Evaluation of 'TRY': an algorithm for neonatal continuous positive airways pressure in low-income settings

BACKGROUND: Non-invasive respiratory support using bubble continuous positive airway pressure (bCPAP) is useful in treating babies with respiratory distress syndrome. Despite its proven clinical and cost-effectiveness, implementation is hampered by the inappropriate administration of bCPAP in low-resource settings. A clinical algorithm-'TRY' (based on Tone: good; Respiratory distress; Yes, heart rate above 100 beats/min)-has been developed to correctly identify which newborns would benefit most from bCPAP in a teaching hospital in Malawi. OBJECTIVE: To evaluate the reliability, sensitivity and specificity of TRY when employed by nurses in a Malawian district hospital. METHODS: Nursing staff in a Malawian district hospital baby unit were asked, over a 2-month period, to complete TRY assessments for every newly admitted baby with the following inclusion criteria: clinical evidence of respiratory distress and/or birth weight less than 1.3 kg. A visiting paediatrician, blinded to nurses' assessments, concurrently assessed each baby, providing both a TRY assessment and a clinical decision regarding the need for CPAP administration. Inter-rater reliability was calculated comparing nursing and paediatrician TRY assessment outcomes. Sensitivity and specificity were estimated comparing nurse TRY assessments against the paediatrician's clinical decision. RESULTS: Two hundred and eighty-seven infants were admitted during the study period; 145 (51%) of these met the inclusion criteria, and of these 57 (39%) received joint assessments. The inter-rater reliability was high (kappa 0.822). Sensitivity and specificity were 92% and 96%, respectively. CONCLUSIONS: District hospital nurses, using the TRY-CPAP algorithm, reliably identified babies that might benefit from bCPAP and thus improved its effective implementation

Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer

Background Emergency presentation is recognized to be associated with poorer cancer-specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival. Methods In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29%) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS), which is the combination of an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L). Results In the emergency group, tumor stage was greater (P < 0.01), more patients received adjuvant therapy (P < 0.01) more patients had an elevated mGPS (P < 0.01), and more patients died of their disease (P < 0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3-year cancer-specific survival in those patients aged 65 to 74 years (P < 0.01), in both males and females (P < 0.05), in the deprived (P < 0.01), in patients with tumor-node-metastasis (TNM) stage II disease (P < 0.01), in those who received no adjuvant therapy (P < 0.01), and in the mGPS 0 and 1 groups (P < 0.05) groups. On multivariate survival analysis of patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (P < 0.05) and mGPS (P < 0.05) were independently associated with cancer-specific survival. Conclusions These results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing the likely outcome of these patients

Levels of organochlorine pesticides are associated with amyloid aggregation in apex avian brains

Organochlorine (OC) pesticides pose a significant environmental risk to wildlife and humans and have been associated with Alzheimer’s disease (AD). This study aims to spectroscopically analyse brains from free-flying birds and link the results to OC exposure and consequent amyloid aggregation. As long-lived apex predators, predatory birds represent a sentinel species similar to humans. Therefore, the results have implications for both species and may also add to our understanding of the role OC pesticides play in the development of AD. Brains of wild sparrowhawks were analysed using ATR-FTIR and Raman spectroscopy and Congo red staining; results were correlated with OC pesticide concentrations in livers. Effects of OC exposure were sex and age dependant and associated alterations were seen in lipids and protein secondary structure. A shift from α-helix to β-sheet conformation of proteins indicated that concentrations of OC pesticides > 7.18 µg/g may lead to cerebral amyloid aggregation

Barriers to Optimal Health for Under 5s Experiencing Homelessness and Living In Temporary Accommodation in High-Income Countries: A Scoping Review

