Severe acute malnutrition and mortality in children in the community : Comparison of indicators in a multi-country pooled analysis

Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Acknowledgments We would like to acknowledge the principal investigators of the original studies: Jan Van den Broeck for the DRC cohort, Michel Garenne for the Senegal cohort, and Keith West for the Nepal cohort. The DRC study was supported by the Centre de Développement Intégrale–Bwamanda, and funding was provided by the Flemish Inter-University Council (Vlaamse Interuniversitaire Raad), the Belgian Administration for Development Cooperation, and the Nutricia Research Foundation. Catherine Schwinger is affiliated to the Centre for Intervention Science in Maternal and Child Health (CISMAC), which is funded by the Research Council of Norway through its Centres of Excellence funding scheme (project number 223269), the University of Bergen (UiB), Norway.Peer reviewedPublisher PD

Research and education in management of large-scale technical programs

A research effort is reported which was conducted by NASA in conjunction with Drexel University, and which was aimed at an improved understanding of large scale systems technology and management

NADPH oxidase deficiency results in reduced alveolar macrophage 5â lipoxygenase expression and decreased leukotriene synthesis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141933/1/jlb1585.pd

Estudo Sobre O Estado Nutricional Em Relação Ao Zinco Na Amazônia. I. Níveis De Zinco No Sôro E Ingestão De Zinco Em Operários De Manaus, 1978 ()

The objective of this study was to verify if the low zinc intakes reported for the urban Amazon are associated with low serum zinc levels. A survey was carried out amongst the low salaried workers of four Manaus factories. Two of these factories provided meals and medical assistance. The mean and median dietary zinc intakes were 54.7% and 49.3% respectively of the American RDA. Zinc intakes were higher in those workers born in Manaus, that were better educated and that came from higher income families but these differences were only apparent in factories that didn't provide meals. Zinc intake decreased with age in both men and women, being higher in men than women in all age groups. These trends were observed in all factories. No significant difference was found between serum zinc levels for men and women. Whilst serum zinc values tended to decline with age in both sexes, there was no significant correlation with age in either sex. Mean serum zinc levels of low and medium family income workers were significantly lower than high family income workers. (P<.001 P<.05). 34% of all low family income, 26% of medium family income and 17% of high family income workers had deficient serum zinc levels (<11.5 μmol/l). Serum zinc concentrations were related to zinc intake in male (r = 0.26 p<.02) but not female workers (r=0.11 p<.1). Zinc intakes of male and female workers with deficient serum zinc levels were significantly lower than those with normal serum zinc levels. Zinc intakes of male workers were higher than those of female workers at all serum zinc levels.", 'enO objetivo deste estudo foi verificar se a baixa ingestão de zinco relatada para a população da área urbana da cidade de Manaus, no Estado do Amazonas, está associada com niveis balxos de zinco sérico. O estudo foi realizado com trabaIhadores percebendo salários baixos, em quatro fábricas de Manaus. Duas destas fábricas forneciam alimentação e assistência médica. A média e a mediana da ingestão de zinco dietético, foi 54.7% e 49.3% respectivamente das recomendações diárias. americanas. A ingestão de zinco foi mais alta nos trabalhadores nascidos em Manaus, que possuiam um meIhor nível de escolaridade e que tinham renda familiar mais alta, mas essas diferenças foram evidentes unicamente nas fábricas que não forneciam refeição. A ingestão de zinco diminui com a idade em ambos os sexos, sendo mais alto nos homens do que nas mulheres em todos os grupos por idade. Essa tendência foi observada em todas as fábricas. Não houve diferença significativa do nível de zinco sérico entre homens e mulheres. Porém o valor de zinco no soro tende a declinar também com a idade em ambos os sexos. A média do nível de zinco sérico de trabalhadores com renda familiar baixa e média foi significativamente mais baixa do que trabalhadores com renda familiar alta (P<.001. P<.05). 34% de todos os trabalhadores com renda familiar baixa, 26% com renda familiar média e 17% com renda familiar alta, tinham níveis de zinco sérico deficientes (< 11.5 μmol/l). A concentração de zinco no soro foi relacionada com ingestão de zinco do sexo masculino (r=0.26 p<.02) mas não em operários do sexo feminino (r=0.11 p<.1). A ingestão de zinco em trabalhadores de ambos os sexos com nível de zinco sérico déficiente foi significativamente mais baixa do que aqueles com nível de zinco sérico normal. A ingesta de zinco nos homens foi mais alta do que nas mulheres para todos os níveis de zinco sérico

Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

<p>Abstract</p> <p>Background</p> <p>Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED) waiting times in Ontario, Canada.</p> <p>Methods</p> <p>Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management) panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition.</p> <p>Results</p> <p>An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal.</p> <p>Conclusion</p> <p>We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.</p

Decisional Informatics for Psychosocial Rehabilitation: A Feasibility Pilot on Tailored and Fluid Treatment Algorithms for Serious Mental Illness

This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional treatment planning using similar behavioral therapies in 52 adults with severe mental illness attending community-based day treatment. At posttreatment and follow-up, group differences and moderate-to-large effect sizes favoring FORT were detected in social function, work readiness, self-esteem, working memory, processing speed, and mental flexibility. Of participants who identified obtaining a General Education Diploma as their goal, 73% in FORT passed the examination compared with 18% in traditional treatment planning. FORT was also associated with higher agency cost-effectiveness and a better average benefit-cost ratio, even when considering diagnosis, baseline symptoms, and education. Although the comparison groups were not completely equivalent, the findings suggest computerized decision support systems that collaborate with human decision-makers to personalize psychiatric rehabilitation and address critical decisions may have a role in improving treatment effectiveness and efficiency

Evaluation of an emergency department lean process improvement program to reduce length of stay

Study objective In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. Methods We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of outcomes before and after the program and difference-in-differences analyses comparing changes in program sites with control sites were conducted. Results In before-after models among program sites alone, 90th percentile ED length of stay did not change in wave 1 (–14 minutes [95% confidence interval {CI} –47 to 20]) but decreased after wave 2 (–87 [95% CI –108 to –66]) and wave 3 (–33 [95% CI –50 to –17]); median ED length of stay decreased after wave 1 (–18 [95% CI –24 to –12]), wave 2 (–23 [95% CI –27 to –19]), and wave 3 (–15 [95% CI –18 to –12]). In all waves, decreases were observed in time to physician assessment, left-without-being-seen rates, and 72-hour ED revisit rates. In the difference-in-difference models, in which changes in program sites were compared with controls, the program was associated with no change in 90th percentile ED length of stay in wave 2 (17 [95% CI –0.2 to 33]) and increases in wave 1 (23 [95% CI 0.9 to 45]) and wave 3 (31 [95% CI 10 to 51]), modest reductions in median ED length of stay in waves 2 and 3 alone, and a decrease in time to physician assessment in wave 3 alone. Conclusion Although the program reduced ED waiting times, it appeared that its benefits were diminished or disappeared when compared with that of control sites, which were exposed to system-wide initiatives such as public reporting and pay for performance. This study suggests that further evaluation of the effectiveness of lean methods in the ED is warranted before widespread implementation

Urban Stream Burial Increases Watershed-Scale Nitrate Export

Nitrogen (N) uptake in streams is an important ecosystem service that reduces nutrient loading to downstream ecosystems. Here we synthesize studies that investigated the effects of urban stream burial on N-uptake in two metropolitan areas and use simulation modeling to scale our measurements to the broader watershed scale. We report that nitrate travels on average 18 times farther downstream in buried than in open streams before being removed from the water column, indicating that burial substantially reduces N uptake in streams. Simulation modeling suggests that as burial expands throughout a river network, N uptake rates increase in the remaining open reaches which somewhat offsets reduced N uptake in buried reaches. This is particularly true at low levels of stream burial. At higher levels of stream burial, however, open reaches become rare and cumulative N uptake across all open reaches in the watershed rapidly declines. As a result, watershed-scale N export increases slowly at low levels of stream burial, after which increases in export become more pronounced. Stream burial in the lower, more urbanized portions of the watershed had a greater effect on N export than an equivalent amount of stream burial in the upper watershed. We suggest that stream daylighting (i.e., uncovering buried streams) can increase watershed-scale N retention

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Ready-to-use therapeutic foods (RUTFs) are solid foods that were developed by changing the formulation of the existing liquid diet, F-100, recommended by the World Health Organization (WHO) for the rapid catch-up phase of the treatment of children suffering from severe acute malnutrition (SAM). The resulting products proved highly effective in promoting weight gain in both severely and moderately wasted children and adults, including those infected with HIV. The formulation of the existing RUTFs, however, has never been optimized to maximize linear growth, vitamin and mineral status, and functional outcomes. The high milk content of RUTFs makes it an expensive product, and using lower quantities of milk seems desirable. However, the formulation of alternative, less expensive but more effective versions of RUTF faces difficult challenges, as there are uncertainties regarding the effect in terms of protein quality, antinutrient content, and flatulence factors that will result from the replacement of current dairy ingredients by less expensive protein-rich ingredients. The formulation of alternative RUTFs will require further research on these aspects, followed by efficacy studies comparing the future RUTFs to the existing formulations