Recognition of the Asthmatic Componnent of Respiratory Failure

Respiratory failure from various causes is occasionally associated with or confused with asthma. Therefore, asthma should be considered and looked for in all patients with respiratory failure. Sputum eosinophilia when present is the most important indication that asthma may be important. Steroids used early and aggressively are usually indicated and effective

Characterizing the metabolic phenotype of intestinal villus blunting in Zambian children with severe acute malnutrition and persistent diarrhea

Background: Environmental enteric dysfunction (EED) is widespread throughout the tropics and in children is associated with stunting and other adverse health outcomes. One of the hallmarks of EED is villus damage. In children with severe acute malnutrition (SAM) the severity of enteropathy is greater and short term mortality is high, but the metabolic consequences of enteropathy are unknown. Here, we characterize the urinary metabolic alterations associated with villus health, classic enteropathy biomarkers and anthropometric measurements in severely malnourished children in Zambia. Methods/Principal findings: We analysed 20 hospitalised children with acute malnutrition aged 6 to 23 months in Zambia. Small intestinal biopsies were assessed histologically (n = 15), anthropometric and gut function measurements were collected and the metabolic phenotypes were characterized by 1H nuclear magnetic resonance (NMR) spectroscopy. Endoscopy could not be performed on community controls children. Growth parameters were inversely correlated with enteropathy biomarkers (p = 0.011) and parameters of villus health were inversely correlated with translocation and permeability biomarkers (p = 0.000 and p = 0.015). Shorter villus height was associated with reduced abundance of metabolites related to gut microbial metabolism, energy and muscle metabolism (p = 0.034). Villus blunting was also related to increased sucrose excretion (p = 0.013). Conclusions/Significance: Intestinal villus blunting is associated with several metabolic perturbations in hospitalized children with severe undernutrition. Such alterations include altered muscle metabolism, reinforcing the link between EED and growth faltering, and a disruption in the biochemical exchange between the gut microbiota and host. These findings extend our understanding on the downstream consequences of villus blunting and provide novel non-invasive biomarkers of enteropathy dysfunction. The major limitations of this study are the lack of comparative control group and gut microbiota characterization

Brote de gastroenteritis por agua potable de suministro público

ResumenIntroducciónLa potabilidad del agua induce a descartar el posible origen hídrico de los brotes. El objetivo fue investigar un brote de gastroenteritis por agua potable de suministro público.MétodosDespués de la notificación de un brote de gastroenteritis en el municipio de Baqueira (Valle de Arán) se diseñó un estudio epidemiológico de cohortes retrospectivo. Mediante un muestreo sistemático se eligió a 87 personas hospedadas en los hoteles y a 62 alojadas en diferentes apartamentos. Se recogió información sobre 4 factores (consumo de agua de la red, bocadillos, agua y alimentos en las pistas de esquí) y presencia de síntomas. Se determinó la existencia de cloro, se analizó el agua de la red y se realizó un coprocultivo a 4 enfermos. La implicación de cada factor se determinó con el riesgo relativo (RR) y su intervalo de confianza (IC) del 95%.ResultadosLa incidencia de gastroenteritis fue del 51,0% (76/149). Los porcentajes de los síntomas fueron los siguientes: fiebre, 27,0%; diarrea, 87,5%; náuseas, 50,7%; vómitos, 30,3%, y dolor abdominal, 80,0%. El único factor que presentó un riesgo estadísticamente significativo fue el consumo de agua de la red (RR = 11,0; IC del 95%, 1,6-74,7). La calificación sanitaria del agua fue de potabilidad. Se observó un defecto de situación del clorador en el depósito, que fue corregido. Se recomendó incrementar aún más las concentraciones de cloro, lo cual se acompañó de una disminución de los casos. Los coprocultivos de los 4 enfermos fueron negativos para las enterobacterias investigadas.ConclusionesEl estudio demuestra la posibilidad de presentación de brotes hídricos por agua cualificada como potable y sugiere la necesidad de mejorar la investigación microbiológica (determinación de protozoos y virus) en este tipo de brotes.AbstractIntroductionThe chlorination of public water supplies has led researchers to largely discard drinking water as a potential source of gastroenteritis outbreaks. The aim of this study was to investigate an outbreak of waterborne disease associated with drinking water from public supplies.MethodsA historical cohort study was carried out following notification of a gastroenteritis outbreak in Baqueira (Valle de Arán, Spain). We used systematic sampling to select 87 individuals staying at hotels and 67 staying in apartments in the target area.Information was gathered on four factors (consumption of water from the public water supply, sandwiches, water and food in the ski resorts) as well as on symptoms. We assessed residual chlorine in drinking water, analyzed samples of drinking water, and studied stool cultures from 4 patients. The risk associated with each water source and food type was assessed by means of relative risk (RR) and 95% confidence intervals (CI).ResultsThe overall attack rate was 51.0% (76/149). The main symptoms were diarrhea 87.5%, abdominal pain 80.0%, nausea 50.7%, vomiting 30.3%, and fever 27.0%. The only factor associated with a statistically significant risk of disease was consumption of drinking water (RR = 11.0; 95% CI, 1.6-74.7). No residual chlorine was detected in the drinking water, which was judged acceptable. A problem associated with the location of the chlorinator was observed and corrected. We also recommended an increase in chlorine levels, which was followed by a reduction in the number of cases. The results of stool cultures of the four patients were negative for enterobacteria.ConclusionsThis study highlights the potential importance of waterborne outbreaks of gastroenteritis transmitted through drinking water considered acceptable and suggests the need to improve microbiological research into these outbreaks (viruses and protozoa detection)

