Injury experience in Tanzania - Need for intervention

Objective: To determine distribution of injuries and factors associated with mortality in six hospitals of Tanzania mainland.Design: A Cross - Sectional hospital based study.Setting: Data were collected from casualty departments of Muhimbili Orthopaedic Institute, Morogoro, Mtwara, Kigoma, Musoma regional hospitals and Korogwe district hospital.Subjects: Patients who sustained injuries and attended in six involved hospitals between November 2011 and December 2012.Results: Of the 9316 injury patients seen, 71.7% were males. Majority (55%) were between 18 – 45 years age group. Traffic crashes were the leading cause of injuries and accounted for 47.5% of all injuries. Fractures accounted for 49.2%, and injuries were severe in 1.2% as determined by the Kampala trauma score II (KTS II). Majorities 66.7% were admitted and 2.4% died at the casualty. Factors associated with mortality were; being unemployed (P = 0.000), using ambulances to the hospital (P = 0.000), receiving medical attention within 2 to 10 hours after injury (P = 0.001), road traffic crashes (P = 0.000), 18 - 45 years age group (P = 0.003), low KTS II score (P = 0.000) and sustaining head injury (P = 0.000).Conclusion: Injuries in Tanzania are an important public health problem, predominantly in adult males, mostly due to traffic crashes. It is therefore important to reinforce preventive measures and pre-hospital emergency service is urgently needed

African vegetable diversity in the limelight: project activities by ProNIVA.

Poster presented at Botanical Congress. Hamburg (Germany), 3-7 Sep 200

Highly efficient spin-orbit torque and switching of layered ferromagnet Fe3GeTe2

Among van der Waals (vdW) layered ferromagnets, Fe3GeTe2 (FGT) is an excellent candidate material to form FGT/heavy metal heterostructures for studying the effect of spin-orbit torques (SOT). Its metallicity, strong perpendicular magnetic anisotropy built in the single atomic layers, relatively high Curie temperature (Tc about 225 K) and electrostatic gate tunability offer a tantalizing possibility of achieving the ultimate high SOT limit in monolayer all-vdW nanodevices. The spin current generated in Pt exerts a damping-like SOT on FGT magnetization. At about 2.5x1011 A/m2 current density,SOT causes the FGT magnetization to switch, which is detected by the anomalous Hall effect of FGT. To quantify the SOT effect, we measure the second harmonic Hall responses as the applied magnetic field rotates the FGT magnetization in the plane. Our analysis shows that the SOT efficiency is comparable with that of the best heterostructures containing three-dimensional (3D) ferromagnetic metals and much larger than that of heterostructures containing 3D ferrimagnetic insulators. Such large efficiency is attributed to the atomically flat FGT/Pt interface, which demonstrates the great potential of exploiting vdW heterostructures for highly efficient spintronic nanodevices

Correlates of Delayed Diagnosis among Human Immunodeficiency Virus-Infected Pulmonary Tuberculosis Suspects in a Rural HIV Clinic, South Africa

Delay in pulmonary tuberculosis (PTB) diagnosis is one of the major factors that affect outcome and threatens continued spread of tuberculosis. This study aimed at determining factors associated with delayed PTB diagnosis among human immunodeficiency virus (HIV) infected individuals. Methods. A retrospective observational study was done using clinic records of HIV-infected PTB suspects attending an HIV/AIDS clinic at Tintswalo rural hospital in South Africa (SA) between January 2006 and December 2007. Using routine clinic registers, 480 records were identified. Results. PTB diagnosis delay was found among 77/176 (43.8%) of the patients diagnosed with PTB. The mean delay of PTB diagnosis was 170.6 days; diagnosis delay ranged 1–30 days in 27 (35.1%) patients, 31–180 days in 24 (33.8%) patients; 24 (31.2%) patients remained undiagnosed for ≥180 days. Independent factors associated with delayed diagnosis were: older age >40 years (Odds Ratio (OR) 3.43, 95% CI 1.45–8.08) and virological failure (OR 2.72, 95% CI 1.09–6.74). Conclusion. There is a considerable delayed PTB diagnosis among HIV-infected patients in rural SA. Older patients as well as patients with high viral load are at a higher risk of PTB diagnosis delay. Therefore efforts to reduce PTB diagnosis delay need to emphasised

