship with Biosure
- 4. HIV self-testing — Available to buy on-line (£29.95) — Post marketing surveillance: — Number and timing of orders — Gender of client — Postcode of residence — User feedback: — E-mail and telephone feedback — User surveys — http://www.peblfeedback.com/hivselftest
- 5. Results — 27,917 units sold between April ‘15 – February ‘16 — 10.5% have ordered a test more than once — 50.4% (1644/3259) had never tested before April 2015 – February 2016 Gender Male 76.6% Female 23.4% Geographical location ‘Non-metropolitan’ 21,027 (75.3%) London 4,841 (17.3%) Manchester 879 (3.2%) Birmingham 492 (1.8%) Leeds 360 (1.3%) Liverpool 318 (1.1%)
- 6. HIV self-test: order history Similar pattern of testing behaviour seen in home sampling services1 1Brady et al Home HIV sampling linked to national HIV testing campaigns: a novel approach to improve HIV diagnosis. Third joint conference of BHIVA and BASHH. April 2014 (O21)
- 7. HIV self-test: kit performance — Issues of kit performance rely on self-reporting — Currently no standardised way of recording and confirming access to care — 6 reported false reactives (0.02%) — Expected to be in the range of 53 to 56. — 12 reported invalid tests (0.04%) — Device problems, failure to generate a control line
- 8. HIV self test: user feedback — 1334 (4.7%) provided some kind of feedback — From a sample of 555 — 97.5% would use it again — 98.1% said the test was easy to do — 99.4% said it was easy to read
- 9. HIV self test: user feedback (101) “Simple” “Easy” “Convenient” “Clear instructions”“Discrete” “Value for money” “Privacy” “Nearest clinic too far away“ “Excellent” “Amazing” “Horrendous” http://www.peblfeedback.com/hivs elftest “Waiting for result from clinic is stressful“
- 10. Conclusions (1) — HIV self testing is proving popular in a ‘private’ setting — Lower than expected levels of kit failure or false positives — User feedback very positive — Ordering closely linked to social media promotion and ‘HIV’ in the news
- 11. Conclusions (2) — Post marketing surveillance gives only a limited picture — Ideal to integrate data collection with statutory returns — More data are needed on: — How the test would perform if available for free — How the test will perform when targeted at those most at risk — The experience of receiving a reactive result — How to ensure and confirm access to care — Impact on testing rates and sexual behaviour
- 12. Acknowledgements Biosure UK Ltd — Gary Carpenter — Brigette Bard [email protected]