Operative mortality in resource-limited settings: the experience of Medecins Sans Frontieres in 13 countries.

OBJECTIVE: To determine operative mortality in surgical programs from resource-limited settings. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 surgical programs in 13 developing countries by 1 humanitarian organization, Médecins Sans Frontières, was performed between January 1, 2001, and December 31, 2008. Participants included patients undergoing surgical procedures. MAIN OUTCOME MEASURE: Operative mortality. Determinants of mortality were modeled using logistic regression. RESULTS: Between 2001 and 2008, 19,643 procedures were performed on 18,653 patients. Among these, 8329 procedures (42%) were emergent; 7933 (40%) were for obstetric-related pathology procedures and 2767 (14%) were trauma related. Operative mortality was 0.2% (31 deaths) and was associated with programs in conflict settings (adjusted odds ratio [AOR] = 4.6; P = .001), procedures performed under emergency conditions (AOR = 20.1; P = .004), abdominal surgical procedures (AOR = 3.4; P = .003), hysterectomy (AOR = 12.3; P = .001), and American Society of Anesthesiologists classifications of 3 to 5 (AOR = 20.2; P < .001). CONCLUSIONS: Surgical care can be provided safely in resource-limited settings with appropriate minimum standards and protocols. Studies on the burden of surgical disease in these populations are needed to improve service planning and delivery. Quality improvement programs are needed for the various stakeholders involved in surgical delivery in these settings

S-wave quantum entanglement in a harmonic trap

We analyze the quantum entanglement between two interacting atoms trapped in a spherical harmonic potential. At ultra-cold temperature, ground state entanglement is generated by the dominated s-wave interaction. Based on a regularized pseudo-potential Hamiltonian, we examine the quantum entanglement by performing the Schmidt decomposition of low-energy eigenfunctions. We indicate how the atoms are paired and quantify the entanglement as a function of a modified s-wave scattering length inside the trap.Comment: 10 pages, 5 figures, to be apear in PR

Evidence for the Role of Instantons in Hadron Structure from Lattice QCD

Cooling is used as a filter on a set of gluon fields sampling the Wilson action to selectively remove essentially all fluctuations of the gluon field except for the instantons. The close agreement between quenched lattice QCD results with cooled and uncooled configurations for vacuum correlation functions of hadronic currents and for density-density correlation functions in hadronic bound states provides strong evidence for the dominant role of instantons in determining light hadron structure and quark propagation in the QCD vacuum.Comment: 26 pages in REVTeX, plus 10 figures, uuencoded. Submitted to Physical Review D. MIT-CTP-226

Nevirapine-Induced Heratotoxicity: Incidence, Risk Factors and Associated Mortality in a Primary Care ART Programme in South Africa

CROI 200

Absence of ferromagnetism in V-implanted ZnO single crystals

The structural and magnetic properties of V doped ZnO are presented. V ions were introduced into hydrothermal ZnO single crystals by ion implantation with fluences of 1.2*10^16 to 6*10^16 cm^-2. Post-implantation annealing was performed in high vacuum from 823 K to 1023 K. The ZnO host material still partly remains in a crystalline state after irradiation, and is partly recovered by annealing. The V ions show a thermal mobility as revealed by depth profile Auger electron spectroscopy. Synchrotron radiation x-ray diffraction revealed no secondary phase formation which indicates the substitution of V onto Zn site. However in all samples no pronounced ferromagnetism was observed down to 5 K by a superconducting quantum interference device magnetometer.Comment: 13 pages, 4 figs, MMM conference 2007, accepted by J. Appl. Phy

Nevirapine- and efavirenz-associated hepatotoxicity under programmatic conditions in Kenya and Mozambique.

To describe the frequency, risk factors, and clinical signs and symptoms associated with hepatotoxicity (HT) in patients on nevirapine- or efavirenz-based antiretroviral therapy (ART), we conducted a retrospective cohort analysis of patients attending the ART clinic in Kibera, Kenya, from April 2003 to December 2006 and in Mavalane, Mozambique, from December 2002 to March 2007. Data were collected on 5832 HIV-positive individuals who had initiated nevirapine- or efavirenz-based ART. Median baseline CD4+ count was 125 cells/μL (interquartile range [IQR] 55-196). Over a median follow-up time of 426 (IQR 147-693) days, 124 (2.4%) patients developed HT. Forty-one (54.7%) of 75 patients with grade 3 HT compared with 21 (80.8%) of 26 with grade 4 had associated clinical signs or symptoms (P = 0.018). Four (5.7%) of 124 patients with HT died in the first six months compared with 271 (5.3%) of 5159 patients who did not develop HT (P = 0.315). The proportion of patients developing HT was low and HT was not associated with increased mortality. Clinical signs and symptoms identified 50% of grade 3 HT and most cases of grade 4 HT. This suggests that in settings where alanine aminotransferase measurement is not feasible, nevirapine- and efavirenz-based ART may be given safely without laboratory monitoring

Identification of the dominant diffusing species in silicide formation

Implanted noble gas atoms of Xe have been used as diffusion markers in the growth study of three silicides: Ni2Si, VSi2, and TiSi2. Backscattering of MeV He has been used to determine the displacement of the markers. We found that while Si atoms predominate the diffusion in VSi2 and TiSi2, Ni atoms are the faster moving species in Ni2Si