Independent associations between different measures of socioeconomic position and smoking status: A cross-sectional study of adults in England

Introduction: To gain a better understanding of the complex and independent associations between different measures of socioeconomic position (SEP) and smoking in England. Aims and Methods: Between March 2013 and January 2019 data were collected from 120 496 adults aged 16+ in England taking part in the Smoking Toolkit Study. Of these, 18.04% (n = 21 720) were current smokers. Six indicators of SEP were measured: social grade, employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each measure of SEP, taking account of high collinearity. Results:: The strongest predictor of smoking status was housing tenure. Those who did not own their own home had twice the odds of smoking compared with homeowners (odds ratio [OR] = 2.01). Social grade, educational qualification, and income were also good predictors. Those in social grades C1 (OR = 1.04), C2 (OR = 1.29), D (OR = 1.39), and E (OR = 1.78) had higher odds of smoking than those in social grade AB. Similarly, those with A-level/equivalent (OR = 1.15), GCSE/vocational (OR = 1.48), other/still studying (OR = 1.12), and no post-16 qualifications (OR = 1.48) had higher odds of smoking than those with university qualifications, as did those who earned in the lowest (OR = 1.23), third (OR = 1.18), and second quartiles (OR = 1.06) compared with those earning in the highest. Associations between smoking and employment (OR = 1.03) and car ownership (OR = 1.05) were much smaller. Conclusions: Of a variety of socioeconomic measures, housing tenure appears to be the strongest independent predictor of smoking in England, followed by social grade, educational qualifications, and income. Employment status and car ownership have the lowest predictive power. Implications: This study used ridge regression, a technique which takes into account high collinearity between variables, to gain a better understanding of the independent associations between different measures of SEP and smoking in England. The findings provide guidance as to which SEP measures one could use when trying to identifying individuals most at risk from smoking, with housing tenure identified as the strongest independent predictor

Circadian variation of pain as a measure of the analgesia requirements during the first 24-postoperative hours in patients using an opioid Patient Controlled Analgesia delivery system

Circadian rhythms have governed the everyday life of every single organism that has lived on Earth. The present study addresses the rhythms of cortisol and melatonin, their analgesic properties and the potential circadian rhythm of pain as a driver of the frequency of self-administered analgesia in postoperative patients with an opioid Patient Controlled Analgesia (PCA) delivery system. It aims to determine if acute 24-hour post-operative pain displays a circadian variation by analysing the number of times that patients self-administered morphine for pain relief and incidentally to determine if gender has any association with the frequency of self-administered analgesia. For that purpose, the frequencies of self-administered analgesia were divided into four periods of six hours each (three of them approximately corresponded to the day, and 1 to the night). A Multi-level Poisson regression analysis compared frequencies during period 4 (night) to all others (1, 2 and 3). The results show that there was a statistically significant difference between the frequencies of self-administered opioids in the night period compared to any other day period (p-value of <0.001, for periods 1, 2 and 3 respectively compared to period 4). Differences in terms of gender were also statistically significant (p < 0.001) with men’s opioid consumption almost double that of women’s but with much steeper rate of decline (p<0.001). These results may be partly explained by the rhythms of melatonin, cortisol and ß-endorphine, morphine’s chronopharmacology and possibly by oestrogen and progesterone

Performance de l’oxymétrie nocturne dans le diagnostic du syndrome d’apnées du sommeil. Etude monocentrique menée au centre Hospitalier de Longjumeau/France: Performance of nocturnal oximetry in the diagnosis of sleep apnea syndrome. Single-center study from Longjumeau Hospital Center / France

