Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect

Time reparametrization group and the long time behaviour in quantum glassy systems

We study the long time dynamics of a quantum version of the Sherrington-Kirkpatrick model. Time reparametrizations of the dynamical equations have a parallel with renormalization group transformations, and within this language the long time behaviour of this model is controlled by a reparametrization group (R$_p$G) fixed point of the classical dynamics. The irrelevance of the quantum terms in the dynamical equations in the aging regime explains the classical nature of the violation of the fluctuation-dissipation theorem.Comment: 4 page

Reconstructing boulder deposition histories: extreme wave signatures on a complex rocky shoreline of Malta

The Żonqor coastline, southeast Malta, displays an exceptional range of geomorphic signatures of extreme coastal events. This paper brings together evidence acquired from a field survey, analysis of time-sequential imagery, and hydrodynamic modelling to investigate the histories of boulder groups identified by their intrinsic and contextual characteristics. Clear differences are revealed between the distribution of boulders recently moved and those of considerable age. Tracking the movement of boulders since 1957 confirms that storms of surprisingly frequent interval are capable of complex boulder movements, including lifting of megaclasts. Scrutiny of the ancient boulders, including weathering features and fascinating landward-facing (reverse) imbrication, cautiously suggests tsunami as the agent for their emplacement. A novel method is developed for depicting the velocity decay profiles of hypothetical waves, which overcomes some of the limitations of the Nott approach. Applied here, the wave run-up context further sets the ancient movers apart from their recent mover companions. The combined evidence implies a palimpsestic landscape where storm waves are regular geomorphic agents that add to and rework the distribution of boulders close to the shoreline, but over long time periods the landscape becomes reset by tsunami—a concept that is of value to agencies in Malta responsible for coastal safety, planning and management

Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study

Background Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. Methods A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. Results Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. Conclusions Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.publishedVersio

A randomised controlled trial comparing opt-in and opt-out home visits for tracing lost participants in a prospective birth cohort study

© 2015 Bray et al. Background: Attrition is an important problem in cohort studies. Tracing cohort members who have moved or otherwise lost contact with the study is vital. There is some debate about the acceptability and relative effectiveness of opt-in versus opt-out methods of contacting cohort members to re-engage them in this context. We conducted a randomised controlled trial to compare the two approaches in terms of effectiveness (tracing to confirm address and consenting to continue in the study), cost-effectiveness and acceptability. Methods: Participants in this trial were individuals (young people and mothers) recruited to the Avon Longitudinal Study of Parents and Children (ALSPAC), who had not engaged with the study in the previous 5 years and for whom mail had been returned from their last known address. The sampling frame was restricted to those for whom database searching led to a potential new address being found in the Bristol area. 300 participants were randomly selected and assigned using stratified randomisation to the opt-in or opt-out arm. A tailored letter was sent to the potential new address, either asking participants to opt in to a home visit, or giving them the option to opt out of a home visit. Fieldworkers from Ipsos MORI conducted home visits to confirm address details. Results: The proportion who were traced was higher in the opt-out arm (77/150∈=∈51 %) than the opt-in arm (6/150∈=∈4 %), as was the proportion who consented to continue in ALSPAC (46/150∈=∈31 % v 4/150∈=∈3 %). The mean cost per participant was £8.14 in the opt-in arm and £71.93 in the opt-out arm. There was no evidence of a difference in acceptability between the opt-in and opt-out approaches. Conclusion: Since the opt-in approach yielded very low response rates, and there were no differences in terms of acceptability, we conclude that the opt-out approach is the most effective method of tracing disengaged study members. The gains made in contacting participants must be weighed against the increase in cost using this methodology