BACKGROUND: The first 5 years of life are crucial for optimising growth, health, and cognitive development. However, many children do not reach their full cognitive and developmental potential because of multilevel barriers, including those resulting from poverty and homelessness. This review summarises the evidence characterising the barriers to achieving optimal health and cognitive outcomes, and to accessing health services for homeless children younger than 5 years of age (U5s)-one of the most vulnerable populations in High Income Countries (HICs). METHODS: For this scoping review, we followed the PRISMA-ScR checklist and CATS framework. We searched Medline, PubMed, Embase, CINAHL, Web of Science, OVID Maternity and Infant Care, and The Cochrane Library (publications dates from Jan 1, 1980, to Jun 23, 2020) using the key words “homelessness”, “housing”, “paediatrics”, “interpersonal relations”, “social exclusion”, “toddler”, “children under 5”, “engagement”, and “communication and insecurity”. The search strategy yielded 3253 articles. Retrieved articles were organised by study design. Because of the considerable heterogeneity of methods and outcomes, we used a narrative synthesis analytic approach. Our outcome of interest was barriers to optimal health and accessing health services, focusing on U5s living in HICs. FINDINGS: Twenty-nine full texts were selected in the final synthesis, including primary research studies and systematic or narrative reviews of primary research studies from HICs. There was limited evidence describing links among housing insecurity, health, and cognitive outcomes in U5s. This age group was rarely studied as a discrete group and often combined with older ages (eg, ≤25 years). The quality of articles varied greatly because of the heterogeneity in study design. Nevertheless, important themes were identified: barriers were described at the individual and family level (eg, ethnicity, immigration status, and fear), system level (eg, policies, poor access to medication, absence of care plan, and no insurance) and community level (eg, transportation limitations and poor housing conditions). INTERPRETATION: Although evidence is sparse, further methodologically rigorous research is needed to identify what barriers exist for U5s and their parents in accessing health services, and how this affects the child’s health. The multi-level nature of these barriers implies a system’s approach may be required. However, more evidence is needed including cross-sector studies and tailored interventions to address these barriers by working directly with experts with experience of social exclusion and their children

Admissions to a low resource neonatal unit in Malawi using The NeoTree application: A digital perinatal outcome audit

Background: Mobile-health has increasing potential to address health outcomes in under-resourced settings as smart-phone coverage increases. The NeoTree is a mobile-health application co-developed in Malawi to improve the quality of newborn care at the point of admission to neonatal units. While collecting vital demographic and clinical data this interactive platform provides clinical decision-support, and training for the end-users (health care workers (HCW)), according to evidence based national and international guidelines. Objective: Our aims were to examine one month of data collected using the NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital audit data in this setting. Methods: Using a phased approach over one month (21 Nov – 19 Dec, 2016), frontline HCWs were trained and supported to use the NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within the NeoTree ‘NeoDischarge’. Descriptive analysis was conducted on the exported pseudonomysed data and presented to the newborn care department as a digital audit. Results: Of 191 total admissions, 134 (70%) admissions were completed using the NeoTree and 129 (67%) were exported and analysed. Of these 129, 102 (79%) were discharged alive. Overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, Birth Asphyxia, and Neonatal sepsis contributed to 41.6%, 58.3% and 16.6% of deaths respectively. Deaths may have been under-reported due to phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterisation of the data enabled departmental discussion of modifiable factors for quality improvement, for example improved thermoregulation of infants. Conclusions: This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCWs in under-resourced newborn facilities and these data can contribute to meaningful review of quality of care/outcomes and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audit in low-resource settings and are a proof of concept for a novel newborn data system in these settings

Engineering study for closure of 209E facility

This document is an engineering study for evaluating alternatives to determine the most cost effective closure plan for the 209E Facility, Critical Mass Laboratory. This laboratory is located in the 200 East Area of the Hanford Site and contains a Critical Assembly Room and a Mix room were criticality experiments were once performed

First-Order System Least Squares and the Energetic Variational Approach for Two-Phase Flow

This paper develops a first-order system least-squares (FOSLS) formulation for equations of two-phase flow. The main goal is to show that this discretization, along with numerical techniques such as nested iteration, algebraic multigrid, and adaptive local refinement, can be used to solve these types of complex fluid flow problems. In addition, from an energetic variational approach, it can be shown that an important quantity to preserve in a given simulation is the energy law. We discuss the energy law and inherent structure for two-phase flow using the Allen-Cahn interface model and indicate how it is related to other complex fluid models, such as magnetohydrodynamics. Finally, we show that, using the FOSLS framework, one can still satisfy the appropriate energy law globally while using well-known numerical techniques.Comment: 22 pages, 8 figures submitted to Journal of Computational Physic

The Hamiltonian limit of (3+1)D SU(3) lattice gauge theory on anisotropic lattices

The extreme anisotropic limit of Euclidean SU(3) lattice gauge theory is examined to extract the Hamiltonian limit, using standard path integral Monte Carlo (PIMC) methods. We examine the mean plaquette and string tension and compare them to results obtained within the Hamiltonian framework of Kogut and Susskind. The results are a significant improvement upon previous Hamiltonian estimates, despite the extrapolation procedure necessary to extract observables. We conclude that the PIMC method is a reliable method of obtaining results for the Hamiltonian version of the theory. Our results also clearly demonstrate the universality between the Hamiltonian and Euclidean formulations of lattice gauge theory. It is particularly important to take into account the renormalization of both the anisotropy, and the Euclidean coupling $\beta_E$, in obtaining these results.Comment: 10 pages, 11 figure