Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in Blantyre, Malawi : a prospective cohort study

Early warning scores (EWS) are widely used in well-resourced healthcare settings to identify patients at risk of mortality. The Modified Early Warning Score (MEWS) is a well-known EWS used comprehensively in the United Kingdom. The HOTEL score (Hypotension, Oxygen saturation, Temperature, ECG abnormality, Loss of independence) was developed and tested in a European cohort; however, its validity is unknown in resource limited settings. This study compared the performance of both scores and suggested modifications to enhance accuracy

Two randomized trials of effect of live attenuated influenza vaccine on pneumococcal colonization

The human nasopharynx is frequently colonized by Streptococcus pneumoniae (the pneumococcus), serving as the reservoir for transmission, a state which necessarily precedes invasive pneumococcal infection. Influenza infection increases pneumococcal colonization density and dysregulates host immune responses, increasing the risk of secondary bacterial pneumonia and death

Outcomes of World Health Organization–defined Severe Respiratory Distress without Shock in Adults in Sub-Saharan Africa

Sepsis is the leading cause of global mortality and is most often attributed to lower respiratory tract infections and subsequent acute respiratory distress syndrome (ARDS) (1). The greatest burden of sepsis rests on sub-Saharan Africa, where lower respiratory tract infections account for approximately 390,000 adult deaths each year (2). However, patients from sub-Saharan Africa are underrepresented in sepsis and ARDS research (3). ARDS is difficult to diagnose in low-income countries because it requires often unavailable imaging, mechanical ventilation to set positive end-expiratory pressure and deliver a reliable fraction of inspired oxygen, and arterial blood gases to identify hypoxemia (4). To mitigate this gap, the World Health Organization (WHO) pragmatically defined severe respiratory distress without shock (SRD) in adults as oxygen saturation of less than 90% or a respiratory rate of more than 30 breaths per minute, and a systolic blood pressure over 90 mm Hg in the setting of infection and in the absence of clinical cardiac failure (5). The natural history of SRD has not been fully described; accordingly, we aimed to evaluate the prevalence, characteristics, and outcomes of SRD in hospitalized patients in sub-Saharan Africa

Unlocking Pre-1850 Instrumental Meteorological Records: A Global Inventory

Instrumental meteorological measurements from periods prior to the start of national weather services are designated “early instrumental data.” They have played an important role in climate research as they allow daily to decadal variability and changes of temperature, pressure, and precipitation, including extremes, to be addressed. Early instrumental data can also help place twenty-first century climatic changes into a historical context such as defining preindustrial climate and its variability. Until recently, the focus was on long, high-quality series, while the large number of shorter series (which together also cover long periods) received little to no attention. The shift in climate and climate impact research from mean climate characteristics toward weather variability and extremes, as well as the success of historical reanalyses that make use of short series, generates a need for locating and exploring further early instrumental measurements. However, information on early instrumental series has never been electronically compiled on a global scale. Here we attempt a worldwide compilation of metadata on early instrumental meteorological records prior to 1850 (1890 for Africa and the Arctic). Our global inventory comprises information on several thousand records, about half of which have not yet been digitized (not even as monthly means), and only approximately 20% of which have made it to global repositories. The inventory will help to prioritize data rescue efforts and can be used to analyze the potential feasibility of historical weather data products. The inventory will be maintained as a living document and is a first, critical, step toward the systematic rescue and reevaluation of these highly valuable early records. Additions to the inventory are welcome

Intercalation predicts improved academic performance across the medical undergraduate curriculum

Introduction: Intercalation has significant costs and students need to balance these with information about potential benefit. Thus this study sought to identify whether undertaking an intercalated degree impacted upon exam performance in the primary medical qualification. Methods: Retrospective case-matched data analyses of anonymised student databases from the University of Birmingham Medical School. 171 students who intercalated, were matched for MBChB performance with students from the same cohort who did not intercalate. Individual student change in overall year mark (percentage), between two consecutive years of the MBChB, was compared between groups. Results: There was a significant difference (t(170)=4.095, p<0.001) in change in mark in the intercalation group (mean improvement = 4.48, SD = 6.16) compared with the non-intercalation group (mean improvement = 2.11, SD = 5.04). Intercalation within the home institution, earlier in the MBChB degree and female gender also had positive effects on change in mark. Conclusion: Students from the University of Birmingham who undertook an intercalated degree demonstrated significant improvements in academic performance. This finding supports evidence from other single institution studies and confirms positive impact of intercalation. Threats to financial support for intercalated degrees may therefore be detrimental in the education of tomorrow’s doctors

Intercalation predicts improved academic performance across the medical undergraduate curriculum

Abstract Introduction: Intercalation has significant costs and students need to balance these with information about potential benefit. Thus this study sought to identify whether undertaking an intercalated degree impacted upon exam performance in the primary medical qualification

Consumption of cotton cloth in India, 1795-1940

Using data on the production and usage of cotton, the paper develops estimates for the production and consumption of cotton cloth in India during 1795-1940, and based on these numbers, revisits three issues central to interpretations of economic change in colonial India. These are trends in levels of living, the correlation between production of textiles and consumption of textiles, and consumption of clothing in India in relation to the rest of the world. Average consumption of cotton cloth in India rose even as production declined, while real income grew more slowly, if at all, than the consumption of clothin

Sensitivities and specificities (in percentages) with 95% confidence intervals for MEWS, HOTEL and TOTAL at select cut-points (n = 302).

<p>Sensitivities and specificities (in percentages) with 95% confidence intervals for MEWS, HOTEL and TOTAL at select cut-points (n = 302).</p