Incorporating scale dependence in disease burden estimates:the case of human African trypanosomiasis in Uganda

The WHO has established the disability-adjusted life year (DALY) as a metric for measuring the burden of human disease and injury globally. However, most DALY estimates have been calculated as national totals. We mapped spatial variation in the burden of human African trypanosomiasis (HAT) in Uganda for the years 2000-2009. This represents the first geographically delimited estimation of HAT disease burden at the sub-country scale.Disability-adjusted life-year (DALY) totals for HAT were estimated based on modelled age and mortality distributions, mapped using Geographic Information Systems (GIS) software, and summarised by parish and district. While the national total burden of HAT is low relative to other conditions, high-impact districts in Uganda had DALY rates comparable to the national burden rates for major infectious diseases. The calculated average national DALY rate for 2000-2009 was 486.3 DALYs/100 000 persons/year, whereas three districts afflicted by rhodesiense HAT in southeastern Uganda had burden rates above 5000 DALYs/100 000 persons/year, comparable to national GBD 2004 average burden rates for malaria and HIV/AIDS.These results provide updated and improved estimates of HAT burden across Uganda, taking into account sensitivity to under-reporting. Our results highlight the critical importance of spatial scale in disease burden analyses. National aggregations of disease burden have resulted in an implied bias against highly focal diseases for which geographically targeted interventions may be feasible and cost-effective. This has significant implications for the use of DALY estimates to prioritize disease interventions and inform cost-benefit analyses

Monitorización de la presión tisular de oxígeno (ptio2) en la UVI del Hospital de la Ribera y hoja de registro de Enfermería

[email protected] monitorización de la presión tisular de oxigeno (PtiO2) permite el conocimiento de las repercusiones de las lesiones tisulares y el diagnóstico de lesiones secundarias en el paciente con traumatismo craneoencefálico grave (TCEG). Este método de monitorización detecta cambios fisiopatológicos que conllevan las lesiones neurotraumáticas. El objetivo de nuestro artículo es describir y analizar este tipo de monitorización, así como los cuidados de enfermería con relación a los casos que hemos atendido en nuestra unidad y según nuestra experiencia. Se ha confeccionado una hoja de “registro de enfermería” que contiene los datos del paciente, diagnóstico, tipo de catéter, constantes horarias, etc. Con estos controles, pretendemos recoger las posibles complicaciones derivadas del catéter y del propio proceso del paciente, mejorando de esta manera la calidad asistencial.Tissue pressure of oxygen (PtiO2) monitoring allows knowing the tissue injuries implications, and the diagnosis of secondary lesions in the patient with craneoencephalic traumatism. This monitoring method detects physiopathologic changes brought about by neurotraumatic injuries. The objective of our contribution is to describe and analyze this specific type of monitoring and the nurse cares with relationship to the cases taken care of in our unit, according to our experience. A Nurse’s Record Card has been developed, containing the patient's name, diagnosis, medical history number, catheter type, schedules, etc. In this way, the possible complications derived from the catheter and from the patient's own development will be avoided, and nursing quality care will be [email protected]

Optimizing the colour and fabric of targets for the control of the tsetse fly Glossina fuscipes fuscipes

