User fees impact access to healthcare for female children in rural Zambia

The World Bank and International Monetary Fund favor healthcare user fees. User fees offer revenue and may decrease inappropriate care. However, user fees may deter needed care, especially in vulnerable populations. A cross-sectional analysis of healthcare utilization in a large Zambian hospital was conducted for children 3-6 years of age during a 1-month observation period. Diagnoses and treatments were compared using paired t-tests. Chi-squared tests compared outpatient service use. The relative risk of admission was determined for each stratum. Logistic models were developed to evaluate the impact of age, gender, and the age-gender interaction on hospital admissions. Trends suggest female children may be less likely to present for care when user fees are imposed. However, treatment type, treatment number, and number of diagnoses did not differ between genders. The relative risk of admission was highest for males 5-6 years old. Neither age nor gender alone was a significant determinant of hospital admission. However, the age-gender interaction was significant with female admissions least likely when costs were incurred. We conclude that user fees appear to decrease differentially utilization of inpatient care for female children in rural Zambia

Core-scale solute transport model selection using Monte Carlo analysis

Model applicability to core-scale solute transport is evaluated using breakthrough data from column experiments conducted with conservative tracers tritium and sodium-22 , and the retarding solute uranium-232 . The three models considered are single-porosity, double-porosity with single-rate mobile-immobile mass-exchange, and the multirate model, which is a deterministic model that admits the statistics of a random mobile-immobile mass-exchange rate coefficient. The experiments were conducted on intact Culebra Dolomite core samples. Previously, data were analyzed using single-porosity and double-porosity models although the Culebra Dolomite is known to possess multiple types and scales of porosity, and to exhibit multirate mobile-immobile-domain mass transfer characteristics at field scale. The data are reanalyzed here and null-space Monte Carlo analysis is used to facilitate objective model selection. Prediction (or residual) bias is adopted as a measure of the model structural error. The analysis clearly shows single-porosity and double-porosity models are structurally deficient, yielding late-time residual bias that grows with time. On the other hand, the multirate model yields unbiased predictions consistent with the late-time slope diagnostic of multirate mass transfer. The analysis indicates the multirate model is better suited to describing core-scale solute breakthrough in the Culebra Dolomite than the other two models

An exploration of ebook selection behavior in academic library collections

Academic libraries have offered ebooks for some time, however little is known about how readers interact with them while making relevance decisions. In this paper we seek to address that gap by analyzing ebook transaction logs for books in a university library

HIV-1 Effects on Neuropsychological Performance in a Resource-Limited Country, Zambia

Zambia has substantially been affected by the HIV/AIDS epidemic with prevalence rates at 14% in a population estimated at 12 million. Yet, the extent of HIV-associated neurocognitive disorders (HAND) in this population remains to be clearly understood. A series of culturally appropriate neuropsychological (NP) assessments [International HIV Dementia Scale (IHDS), Color Trails Test 1 and 2, Grooved pegboard Test, and Time Gait Test] were used to test the effects of HIV on NP performance of HIV seropositive and seronegative individuals. Twenty-two percent HIV positive individuals ARV naïve met the criteria for IHDS-defined NP impairment. Gender significantly influenced the performance on NP tests with females performing more poorly compared to males. Larger studies that will accommodate gender differences and age are necessary to generate appropriate norms in Zambia in order to better assess the prevalence of HAND in the developing country setting

Lyman-alpha Absorption from Heliosheath Neutrals

We assess what information HST observations of stellar Ly-alpha lines can provide on the heliosheath, the region of the heliosphere between the termination shock and heliopause. To search for evidence of heliosheath absorption, we conduct a systematic inspection of stellar Ly-alpha lines reconstructed after correcting for ISM absorption (and heliospheric/astrospheric absorption, if present). Most of the stellar lines are well centered on the stellar radial velocity, as expected, but the three lines of sight with the most downwind orientations relative to the ISM flow (Chi1 Ori, HD 28205, and HD 28568) have significantly blueshifted Ly-alpha lines. Since it is in downwind directions where heliosheath absorption should be strongest, the blueshifts are almost certainly caused by previously undetected heliosheath absorption. We make an initial comparison between the heliosheath absorption and the predictions of a pair of heliospheric models. A model with a complex multi-component treatment of plasma within the heliosphere predicts less absorption than a model with a simple single-fluid treatment, which leads to better agreement with the data. Finally, we find that nonplanetary energetic neutral atom (ENA) fluxes measured by the ASPERA-3 instrument on board Mars Express, which have been interpreted as being from the heliosheath, are probably too high to be consistent with the relative lack of heliosheath absorption seen by HST. This would argue for a local interplanetary source for these ENAs instead of a heliosheath source.Comment: 27 pages, 7 figures, AASTEX v5.0, accepted by Ap

Unconfined Aquifer Flow Theory - from Dupuit to present

Analytic and semi-analytic solution are often used by researchers and practicioners to estimate aquifer parameters from unconfined aquifer pumping tests. The non-linearities associated with unconfined (i.e., water table) aquifer tests makes their analysis more complex than confined tests. Although analytical solutions for unconfined flow began in the mid-1800s with Dupuit, Thiem was possibly the first to use them to estimate aquifer parameters from pumping tests in the early 1900s. In the 1950s, Boulton developed the first transient well test solution specialized to unconfined flow. By the 1970s Neuman had developed solutions considering both primary transient storage mechanisms (confined storage and delayed yield) without non-physical fitting parameters. In the last decade, research into developing unconfined aquifer test solutions has mostly focused on explicitly coupling the aquifer with the linearized vadose zone. Despite the many advanced solution methods available, there still exists a need for realism to accurately simulate real-world aquifer tests

