Proposed vitamin A supplementation programme for South Africa - design, coverage and cost

Background. A national survey of the micronutrient status of preschool children in South Africa established that vitamin A deficiency is a significant public health problem, requiring urgent attention. A number of immediate and long-term intenrentions were recommended, including the introduction of a vitamin A supplementation programme and a food fortification programme.Objectives. The aim of the study was to assist in the development and implementation of a national vitamin A supplementation programme at primary health care facilities for mothers and children. This was achieved by determining the design, coverage and cost of a national primary health care facility vitamin A supplementation programme.Methods. Based on an extensive review of the literature, the main components of a primary health care facility vitamin A supplementation programme were identified. The annual, recurrent cost of each of the programme component wer estimated for the nine provinces in South Africa. Immunisation coverage rates were used as a proxy for estimating the coverage of the programme.Results. The main components of the programme were identified as: promotion, training, purchase of vitamin A capsules, distribution of vitamin A capsules to primary health care facilities, clistribution of cap ule to the programme beneficiaries, and monitoring and evaluation. The programme would operate from primary health care facililities and would target all children between 6 and 24  months of age and newly delivered mothers. It was estimated that the programme would cover 74% of children and 95% of postpartum women nationally. The total annual, recurrent cost of the national programme was estimated at R16.4 million. The bulk of the costs would include personnel costs, comprising 68% of the total costs. Other costs included promotion (27%), vitamin A capsules (4%) and training (1%). The cost of the programme would vary significantly by province, but the provinces' average total cost per beneficiary would be similar.Conclusion. A primary health care facility vitamin A supplementation programme has been designed and accompanied by an estimated overall cost and coverage for implementation. The findings of the study showed that the programme would be financially feasible and would reach the majority of children under 24 months of age. It is recommended that further research be undertaken to extend the programme to the more 'hard to reach' population using other stategies such as mass immunisation campaigns

Poisoning by non-edible squash: retrospective series of 353 patients from French Poison Control Centers

CONTEXT: Among the numerous varieties of squash that exist, some are edible while other bitter-tasting ones are not fit for human consumption. Cases of confusion seem to be multiplying and are characterized by digestive problems (diarrhea, vomiting, and abdominal pain). METHODS: This is a descriptive retrospective study of cases of exposure reported to French Poison Control Centers between 1 January 2012 and 12 December 2016. RESULTS: 353 patients were included, with 71.7% belonging to collective cases of poisoning. The male to female sex ratio was 0.75 for an average age of 38.2 ± 23.6 years. The circumstances of exposure were dietary for 337 patients (95.5%). The majority of the squash consumed was purchased at a store (55.8%) but some also came from the garden (25.5%). 204 patients (57.8%) mostly presented with diarrhea, vomiting, abdominal pain, sometimes with the consequent dehydration, hypotension, tachycardia, headaches, or vertigo. There were no deaths or severe (Poisoning Severity Score (PSS) 3) cases, but there were 14 patients (4.0%) of moderate severity, 190 patients (53.8%) of minor severity (PSS 1), and 149 patients (42.2%) without severity (PSS 0) but among which we include the bitter taste of the squash. The average age of PSS 2 patients was significantly (p = .003) older than that of the PSS <2 patients. CONCLUSION: As the first consequential series in Europe, our study shows that exposure to non-edible squash is frequent. Usually benign, poisoning could be the consequence of the irritating effect of certain cucurbits, the molecules responsible for the taste and toxicity of the fruits. In terms of prevention therefore, we recommend disposing of any squash with a bitter taste

Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey

Abstract Introduction Anemia is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). It remains unclear whether this association can be modified with more aggressive use of red blood cell (RBC) transfusions. The degree to which restrictive thresholds have been adopted in neurocritical care patients remains unknown. Methods We performed a survey of North American academic neurointensivists, vascular neurosurgeons and multidisciplinary intensivists who regularly care for patients with SAH to determine hemoglobin (Hb) concentrations which commonly trigger a decision to initiate transfusion. We also assessed minimum and maximum acceptable Hb goals in the context of a clinical trial and how decision-making is influenced by advanced neurological monitoring, clinician characteristics and patient-specific factors. Results The survey was sent to 531 clinicians, of whom 282 (53%) responded. In a hypothetical patient with high-grade SAH (WFNS 4), the mean Hb concentration at which clinicians administered RBCs was 8.19 g/dL (95% CI, 8.07 to 8.30 g/dL). Transfusion practices were comparatively more restrictive in patients with low-grade SAH (mean Hb 7.85 g/dL (95% CI, 7.73 to 7.97 g/dL)) (P < 0.0001) and more liberal in patients with delayed cerebral ischemia (DCI) (mean Hb 8.58 g/dL (95% CI, 8.45 to 8.72 g/dL)) (P < 0.0001). In each setting, there was a broad range of opinions. The majority of respondents expressed a willingness to study a restrictive threshold of ≤8 g/dL (92%) and a liberal goal of ≥10 g/dl (75%); in both cases, the preferred transfusion thresholds were significantly higher for patients with DCI (P < 0.0001). Neurosurgeons expressed higher minimum Hb goals than intensivists, especially for patients with high-grade SAH (β = 0.46, P = 0.003), and were more likely to administer two rather than one unit of RBCs (56% vs. 19%; P < 0.0001). Institutional use of transfusion protocols was associated with more restrictive practices. More senior clinicians preferred higher Hb goals in the context of a clinical trial. Respondents were more likely to transfuse patients with brain tissue oxygen tension values <15 mmHg and lactate-to-pyruvate ratios >40. Conclusions There is widespread variation in the use of RBC transfusions in SAH patients. Practices are heavily influenced by the specific dynamic clinical characteristics of patients and may be further modified by clinician specialty and seniority, the use of protocols and advanced neurological monitoring