Background: Most cases of human African trypanosomiasis (HAT) start with a bite from one of the subspecies of Glossina fuscipes. Tsetse use a range of olfactory and visual stimuli to locate their hosts and this response can be exploited to lure tsetse to insecticide-treated targets thereby reducing transmission. To provide a rational basis for cost-effective designs of target, we undertook studies to identify the optimal target colour. Methodology/Principal Findings: On the Chamaunga islands of Lake Victoria , Kenya, studies were made of the numbers of G. fuscipes fuscipes attracted to targets consisting of a panel (25 cm square) of various coloured fabrics flanked by a panel (also 25 cm square) of fine black netting. Both panels were covered with an electrocuting grid to catch tsetse as they contacted the target. The reflectances of the 37 different-coloured cloth panels utilised in the study were measured spectrophotometrically. Catch was positively correlated with percentage reflectance at the blue (460 nm) wavelength and negatively correlated with reflectance at UV (360 nm) and green (520 nm) wavelengths. The best target was subjectively blue, with percentage reflectances of 3%, 29%, and 20% at 360 nm, 460 nm and 520 nm respectively. The worst target was also, subjectively, blue, but with high reflectances at UV (35% reflectance at 360 nm) wavelengths as well as blue (36% reflectance at 460 nm); the best low UV-reflecting blue caught 3× more tsetse than the high UV-reflecting blue. Conclusions/Significance: Insecticide-treated targets to control G. f. fuscipes should be blue with low reflectance in both the UV and green bands of the spectrum. Targets that are subjectively blue will perform poorly if they also reflect UV strongly. The selection of fabrics for targets should be guided by spectral analysis of the cloth across both the spectrum visible to humans and the UV region

Sizing of riprap for spill-through abutments

An experimental investigation of riprap stability at spill-through abutments has been carried out in two similar horiontal-bed flumes, avoiding riprap failure modes other than shear failure and erosion failure. Tests were conducted for two common abutment side slopes, subcritical flow regime, short to intermediate abutment lenghts and high bed roughness. The aim of the experiments was to determine the size of stone riprap necessary to resist (a) shear failure in aprons placed at the base of spill-through abutments, and (b) erosion failure over their side slopes. Results are compared with predictions of stone riprap size given by expressions found in the literature. The predictor of Pagan-Ortiz is confirmed as being appropriate for shear failure at abutment aprons and can be adapted to account for erosion failure over abutment side slopes. Alternatively, two news expressions, written in terms of the (critical) approach flow intensity required to make the riprap stones move, are suggested

In-hospital safety in field conditions of Nifurtimox Eflornithine Combination Therapy (NECT) for T. B. Gambiense Sleeping Sickness

Trypanosoma brucei (T.b.) gambiense Human African trypanosomiasis (HAT; sleeping sickness) is a fatal disease. Until 2009, available treatments for 2(nd) stage HAT were complicated to use, expensive (eflornithine monotherapy), or toxic, and insufficiently effective in certain areas (melarsoprol). Recently, nifurtimox-eflornithine combination therapy (NECT) demonstrated good safety and efficacy in a randomised controlled trial (RCT) and was added to the World Health Organisation (WHO) essential medicines list (EML). Documentation of its safety profile in field conditions will support its wider use

Challenges of controlling sleeping sickness in areas of violent conflict: experience in the Democratic Republic of Congo

Human African trypanosomiasis (HAT), or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC), which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT

International Glossina Genome Initiative 2004-2014: a driver for post-genomic era research on the African continent

Human African trypanosomiasis (HAT), also known as sleeping sickness, is a neglected disease that impacts 70 million people distributed over 1.55 million km2 in sub- Saharan Africa and includes at least 50% of the population of theDemocratic Republic of the Congo [1]. Trypanosoma brucei gambiense accounts for more than 98% of the infections in central and West Africa, the remaining infections being from Trypanosoma brucei rhodesiense in East Africa [2]. The parasites are transmitted to the hosts through the bite of an infected tsetse fly. Disease control is challenging as there are no vaccines, and effective, easily delivered drugs are still lacking. Treatment invariably involves lengthy hospitalization, with both medical and socioeconomic consequences.Web of Scienc

Toe protection for spill-through and vertical-wall abutments

This study addresses the design of riprap aprons as a scour countermeasure near abutments under clear-water conditions. It deals with the lateral extent of riprap aprons and the geometry of the scour hole prevailing at the apron edge. The study applies to riprap aprons acting as granular filters. The scour depth appears to be independent for a sufficiently long relative abutment length. Scour holes develop farther away from spill-through abutments than from vertical-wall abutments; the distance between the point of maximum scour depth and the abutment increases with the relative abutment length. The effect of contraction on this distance was not identified. The angle defining the position of the deepest scour point is close to 308. Neither the abutment shape nor the flow contraction seems to influence the minimum stable apron width