Review of Inverse Laplace Transform Algorithms for Laplace-Space Numerical Approaches

A boundary element method (BEM) simulation is used to compare the efficiency of numerical inverse Laplace transform strategies, considering general requirements of Laplace-space numerical approaches. The two-dimensional BEM solution is used to solve the Laplace-transformed diffusion equation, producing a time-domain solution after a numerical Laplace transform inversion. Motivated by the needs of numerical methods posed in Laplace-transformed space, we compare five inverse Laplace transform algorithms and discuss implementation techniques to minimize the number of Laplace-space function evaluations. We investigate the ability to calculate a sequence of time domain values using the fewest Laplace-space model evaluations. We find Fourier-series based inversion algorithms work for common time behaviors, are the most robust with respect to free parameters, and allow for straightforward image function evaluation re-use across at least a log cycle of time

Molecular epidemiology, drug susceptibility and economic aspects of tuberculosis in mubende district, Uganda

<div><p>Background</p><p>Tuberculosis (TB) remains a global public health problem whose effects have major impact in developing countries like Uganda. This study aimed at investigating genotypic characteristics and drug resistance profiles of <i>Mycobacterium tuberculosis</i> isolated from suspected TB patients. Furthermore, risk factors and economic burdens that could affect the current control strategies were studied.</p><p>Methods</p><p>TB suspected patients were examined in a cross-sectional study at the Mubende regional referral hospital between February and July 2011. A questionnaire was administered to each patient to obtain information associated with TB prevalence. Isolates of <i>M. tuberculosis</i> recovered during sampling were examined for drug resistance to first line anti-TB drugs using the BACTEC-MGIT960^TMsystem. All isolates were further characterized using deletion analysis, spoligotyping and MIRU-VNTR analysis. Data were analyzed using different software; MIRU-VNTR <i>plus</i>, SITVITWEB, BioNumerics and multivariable regression models.</p><p>Results</p><p><i>M. tuberculosis</i> was isolated from 74 out of 344 patients, 48 of these were co-infected with HIV. Results from the questionnaire showed that previously treated TB, co-infection with HIV, cigarette smoking, and overcrowding were risk factors associated with TB, while high medical related transport bills were identified as an economic burden. Out of the 67 isolates that gave interpretable results, 23 different spoligopatterns were detected, nine of which were novel patterns. T2 with the sub types Uganda-I and Uganda-II was the most predominant lineage detected. Antibiotic resistance was detected in 19% and multidrug resistance was detected in 3% of the isolates.</p><p>Conclusion</p><p>The study detected <i>M. tuberculosis</i> from 21% of examined TB patients, 62% of whom were also HIV positive. There is a heterogeneous pool of genotypes that circulate in this area, with the T2 lineage being the most predominant. High medical related transport bills and drug resistance could undermine the usefulness of the current TB strategic interventions.</p></div

Abattoir-based estimates of mycobacterial infections in Cameroon

Mycobacteria cause major diseases including human tuberculosis, bovine tuberculosis and Johne’s disease. In livestock, the dominant species is M. bovis causing bovine tuberculosis (bTB), a disease of global zoonotic importance. In this study, we estimated the prevalence of Mycobacteria in slaughter cattle in Cameroon. A total of 2,346 cattle were examined in a cross-sectional study at four abattoirs in Cameroon. Up to three lesions per animal were collected for further study and a retropharyngeal lymph node was collected from a random sample of non-lesioned animals. Samples were cultured on Lowenstein Jensen media and the BACTEC MGIT 960 system, and identified using the Hain® Genotype kits. A total of 207/2,346 cattle were identified with bTB-like lesions, representing 4.0% (45/1,129), 11.3% (106/935), 23.8% (38/160) and 14.8% (18/122) of the cattle in the Bamenda, Ngaoundere, Garoua and Maroua abattoirs respectively. The minimum estimated prevalence of M. bovis was 2.8% (1.9–3.9), 7.7% (6.1–9.6), 21.3% (15.2–28.4) and 13.1% (7.7–20.4) in the four abattoirs respectively. One M. tuberculosis and three M. bovis strains were recovered from non-lesioned animals. The high prevalence of M. bovis is of public health concern and limits the potential control options in this setting without a viable vaccine as an alternative

Characterization of Non-Tuberculous Mycobacterium from Humans and Water in an Agro pastoral area in Zambia

Abstract Background The non-tuberculous mycobacteria include those mycobacterium species that are not members of the Mycobacterium tuberculosis complex, the causative agent of pulmonary tuberculosis and Mycobacterium leprae. In Zambia, Non-tuberculous Mycobacteria are gaining recognition as pathogens of public health significance. However, there is scanty information on the isolation and speciation of these organisms for better patient management, consequently reducing the burden of these infections. Given the above information, the thrust of this study was to isolate and characterize NTM from humans and water in Namwala district of Zambia. Method This was a cross-sectional study were 153 individuals with suspected TB were sampled from four health facilities in Namwala district, sputum samples were also collected. Additionally, 149 water samples were collected from different water drinking sources such as Tap water, Borehole water, rivers, wells and streams. Standard TB culture methods were employed to isolate Non-tuberculous Mycobacteria and later 16S–23S internal transcribed spacer region Sequencing was employed to characterize NTM. Results Seven (7, 4.6%) NTM species were identified from humans with M. arupense (3, 42.9%) being the most common organism, while twenty three (23, 15.4%) NTM were identified from water with the common species being Mycobacterium gordonae (5, 21.7%). Mycobacterium avium and Mycobacterium fortuitum were both identified from human and water samples. Conclusion This study has shown the isolation of NTM species from humans and water. The isolation of NTM from drinking water sources could signify a public health risk to humans