Grazing in a megagrazer-dominated savanna does not reduce soil carbon stocks, even at high intensities

Recent studies suggest that wild animals can promote ecosystem carbon sinks through their impacts on vegetation and soils. However, livestock studies show that intense levels of grazing reduce soil organic carbon (SOC), leading to concerns that rewilding with large grazers may compromise ecosystem carbon storage. Furthermore, wild grazers can both limit and promote woody plant recruitment and survival on savanna grasslands, with both positive and negative impacts on SOC, depending on the rainfall and soil texture contexts. We used grazing lawns in one of the few African protected savannas that are still dominated by megagrazers (> 1000 kg), namely white rhinoceros Ceratotherium simum, as a model to study the impact of prolonged and intense wild grazing on SOC stocks. We contrasted SOC stocks between patches of varying grazing intensity and woody plant encroachment in sites across different rhino habitat types. We found no differences in SOC stocks between the most- and least grazed plots in any of the habitats. Intermediately grazed plots, however, had higher SOC stocks in the top 5 cm compared to most and least grazed plots, but only in the closed-canopy woodland habitat and not in the open habitats. Importantly, we found no evidence to support the hypothesis that wild grazing reduces SOC, even at high grazing intensities by the world's largest megagrazer. Compared to the non-encroached reference plots, woody encroached plots had higher SOC stocks in soils with low clay content and lower SOC stocks in soils with high clay content, although only in the top 5 cm. Accordingly, our study highlights that wild grazers may influence SOC indirectly through their impact on tree-grass ratios in grassy ecosystems. Our study thus provides important insights for future natural climate solutions that focus on wild grazer conservation and restoration.Keywords: fire, grazing impact, rewilding, soil carbon, white rhinoceros, woody encroachmen

Conductance Distributions in Random Resistor Networks: Self Averaging and Disorder Lengths

The self averaging properties of conductance $g$ are explored in random resistor networks with a broad distribution of bond strengths P(g)\simg^{\mu-1}. Distributions of equivalent conductances are estimated numerically on hierarchical lattices as a function of size $L$ and distribution tail parameter $\mu$. For networks above the percolation threshold, convergence to a Gaussian basin is always the case, except in the limit $\mu$ --> 0. A {\it disorder length} $\xi_D$ is identified beyond which the system is effectively homogeneous. This length diverges as $\xi_D \sim |\mu|^{-\nu}$ ($\nu$ is the regular percolation correlation length exponent) as $\mu$-->0. This suggest that exactly the same critical behavior can be induced by geometrical disorder and bu strong bond disorder with the bond occupation probability $p$$\mu$. Only lattices at the percolation threshold have renormalized probability distribution in a {\it Levy-like} basin. At the threshold the disorder length diverges at a vritical tail strength $\mu_c$ as $|\mu-\mu_c|^{-z}$, with $z=3.2\pm 0.1$, a new exponent. Critical path analysis is used in a generalized form to give form to give the macroscopic conductance for lattice above $p_c$.Comment: 16 pages plain TeX file, 6 figures available upon request.IBC-1603-01

Bilateral heterochronic spontaneous hemothorax caused by pulmonary arteriovenous malformation in a gravid: A case report

Bilateral heterochronic spontaneous hemothorax as a result of pulmonary ateriovenous malformation is a very rarely happened disease. A 34-year-old woman presented major symptoms with right-sided chest pain and shortness of breath. The following contrast-enhanced computed tomographic scan of the chest showed a large amount of fluid in the right thorax with mediastinal shift, but without major vessel injury and 2 small dense opacities in the apical segment of the right lower lobe and in the posterior aspect of the left lower lobe. The patient underwent local resection of the right lower lobe. The pulmonary ateriovenous malformation was further identified by pathological examination. One month after she was discharged home, the symptoms described above recurred. A follow-up computed tomographic scan of the chest showed a large amount of fluid in the left thorax. During the emergency operation, we found a bullous lesion in the left lower lobe and a small blood vessel overlying the lesion that was actively bleeding. As stated above, local resection of the left lower lobe was performed once more. Pathological result was the same as observed previously. There were no postoperative complications and she was discharged from the hospital after two weeks. Two months later, she successfully delivered a healthy female infant. Up to now, regular follow-up observation has shown her to be perfectly asymptomatic