Diarrhoea, acute respiratory infection, and fever among children in the Democratic Republic of Congo

Several years of war have created a humanitarian crisis in the Democratic Republic of Congo (DRC) with extensive disruption of civil society, the economy and provision of basic services including health care. Health policy and planning in the DRC are constrained by a lack of reliable and accessible population data. Thus there is currently a need for primary research to guide programme and policy development for reconstruction and to measure attainment of the Millennium Development Goals (MDGs). This study uses the 2001 Multiple Indicators Cluster Survey to disentangle children's health inequalities by mapping the impact of geographical distribution of childhood morbidity stemming from diarrhoea, acute respiratory infection, and fever. We observe a low prevalence of childhood diarrhoea, acute respiratory infection and fever in the western provinces (Kinshasa, Bas-Congo and Bandundu), and a relatively higher prevalence in the south-eastern provinces (Sud-Kivu and Katanga). However, each disease has a distinct geographical pattern of variation. Among covariate factors, child age had a significant association with disease prevalence. The risk of the three ailments increased in the first 8–10 months after birth, with a gradual improvement thereafter. The effects of socioeconomic factors vary according to the disease. Accounting for the effects of the geographical location, our analysis was able to explain a significant share of the pronounced residual geographical effects. Using large scale household survey data, we have produced for the first time spatial residual maps in the DRC and in so doing we have undertaken a comprehensive analysis of geographical variation at province level of childhood diarrhoea, acute respiratory infection, and fever prevalence. Understanding these complex relationships through disease prevalence maps can facilitate design of targeted intervention programs for reconstruction and achievement of the MDGs

The Heliogyro Reloaded

The heliogyro is a high-performance, spinning solar sail architecture that uses long - order of kilometers - reflective membrane strips to produce thrust from solar radiation pressure. The heliogyro s membrane blades spin about a central hub and are stiffened by centrifugal forces only, making the design exceedingly light weight. Blades are also stowed and deployed from rolls; eliminating deployment and packaging problems associated with handling extremely large, and delicate, membrane sheets used with most traditional square-rigged or spinning disk solar sail designs. The heliogyro solar sail concept was first advanced in the 1960s by MacNeal. A 15 km diameter version was later extensively studied in the 1970s by JPL for an ambitious Comet Halley rendezvous mission, but ultimately not selected due to the need for a risk-reduction flight demonstration. Demonstrating system-level feasibility of a large, spinning heliogyro solar sail on the ground is impossible; however, recent advances in microsatellite bus technologies, coupled with the successful flight demonstration of reflectance control technologies on the JAXA IKAROS solar sail, now make an affordable, small-scale heliogyro technology flight demonstration potentially feasible. In this paper, we will present an overview of the history of the heliogyro solar sail concept, with particular attention paid to the MIT 200-meter-diameter heliogyro study of 1989, followed by a description of our updated, low-cost, heliogyro flight demonstration concept. Our preliminary heliogyro concept (HELIOS) should be capable of demonstrating an order-of-magnitude characteristic acceleration performance improvement over existing solar sail demonstrators (HELIOS target: 0.5 to 1.0 mm/s2 at 1.0 AU); placing the heliogyro technology in the range required to enable a variety of science and human exploration relevant support missions

Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control.

BACKGROUND: Mass drug administration (MDA) with azithromycin, carried out for the control of blinding trachoma, has been linked to reduced mortality in children. While the mechanism behind this reduction is unclear, it may be due, in part, to improved nutritional status via a potential reduction in the community burden of infectious disease. To determine whether MDA with azithromycin improves anthropometric indices at the community level, we measured the heights and weights of children aged 1 to 4 years in communities where one (single MDA arm) or three annual rounds (annual MDA arm) of azithromycin had been distributed. METHODS: Data collection took place three years after treatment in the single MDA arm and one year after the final round of treatment in the annual MDA arm. Mean height-for-age, weight-for-age and weight-for-height z scores were compared between treatment arms. RESULTS: No significant differences in mean height-for-age, weight-for-age or weight-for-height z scores were found between the annual MDA and single MDA arms, nor was there a significant reduction in prevalence of stunting, wasting or underweight between arms. CONCLUSIONS: Our data do not provide evidence that community MDA with azithromycin improved anthropometric outcomes of children in The Gambia. This may suggest reductions in mortality associated with azithromycin MDA are due to a mechanism other than improved nutritional status

Global health education in U.S. medical schools.

Interest in global health (GH) among medical students worldwide is measurably increasing. There is a concomitant emphasis on emphasizing globally-relevant health professions education. Through a structured literature review, expert consensus recommendations, and contact with relevant professional organizations, we review the existing state of GH education in US medical schools for which data were available. Several recommendations from professional societies have been developed, along with a renewed emphasis on competencies in global health. The implementation of these recommendations was not observed as being uniform across medical schools, with variation noted in the presence of global health curricula. Recommendations for including GH in medical education are suggested, as well as ways to formalize GH curricula, while providing flexibility for innovation and adaptation.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Increasing Medicare Wellness Visit Participation in a Primary Care Clinic

Background: Medicare Wellness Visits (MWV) came into use in 2011 to provide Medicare patients and their providers a chance to create a 5 to 10 year plan to prevent illness, disease, and disability. These visits are often underutilized due to various barriers on both the provider and patient side. Purpose: The purpose of this study is to assess provider barriers to conducting MWVs and provide an educational tool that will assist providers in increasing the number of MWVs conducted within this system. Design: This is a descriptive, quasi-experimental study to assess provider barriers combined with a Quality improvement project that will focus on overcoming one of these barriers. Methods: Provider barriers to MWVs were assessed via electronic survey. The educational tool, the ‘Differences Between Visits’ chart, was introduced to providers at a single primary care clinic within the healthcare system. Providers were educated on how to use the chart. After two months, a second survey was sent to the providers at the clinic to assess whether the chart was helpful and if providers would be willing to continue using it. Results: Twelve respondents participated in the initial survey on provider barriers. Providers responded that the most important reason they did not complete MWVs was that they felt they already completed the requirements of the MWV during other visits and their patients want to discuss current health issues instead of discussing preventative measures. However, eight-three percent of the twelve respondents were somewhat or very likely to increase the number of MWVs they performed. After deployment of the ‘Differences Between Visits’ chart, one-hundred percent of the 4 providers who responded were satisfied with the chart and are somewhat or extremely likely to continue using the chart. Discussion: In this study, providers seemed willing to improve the rate of MWVs they conducted and were receptive to the educational tool that was provided. Further research should be completed to identify strengths and weakness of the educational tool and what, if any, impact the tool has on completion of MWVs