Context and objective. Sleep apnea-hypopnea syndrome (SAHOS) is currently under diagnosed or ignored, due to a poor access to polysomnography, the ’gold-standard’’ diagnostic test. Yet, sleep disorder is linked to many complications mainly, cardiovascular disorders. The present study aimed to assess the relevance of overnight pulse oximetry in diagnosing SAHOS. Methods. A cross-sectional analysis was conducted between January 1st and September 30th, 2017. All patients suspected of SAHOS syndrome underwent an overnight pulse oximetry (OPO) and a respiratory polygraphy (PG). Data were analysed using Excel 2010 and SSPSS 21.0, to establish the sensitivity, specificity, the positive and negative predictive value and ROC curve was calculated to determine the performance of OPO compared to PG. Results. 201 patients were enrolled (median age of 64.6 +/- 11.8 years). Males (55%) and obese (medium BMI of 32 kg/m² were preponderant. The sensitivity and specificity of overnight pulse oximetry were 87 % and 85 %, respectively with ROC curve prominently rising at 0.75. Conclusion. The study showing a high sensitivity and specificity suggests that the overnight oximetry could stand as a more accessible alternative to polygraphy in the diagnosis of Sleep apnea-hypopnea syndrome where the latter is not available. Contexte &amp; objectif. Le syndrome d’apnées du sommeil est une pathologie fréquemment sous diagnostiquée et souvent méconnue; particulièrement à cause d’une accessibilité insuffisante au gold-standard du diagnostic, la polysomnographie ou la polygraphie ventilatoire. Et pourtant, l’affection est responsable des complications surtout cardiovasculaires majeures. L’objectif de la présente étude était d’évaluer le niveau de performance de l’oxymétrie nocturne dans le diagnostic du syndrome d’apnées du sommeil. Méthodes. Enquête transversale menée entre le 1er janvier 2016 et le 30 septembre 2017. Tous les patients hospitalisés pour suspicion du syndrome d’apnées du sommeil ont bénéficié d’une oxymétrie nocturne et d’une polygraphie ventilatoire. Les logiciels Excel 2010 et SSPSS 21.0 ont permis d’analyser les données. Nous avons déterminé la sensibilité, la spécificité, la valeur prédictive positive et la valeur prédictive négative. La courbe ROC a été calculée. p &lt; 0,05. Résultats. Au total 201 patients d’âge moyen de 64,6±11,8 ans, avec une prédominance masculine (55%) et en majorité obèses (IMC moyen de 32kg/m²) ont été inclus. La sensibilité et la spécificité de l’oxymétrie nocturne sont respectivement de 87 et de 85% avec une courbe ROC montrant une surface importante sous la courbe de 0,75. Conclusion. Avec sa sensibilité et spécificité élevées, l’oxymétrie nocturne peut constituer une alternative valable au diagnostic du syndrome d’apnées du sommeil. Son innocuité et sa bonne acceptabilité en font un outil facilement exportable et recommandable en cas de carence de moyens appropriés

Sediment transport models in Generalized shear shallow water flow equations

International audienceThe classical sediment transport models based on shallow water equations (SWE) describes the hydro-morphodynamic process without horizontal velocity shear along the vertical and considers that the fluid velocity is equal to sediment velocity. The classical shear shallow water (SSW) with friction and topography source terms assumes that the fluid density is uniform in all the space. Nevertheless, for the coastal flows with sediment transport we are interested in it seems essential to consider these shear effects, the phase lag effect and the nonhomogenous ness of fluid density. In this paper, we develop new sediment transport models incorporating the shear velocity along the vertical, the phase lag effect and the spatial variation of the fluid density. The starting point is the 2D equations for the evolution of mixing quantities and sediment volume rate. These equations describe the motion of fluid mixing in a domain bounded by a dynamical water surface and water bed. Contrary to the classical sediment transport models, the second-order vertical fluctuations of the horizontal velocity are considered. Considering the kinematic conditions on the moving surfaces, we apply an average along the depth on the three-dimensional equations to obtain simplified equations. The resulting model has a wider range of validity and integrates the morphodynamic processes proposed in the literature. The proposed mathematical derivation is in the context of recent developments with the additional presence of sediment and a dynamic bed