Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems

Background Estimates of the burden of disease in adults in sub-Saharan Africa largely rely on models of sparse data. We aimed to measure the burden of disease in adults living in a rural area of coastal Kenya with use of linked clinical and demographic surveillance data. Methods We used data from 18 712 adults admitted to Kilifi District Hospital (Kilifi , Kenya) between Jan 1, 2007, and Dec 31, 2012, linked to 790 635 person-years of observation within the Kilifi Health and Demographic Surveillance System, to establish the rates and major causes of admission to hospital. These data were also used to model diseasespecifi c disability-adjusted life-years lost in the population. We used geographical mapping software to calculate admission rates stratifi ed by distance from the hospital. Findings The main causes of admission to hospital in women living within 5 km of the hospital were infectious and parasitic diseases (303 per 100 000 person-years of observation), pregnancy-related disorders (239 per 100 000 personyears of observation), and circulatory illnesses (105 per 100 000 person-years of observation). Leading causes of hospital admission in men living within 5 km of the hospital were infectious and parasitic diseases (169 per 100 000 personyears of observation), injuries (135 per 100 000 person-years of observation), and digestive system disorders (112 per 100 000 person-years of observation). HIV-related diseases were the leading cause of disability-adjusted lifeyears lost (2050 per 100 000 person-years of observation), followed by non-communicable diseases (741 per 100 000 personyears of observation). For every 5 km increase in distance from the hospital, all-cause admission rates decreased by 11% (95% CI 7–14) in men and 20% (17–23) in women. The magnitude of this decline was highest for endocrine disorders in women (35%; 95% CI 22–46) and neoplasms in men (30%; 9–45). Interpretation Adults in rural Kenya face a combined burden of infectious diseases, pregnancy-related disorders, cardiovascular illnesses, and injuries. Disease burden estimates based on hospital data are aff ected by distance from the hospital, and the amount of underestimation of disease burden diff ers by both disease and sex

Rapid Susceptibility Testing and Microcolony Analysis of Candida spp. Cultured and Imaged on Porous Aluminum Oxide

Contains fulltext : 124300.pdf (publisher's version ) (Open Access)BACKGROUND: Acquired resistance to antifungal agents now supports the introduction of susceptibility testing for species-drug combinations for which this was previously thought unnecessary. For pathogenic yeasts, conventional phenotypic testing needs at least 24 h. Culture on a porous aluminum oxide (PAO) support combined with microscopy offers a route to more rapid results. METHODS: Microcolonies of Candida species grown on PAO were stained with the fluorogenic dyes Fun-1 and Calcofluor White and then imaged by fluorescence microscopy. Images were captured by a charge-coupled device camera and processed by publicly available software. By this method, the growth of yeasts could be detected and quantified within 2 h. Microcolony imaging was then used to assess the susceptibility of the yeasts to amphotericin B, anidulafungin and caspofungin (3.5 h culture), and voriconazole and itraconazole (7 h culture). SIGNIFICANCE: Overall, the results showed good agreement with EUCAST (86.5% agreement; n = 170) and E-test (85.9% agreement; n = 170). The closest agreement to standard tests was found when testing susceptibility to amphotericin B and echinocandins (88.2 to 91.2%) and the least good for the triazoles (79.4 to 82.4%). Furthermore, large datasets on population variation could be rapidly obtained. An analysis of microcolonies revealed subtle effects of antimycotics on resistant strains and below the MIC of sensitive strains, particularly an increase in population heterogeneity and cell density-dependent effects of triazoles. Additionally, the method could be adapted to strain identification via germ tube extension. We suggest PAO culture is a rapid and versatile method that may be usefully adapted to clinical mycology and has research applications

Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Introduction: The ability to preserve organs prior to transplant is essential to the organ allocation process. Objective: The purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant. Methods: To identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance. Results: Twenty-six studies met criteria. Functionally, PNF%=-6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean-9.89535) 2 - 0.0067663*(CIT Mean-9.89535) 3, r2=.625, p<.0001. Mean patient survival: 93 % (1 month), 88 % (3 months), 83 % (6 months) and 83 % (12 months). Mean graft survival: 85.9 % (1 month), 80.5 % (3 months), 78.1 % (6 months) and 76.8 % (12 months). Maximum patient and graft survival occurred with CITs between 7.5-12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time, % first time grafts and % immunologic mismatches. Conclusion: The results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ. © 2008 Stahl et al

The Effect of Gender Policies on Fertility: The Moderating Role of Education and Normative Context

In this paper, we aim to assess the extent to which individual-level completed fertility varies across contexts characterized by policies supporting different gender division of labor models. We examine key labor market and care policies that shape gender relations in households and in the public domain. We also consider the role of gender norms, which can act as both a moderator and a confounding factor for policy effects. We hypothesize that, by facilitating role compatibility and reducing the gendered costs of childrearing, policies that support gender equality lead to an increase in fertility levels and to a reduction in fertility differentials by the level of education. Using individual-level data from the European Union Survey on Income and Living Conditions for 16 countries, combined with country-level data, we analyze completed fertility through multilevel Poisson’s models. We find that the national level of childcare coverage is positively associated with fertility. Family allowances, prevalence of women’s part-time employment and length of paid leaves were also found to be positively associated with completed fertility, though the associations were not statistically significant. These variables show a significant positive pattern according to education. A high number of average working hours for men are negatively associated with completed fertility and show a strong negative pattern by educational level. The prevalence of gender-egalitarian norms is highly predictive of fertility levels, yet we found no consistent evidence of a weaker association of gender-equality policies in countries where egalitarian values are less prevalent

Search for heavy resonances decaying into a W or Z boson and a Higgs boson in final states with leptons and b-jets in 36 fb(-1) of root s=13 TeV pp collisions with the ATLAS detector

A search is conducted for new resonances decaying into a W or Z boson and a 125 GeV Higgs boson in the νν¯¯¯bb¯¯, ℓ±νbb¯¯, and ℓ+ℓ−bb¯¯ final states, where ℓ± = e± or μ±, in pp collisions at s√=13 TeV. The data used correspond to a total integrated luminosity of 36.1 fb−1 collected with the ATLAS detector at the Large Hadron Collider during the 2015 and 2016 data-taking periods. The search is conducted by examining the reconstructed invariant or transverse mass distributions of W h and Zh candidates for evidence of a localised excess in the mass range of 220 GeV up to 5 TeV. No significant excess is observed and the results are interpreted in terms of constraints on the production cross-section times branching fraction of heavy W ′ and Z′ resonances in heavy-vector-triplet models and the CP-odd scalar boson A in two-Higgs-doublet models. Upper limits are placed at the 95% confidence level and range between 9.0 × 10−4 pb and 7.3 × 10−1 pb depending on the model and mass of the resonance