1,720,976 research outputs found
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Fulfilling the Specialist Neurosurgery Workforce Needs in Africa: a SWOT Analysis of Training Programs and Projection Towards 2030
No full textBackground/ObjectivesAfrica has only 1% of the global neurosurgery workforce, despite having 14% of the global population and 15% of the global neurosurgical disease burden. Also, neurosurgical training is hampered by paucity of training institutions, dearth of training faculty, and deficiency of optimal training resources. The study appraises the current specialist neurosurgical workforce in Africa, evaluates the major neurosurgery training programs, and projects the 2030 workforce capacity using current growth trends.
Methods
The study involved systematic and gray literature search, with quantitative analysis of retrospective data on the neurosurgery workforce, qualitative evaluation of the major neurosurgery training programs for their strength, weaknesses, opportunities, and threats, and projection modeling of the workforce capacity up to year 2030.
Results
1,974 neurosurgeons serve 1.3 billion people (density 0.15/100,000; ratio 1:678,740), in Africa, with the majority (1,271; 64.39%) in North Africa. There are 106 specialist neurosurgery training institutions in 26 African countries, with North Africa having 52 (49.05%) of the training centers. Training is heterogenous, with the major programs being the West African College of Surgeons (WACS) - 24 centers across 7 countries, and the College of Surgeons of East, Central and Southern Africa (COSECSA) - 17 centers in 8 countries. At the current linear growth rate of 74.2 neurosurgeons/year or exponential growth rate of 6.81% per annum, Africa will have 2,716 - 3,813 neurosurgeons by 2030, with a deficit of 4,795 - 11,953 neurosurgeons. The continent requires a scale-up of its linear growth rate to 663.4 - 1269.5 neurosurgeons/year, or exponential growth rate to 15.87% - 22.21% per annum to meet its needs. While North African countries will likely meet their 2030 workforce requirements, sub-Saharan African countries will have significant workforce deficits.
Conclusion
Despite a recent surge in neurosurgery residency training, the current state of Africa’s neurosurgery workforce is dire, and many countries will be unable to meet their workforce requirements by 2030 at current growth trends. A significant scale-up of the neurosurgery workforce is required in order to meet these targets.</p
Neurosurgical Outcomes Following Establishment of a Twinning Program at Mulago Hospital in Uganda
No full textDuke University Medical Center neurosurgeon, Dr. Micheal Haglund, established a twinning program between Duke and Mulago Hospital in Kampala, Uganda back in 2008. While a study was performed in 2011 that showed that the program had increased neurosurgical capacity, there was no study looking at patient outcomes. This study was thus undertaken to explore patient outcomes in an effort to provide information the program could use for evaluating its impact. This study was carried out in a retrospective fashion including all patients who underwent a neurosurgical procedure at Mulago Hospital from fiscal year 2005 to 2013. Data for this study was extracted from three sources: surgical log books, patient charts, and Mulago Hospital death registry. Information from these sources were collected using electronic data collection tools to determine morality rate (30-day and overall), infection rate (pre-op and post-op), and length of stay (total, pre-op, and post-op). These three outcome measures were then compared pre-program versus post-program. Peri-operative mortality rate (POMR), or 30-day mortality, was significantly increased from 7.41% pre-program to 13.62% post-program. Overall mortality was also significantly increased from 12.96% pre-program to 19.89% post-program. Relative risk for POMR was 1.85 (1.13, 3.03) and overall mortality was 1.53 (1.06, 2.22). Pre-op infection was significantly decreased from 29.74% pre-program to 22.1% post-program with a relative risk of 0.75 (0.56, 1.00). Mean total length of stay and pre-operative length of stay were both significantly decreased. The results show that the program has had a generally positive impact, but the mortality increase is an important question to explore. This result may be attributed to complexity and triaging issues, but a prospective analysis would be the only way to make that determination. Additionally, further qualitative and deeper quantitative investigations can provide a fuller evaluation of the program's impact. Overall it is clear that this program is allowing greater access to neurosurgical care to a population that would have otherwise went without care.</p
Understanding the Barriers and Potential Solutions to Epilepsy Care in Uganda: A Qualitative Study
No full textIntroduction: Epilepsy is one of the most prevalent neurological diseases in the world. In Sub-Saharan Africa, people with epilepsy frequently seek treatment from traditional or pastoral healers, who are more accessible than biomedical care providers. This is problematic because it often contributes to a time delay preventing patients from obtaining adequate biomedical care. In Uganda, biomedical providers who treat epilepsy are also available, including neurologists and psychiatrists. This study sought to elucidate the barriers to biomedical care for people with epilepsy as well as identify potential solutions to overcome these barriers.Methods: The study used qualitative research methods. Semi-structured interviews and focus group discussions were conducted with four major groups: patients with epilepsy or family members of patients with epilepsy, neurologists and psychiatrists, pastoral healers, and traditional healers. All interviews and focus group discussions that were in English were audio recorded and transcribed verbatim into English. Those that were not in English were translated live and audio recorded. A translator later translated the audio recording to ensure proper transcription into English. Two independent coders coded the dataset and conducted an inter-rater reliability assessment to ensure reliable coding of the data. Thematic analysis was then performed to elucidate themes from the data and to compare nuances in the themes between each of the study design groups.Results: Participants in this study discussed several different causes of epilepsy ranging from spiritual to biological causes, but often incorporating elements of both. Common spiritual causes of epilepsy included witchcraft and ancestral spirits. Common biological causes included genetics, fever, malaria, and brain injury. For patients and families, beliefs about the cause of epilepsy often played a role in whom they chose to seek treatment from. Three major barriers to biomedical care were discussed: practical barriers, barriers relating to medical infrastructure, and barriers related to stigma against people with epilepsy. Practical barriers included logistical barriers such as transportation, cost of medical care, and distance to the nearest healthcare facility. Under medical infrastructure, drug stockouts and lack of access to anti-epileptic drugs were the most consistent problems stated amongst patients. Stigma was heavily discussed and brought up by nearly every participant. Additionally, three significant solutions to improving epilepsy care in Uganda were highlighted by participants: collaboration among treatment providers, community sensitization efforts to address stigma, and building medical infrastructure. Within building infrastructure, all participant types except traditional healers proposed the development of an epilepsy clinic designed to specifically treat epilepsy.Conclusions: Based on these findings, there are four critical interventions that should be considered for improving epilepsy care in Uganda: collaboration between biomedical providers and traditional healers, community outreach programs for sensitization, the establishment of epilepsy clinics, and infrastructure building to address medication stockouts.</p
Outcomes and Predictors of Mortality in Neurosurgical Patients at Mbarara Regional Referral Hospital
No full textBackground:Knowing the scope of neurosurgical disease at Mbarara Hospital is critical for infrastructure planning, education and training. In this study, we aim to evaluate the neurosurgical outcomes and identify predictors of mortality in order to potentiate platforms for more effective interventions and inform future research efforts at Mbarara Hospital. Methods: This is retrospective chart review including patients of all ages with a neurosurgical disease or injury presenting to Mbarara Regional Referral Hospital (MRRH) between January 2012 to September 2015. Descriptive statistics were presented. A univariate analysis was used to obtain the odds ratios of mortality and 95% confidence intervals. Predictors of mortality were determined using multivariate logistic regression model.Results:A total of 1876 charts were reviewed. Of these, 1854 (had complete data and were?) were included in the analysis. The overall mortality rate was 12.75%; the mortality rates among all persons who underwent a neurosurgical procedure was 9.72%, and was 13.68% among those who did not undergo a neurosurgical procedure. Over 50% of patients were between 19 and 40 years old and the majority of were males (76.10%). The overall median length of stay was 5 days. Of all neurosurgical admissions, 87% were trauma patients. In comparison to mild head injury, closed head injury and intracranial hematoma patients were 5 (95% CI: 3.77, 8.26) and 2.5 times (95% CI: 1.64,3.98) more likely to die respectively. Procedure and diagnostic imaging were independent negative predictors of mortality (P Conclusions: The majority of hospital admissions were TBI patients, with RTIs being the most common mechanism of injury. Age, ICU admission, admission GCS, diagnostic imaging and undergoing surgery were independent predictors of mortality. Going forward, further exploration of patient characteristics is necessary to fully describe mortality outcomes and implement resource appropriate interventions that ultimately improve morbidity and mortality.</p
Economic Burden Of Patients Seeking Neurosurgical Care at Mulago hospital, Kampala, Uganda
No full textBackground: Private healthcare resources, which include private health insurance agencies, households, facility-based NGOs and private firms cover over 75% of the health expenditure in Uganda. Uganda’s National Health Accounts for the financial year 2009/2010 reported higher spending from private sources than public sources. Further results showed out of pocket expenditure from households was the largest source of funding, contributing 40% to 46% of total health expenditure. The expenditure of a large fraction of household income on health care results in financial risk for most Ugandans and often leaves families impoverished. Therefore, the goal of this study is to describe in detail the burden of cost of patients, using neurosurgery as a proxy. Methods: The study was carried out in Mulago Hospital, Kampala, Uganda. Eligible patients were patients between the ages of 18-90 years of age who had undergone a neurosurgical procedure at Mulago and were on the neurosurgery ward post-surgery. Ultimately, 144 patients agreed to be part of the study. These patients were recruited three nurses who worked on the neurosurgery ward. The data were collected via the use of questionnaires to interview the patients and/or caregivers. We defined catastrophic expenditure as 10% of the household income, while impoverishment was defined as patients living on less than $1 a day. Our analysis was mainly descriptive; however, we ran several regressions to determine predictors of catastrophic expenditure, and impoverishment. Results: 59% of the patients are living below the poverty line. An additional 12% were impoverished by expenditure on healthcare. 93% of the patients experienced financial catastrophe due to the direct costs they incurred in seeking care at the hospital. The patients pay, on average, 27% of the hospital costs incurred in treating the patients. Conclusions: The majority of the patients in our study experienced financial catastrophe in seeking neurosurgical care. Furthermore, most of the patients who sought surgical care were already impoverished. These data underscore the fact that the costs associated with accessing neurosurgical care at Mulago Hospital often result financial hardship on the patients, despite the fact that care in Mulago Hospital is supposed to be free.</p
Evaluating the Clinical Care of Traumatic Brain Injury Patients and Identifying Opportunities for Quality Improvement in Neurosurgery at Mulago National Referral Hospital in Kampala Uganda
No full textBackground: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The objectives of this study are to describe the quality of care and determine risk factors predictive of poor outcomes for TBI patients presenting to Mulago National Referral Hospital (MNRH), Kampala Uganda. Methods: We used a prospective neurosurgical registry based on Research Electronic Data Capture (REDCap) to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category (mild, moderate, severe GCS 6-8, severe GCS 3-5), mortality differed by management pathway. The variables predictive of mortality were: moderate to severe TBI (GCS 9-12, GCS 6-8, and GCS 3-5), more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.</p
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